Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 27, Number 10—October 2021
Research

Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA

Daniel M. ParkerComments to Author , Tim Bruckner, Verónica M. Vieira, Catalina Medina, Vladimir N. Minin, Philip L. Felgner, Alissa Dratch, Matthew Zahn, Scott M. Bartell, and Bernadette Boden-Albala
Author affiliations: University of California, Irvine, Irvine, California, USA (D.M. Parker, T. Bruckner, V.M. Vieira, C. Medina, V.N. Minin, P.L. Felgner, S.M. Bartell, B. Boden-Albala); Orange County Health Care Agency, Santa Ana, California, USA (A. Dratch, M. Zahn)

Main Article

Table 4

Logistic regression results for odds ratio of testing seropositive for SARS-CoV-2, Orange County, California, USA, July–August 2020*

Characteristic No. (%)
Adjusted odds ratio (95% CI)†
SARS-CoV-2 seropositive, n = 350 Total tested, n = 2,604
Age group, y
18–24 19 (5.43) 158 (5.35) Referent
25–29 31 (8.86) 234 (7.92) 1.09 (0.58–2.04)
30–34 33 (9.43) 275 (9.31) 0.97 (0.52–1.81)
35–39 35 (10) 328 (11.1) 0.85 (0.46–1.56)
40–49 83 (23.71) 651 (22.04) 1.08 (0.62–1.87)
50–59 82 (23.43) 659 (22.31) 1.09 (0.62–1.89)
60–69 46 (13.14) 418 (14.15) 1.02 (0.56–1.86)
70–79 18 (5.14) 188 (6.36) 0.93 (0.45–1.91)
>80
3 (0.86)
43 (1.46)
0.64 (0.18–2.32)
Sex
F 222 (63.43) 1,668 (56.47) Referent
M
128 (36.57)
1,286 (43.53)
0.75 (0.59–0.94)
Race or ethnicity‡
White 108 (30.86) 1,228 (41.57) Referent
Asian 47 (13.43) 435 (14.73) 1.25 (0.85–1.82)
Black 5 (1.43) 42 (1.42) 1.28 (0.48–3.37)
Hispanic 162 (46.29) 1,010 (34.19) 1.54 (1.17–2.03)
Pacific Islander 3 (0.86) 12 (0.41) 3.89 (1.04–14.65)
Unknown
25 (7.14)
227 (7.68)
1.25 (0.78–2)
% With college degree in ZIP code
1st quartile 158 (45.14) 937 (31.72) Referent
2nd quartile 92 (26.29) 893 (30.23) 0.98 (0.65–1.46)
3rd quartile 59 (16.86) 644 (21.8) 1.15 (0.64–2.04)
4th quartile
41 (11.71)
480 (16.25)
1.15 (0.59–2.22)
% With insurance in ZIP code
1st quartile 154 (44) 928 (31.42) Referent
2nd quartile 91 (26) 812 (27.49) 0.98 (0.67–1.43)
3rd quartile 54 (15.43) 597 (20.21) 0.99 (0.56–1.76)
4th quartile
51 (14.57)
617 (20.89)
0.95 (0.51–1.76)
Population density, × 1,000 persons/km2 1.02 (0.81–1.29)
House crowding index


1.00 (0.96–1.04)
Median income (SD) 0.76 (0.57–1.00)
% Persons in ZIP code SARS-CoV-2 positive >10%§ 1.25 (0.80–1.96)

*This cross sectional survey was conducted July 10–August 16, 2020. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. †Model intercept represents odds of testing seropositive for SARS-CoV-2 for a White female diagnosed with SARS-CoV2 in the 18–24 years age group in a ZIP code in the first quartile of college degree and insured with the average population density, and average percentage of SARS-CoV-2 positive persons in Orange County. The odds of this person testing seropositive is estimated to be 0.074 (95% CI 0.031–0.178). 95% CIs computed with robust SEs. ‡For comparison, the estimated race/ethnicity makeup of Orange County in 2021 is non-Hispanic White (38.6%, n = 1,223,157; Black/African American (1.6%, n = 52,696); American Indian or Alaskan Native (0.3%, n = 6,018); Asian (21.1%, n = 685,728); Native Hawaiian or Pacific Islander (0.3%, n = 8,885); other or multiple races (3.1%, n = 100,297); Hispanic or Latinx (35.0%, n = 1,115,740) (21). American Indian or Alaska Native race group not included in analysis because of lack of data; no person of this race group tested seropositive. §Number of persons who tested positive in person’s ZIP code reported to Orange County Public Health Department during March 1–August 16, 2020, divided by estimated population of ZIP code.

