Long COVID (or post-COVID conditions) refers to symptoms or health conditions that persist or occur ≥4 weeks after SARS-CoV-2 infection. 1 Centers for Disease Control and Prevention. COVID-19: Long COVID or Post-COVID Conditions. Available at: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed June 6, 2023. Google Scholar Symptoms such as brain fog, fatigue, pain, dyspnea, depression, and a wide range of other manifestations can occur and may be debilitating. The mechanism(s) of these outcomes are poorly understood, creating challenges to prevention and treatment. The study of Long COVID is rapidly evolving and approaches to describe its burden vary. However, prevalence estimates of activity- or work-limiting Long COVID among U.S. adults in the 3-5 million range have been reported. 2 Tenforde MW Devine OJ Reese HE Silk BJ Iuliano AD Threlkel R Vu QM Plumb ID Cadwell BL Rose C Steele MK Briggs-Hagen M Ayoubkhani D Pawelek P Nafilyan V Saydah SH Bertolli J. Point Prevalence Estimates of Activity-Limiting Long-term Symptoms Among United States Adults ≥1 Month After Reported Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Infect Dis. 2023; 227 (1 November 2021) (Apr 12PMID: 35776165; PMCID: PMC9278232): 855-863https://doi.org/10.1093/infdis/jiac281 Crossref Scopus (7) Google Scholar ,3 Brookings Institution. Is ‘Long COVID’ Worsening the Labor Shortage? January 11, 2022. Available at https://www.brookings.edu/articles/is-long-covid-worsening-the-labor-shortage/. Accessed August 3, 2023. Google Scholar The vast number of individuals at risk of, or with symptoms of Long COVID underscores the urgency of addressing this complex public health issue.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

The coronavirus disease 2019 (COVID-19) pandemic has underscored the need to prevent chronic disease and promote health.1,2 More than a million American lives have been lost to COVID-19, and life expectancy decreased between 2018 and 2020.3,4 Chronic diseases are major risk factors for COVID-19 morbidity and mortality.5 In addition, COVID-19 morbidity and mortality have been higher among persons from racial and ethnic groups such as those who are African American, Hispanic or Latino, and American Indian or Alaska Native as well as those living at lower SES.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

INTRODUCTION:Demonstrating the validity of a public health simulation model helps to establish confidence in the accuracy and usefulness of a model's results. In this study we evaluated the validity of the Prevention Impacts Simulation Model (PRISM), a system dynamics model that simulates health, mortality, and economic outcomes for the US population. PRISM primarily simulates outcomes related to cardiovascular disease but also includes outcomes related to other chronic diseases that share risk factors. PRISM is openly available through a web application.METHODS:We applied the model validation framework developed independently by the International Society of Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making modeling task force to validate PRISM. This framework included model review by external experts and quantitative data comparison by the study team.RESULTS:External expert review determined that PRISM is based on up-to-date science. One-way sensitivity analysis showed that no parameter affected results by more than 5%. Comparison with other published models, such as ModelHealth, showed that PRISM produces lower estimates of effects and cost savings. Comparison with surveillance data showed that projected model trends in risk factors and outcomes align closely with secular trends. Four measures did not align with surveillance data, and those were recalibrated.CONCLUSION:PRISM is a useful tool to simulate the potential effects and costs of public health interventions. Results of this validation should help assure health policy leaders that PRISM can help support community health program planning and evaluation efforts.

The Problem of COVID-19 and Chronic Disease Chronic diseases represent 7 of the top 10 causes of death in the United States (1).Six in 10 Americans live with at least 1 chronic condition, such as heart disease, stroke, cancer, or diabetes (2).Chronic diseases are also the leading causes of disability in the US and the leading drivers of the nation's $3.8 trillion annual health care costs (2,3).The COVID-19 pandemic has resulted in enormous personal and societal losses, with more than half a million lives lost (4).COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can result in respiratory distress.In addition to the physical toll, the emotional impact has yet to be fully understood.For those with chronic disease, the impact has been particularly profound (5,6).Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk for severe illness from COVID-19 (7).Other factors, including smoking and pregnancy, also increase the risk (7).Finally, in addition to COVID-19-related deaths since February 1, 2020, an increase in deaths has been observed among people with dementia, circulatory diseases, and diabetes among other causes (8).This increase could reflect undercounting COVID-19 deaths or indirect effects of the virus, such as underutilization of, or stresses on, the health care system (8).Some populations, including those with low socioeconomic status and those of certain racial and ethnic groups, including African American, Hispanic, and Native American, have a disproportionate burden of chronic disease, SARS-CoV-2 infection, and COVID-19 diagnosis, hospitalization, and mortality (9).These populations are at higher risk because of exposure to suboptimal social determinants of health (SDoH).SDoH are factors that influence health where people live, work, and play, and can create obstacles that contribute to inequities.Education, type of employment, poor or no access to health care, lack of safe and affordable housing, lack of access to healthy food, structural racism, and other conditions all affect a wide range of health outcomes (10-12).The COVID-19 pandemic has exacerbated existing health inequities and laid bare underlying root causes.

On March 13, 2020, the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, states enacted stay-at-home orders to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and reduce the burden on the U.S. health care system. CDC* and the Centers for Medicare & Medicaid Services (CMS)† recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic (1). This report describes trends in ED visits for three acute life-threatening health conditions (myocardial infarction [MI, also known as heart attack], stroke, and hyperglycemic crisis), immediately before and after declaration of the COVID-19 pandemic as a national emergency. These conditions represent acute events that always necessitate immediate emergency care, even during a public health emergency such as the COVID-19 pandemic. In the 10 weeks following the emergency declaration (March 15-May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5-March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic. Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel.

Implications In this commentary, we describe the evidence-based approach used to identify the primary cause of EVALI and to curb the 2019 outbreak. We also discuss future research opportunities and public health practice considerations to prevent a resurgence of EVALI.

Increases in EVALI were identified in 2019. Using the National Syndromic Surveillance Program, which includes about 70% of U.S. EDs, researchers found a gradual increase in ED visits associated with shortness of breath and e-cigarette use from January 2017 through early June 2019. A sharp increase was identified in June, peaking in September. A subsequent decrease was observed.

Background The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. Methods BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. Results State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). Conclusions Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.) In a study involving 51 patients with electronic-cigarette, or vaping, product use-associated lung injury in 16 states across the United States, vitamin E acetate was detected in samples of bronchoalveolar-lavage fluid from 94% of the patients but not in samples from a healthy comparator group.

The EVALI and Youth Vaping Epidemics Interventions aimed at curbing two related U.S. epidemics connected with vaping — an outbreak of lung injuries and a continued surge in use by young people — sh...

BackgroundSince August, 2019, US public health officials have been investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). A spectrum of histological patterns consistent with acute to subacute lung injury has been seen in biopsies; however, autopsy findings have not been systematically characterised. We describe the pathological findings in autopsy and biopsy tissues submitted to the US Centers for Disease Control and Prevention (CDC) for the evaluation of suspected EVALI.MethodsBetween Aug 1, 2019, and Nov 30, 2019, we examined lung biopsy (n=10 individuals) and autopsy (n=13 individuals) tissue samples received by the CDC, submitted by 16 US states, from individuals with: a history of e-cigarette, or vaping, product use; respiratory, gastrointestinal, or constitutional symptoms; and either pulmonary infiltrates or opacities on chest imaging, or sudden death from an undetermined cause. We also reviewed medical records, evaluated histopathology, and performed infectious disease testing when indicated by histopathology and clinical history.Findings21 cases met surveillance case definitions for EVALI, with a further two cases of clinically suspected EVALI evaluated. All ten lung biopsies showed histological evidence of acute to subacute lung injury, including diffuse alveolar damage or organising pneumonia. These patterns were also seen in nine of 13 (69%) autopsy cases, most frequently diffuse alveolar damage (eight autopsies), but also acute and organising fibrinous pneumonia (one autopsy). Additional pulmonary pathology not necessarily consistent with EVALI was seen in the remaining autopsies, including bronchopneumonia, bronchoaspiration, and chronic interstitial lung disease. Three of the five autopsy cases with no evidence of, or a plausible alternative cause for acute lung injury, had been classified as confirmed or probable EVALI according to surveillance case definitions.InterpretationAcute to subacute lung injury patterns were seen in all ten biopsies and most autopsy lung tissues from individuals with suspected EVALI. Acute to subacute lung injury can have numerous causes; however, if it is identified in an individual with a history of e-cigarette, or vaping, product use, and no alternative cause is apparent, a diagnosis of EVALI should be strongly considered. A review of autopsy tissue pathology in suspected EVALI deaths can also identify alternative diagnoses, which can enhance the specificity of public health surveillance efforts.FundingUS Centers for Disease Control and Prevention.

This study from the CDC compared the characteristics of 60 patients who died from EVALI with those of 2558 patients who were hospitalized for the condition but survived. The deaths were reported from 27 states and the District of Columbia, and most were associated with vaping THC-containing products before symptom onset. Background As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC). Methods In a national study, we compared the characteristics of patients with fatal cases of EVALI with those of patients with nonfatal cases to improve the ability of clinicians to identify patients at increased risk for death from the condition. Health departments reported cases of EVALI to the CDC and included, when available, data from medical-record abstractions and patient interviews. Analyses included all the patients with fatal or nonfatal cases of EVALI that were reported to the CDC as of January 7, 2020. We also present three case reports of patients who died from EVALI to illustrate the clinical characteristics common among such patients. Results Most of the patients with fatal or nonfatal cases of EVALI were male (32 of 60 [53%] and 1666 of 2498 [67%], respectively). The proportion of patients with fatal or nonfatal cases was higher among those who were non-Hispanic white (39 of 49 [80%] and 1104 of 1818 [61%], respectively) than among those in other race or ethnic groups. The proportion of patients with fatal cases was higher among those 35 years of age or older (44 of 60 [73%]) than among those younger than 35 years, but the proportion with nonfatal cases was lower among those 35 years of age or older (551 of 2514 [22%]). Among the patients who had an available medical history, a higher proportion of those with fatal cases than those with nonfatal cases had a history of asthma (13 of 57 [23%] vs. 102 of 1297 [8%]), cardiac disease (26 of 55 [47%] vs. 115 of 1169 [10%]), or a mental health condition (32 of 49 [65%] vs. 575 of 1398 [41%]). A total of 26 of 50 patients (52%) with fatal cases had obesity. Half the patients with fatal cases (25 of 54 [46%]) were seen in an outpatient setting before hospitalization or death. Conclusions Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI.

This report provides a nationwide comparison of clinical characteristics of e-cigarette, or vaping, product use–associated lung injury patients who were rehospitalized or died after hospital discharge

Mary E. Evans, MD1; Evelyn Twentyman, MD2; Eleanor S. Click, MD, PhD3; Alyson B. Goodman, MD2; David N. Weissman, MD4; Emily Kiernan, DO5; Susan Adkins Hocevar, MD6; Christina A. Mikosz, MD1; Melissa Danielson, MSPH7; Kayla N. Anderson, PhD7; Sascha Ellington, PhD2; Matthew J. Lozier, PhD8; Lori A. Pollack, MD2; Dale A. Rose, PhD8; Vikram Krishnasamy, MD1; Christopher M. Jones, PharmD, DrPH1; Peter Briss, MD2; Brian A. King, PhD2; Jennifer L. Wiltz, MD2; Lung Injury Response Clinical Task Force; Lung Injury Response Clinical Working Group