Main Article

References
  1. Dowd  JB, Andriano  L, Brazel  DM, Rotondi  V, Block  P, Ding  X, et al. Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci U S A. 2020;117:96968. DOIPubMedGoogle Scholar
  2. Dorn  AV, Cooney  RE, Sabin  ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395:12434. DOIPubMedGoogle Scholar
  3. Yancy  CW. COVID-19 and African Americans. JAMA. 2020;323:18912. DOIPubMedGoogle Scholar
  4. Garg  S, Kim  L, Whitaker  M, O’Halloran  A, Cummings  C, Holstein  R, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 states, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:45864. DOIPubMedGoogle Scholar
  5. Dondorp  AM, Hayat  M, Aryal  D, Beane  A, Schultz  MJ. Respiratory support in novel coronavirus disease (COVID-19) patients, with a focus on resource-limited settings. Am J Trop Med Hyg. 2020;102:11917. DOIPubMedGoogle Scholar
  6. Bhatraju  PK, Ghassemieh  BJ, Nichols  M, Kim  R, Jerome  KR, Nalla  AK, et al. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med. 2020;382:201222. DOIPubMedGoogle Scholar
  7. Yang  X, Yu  Y, Xu  J, Shu  H, Xia  J, Liu  H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:47581. DOIPubMedGoogle Scholar
  8. Grasselli  G, Pesenti  A, Cecconi  M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:15456. DOIPubMedGoogle Scholar
  9. Maxmen  A. Thousands of coronavirus tests are going unused in US labs. Nature. 2020;580:3123. DOIPubMedGoogle Scholar
  10. Orange County Health Care Agency. OC Health Care Agency confirms first case of novel coronavirus. 2020 Jan [cited 2021 Jun 3]. https://mailchi.mp/ochca/novelcoronavirus
  11. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) [cited 2021 Jun 3]. https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
  12. US Department of Health and Human Services. Determination that a public health emergency exists. 2020 Jan [cited 2021 Jun 3]. https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx
  13. California Department of Public Health. CDC confirms possible first instance of COVID-19 community transmission in California [cited 2021 Jun 3]. https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-006.aspx
  14. Villasanta  A. Coronavirus USA update: Santa Clara County extends local health emergency over nCov. International Business Times. 2020 [cited 2021 Jun 3]. https://www.ibtimes.com/coronavirus-usa-update-santa-clara-county-extends-local-health-emergency-over-ncov-2919607
  15. Sisson  P. County declares local health emergency to aid coronavirus response. San Diego Union–Tribune [cited 2021 Jun 3]. https://www.sandiegouniontribune.com/news/health/story/2020-02-14/county-declares-local-health-emergency-to-aid-coronavirus-response
  16. Anderson  P. Orange County declares emergency due to coronavirus. NBC Los Angeles [cited 2021 Jun 3]. https://www.nbclosangeles.com/news/local/orange-county-declares-emergency-due-to-coronavirus/2321434
  17. Office of the Mayor of San Francisco. City of San Francisco moves proactively to prepare for possible novel coronavirus activity in the community. 2020 Feb 25 [cited 2021 Jan 19]. https://sfmayor.org/article/city-san-francisco-moves-proactively-prepare-possible-novel-coronavirus-activity-community
  18. Orange County Operational Area Emergency Operations Center. Press release # 010: county issues amended health order and guidance. 2020 Mar 18 [cited 2020 Dec 18]. https://cms.ocgov.com/civicax/filebank/blobdload.aspx?BlobID=114421
  19. State of California. Essential workforce [cited 2020 Dec 18]. https://covid19.ca.gov/essential-workforce
  20. Rho  HJ, Brown  H. Fremstad S. A basic demographic profile of workers in frontline industries [cited 2021 Jan 19]. https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries
  21. Orange County’s Healthier Together. OC dashboard [cited 2020 Dec 18]. http://www.ochealthiertogether.org/indicators/index/dashboard?alias=ocdashboard&localeId=267&page=2&card=1
  22. Transforming Orange County. Transforming Orange County: assets and needs of Asian Americans and Native Hawaiians and Pacific Islanders [cited 2020 Dec 18]. https://transformingoc.advancingjustice-oc.org
  23. Bruckner  TA, Parker  DM, Bartell  SM, Vieira  VM, Khan  S, Noymer  A, et al. Estimated seroprevalence of SARS-CoV-2 antibodies among adults in Orange County, California. Sci Rep. 2021;11:3081. DOIPubMedGoogle Scholar
  24. Anselin  L. Local indicators of spatial association. Geogr Anal. 1995;27:93115. DOIGoogle Scholar
  25. Zhou  G, Afrane  YA, Malla  S, Githeko  AK, Yan  G. Active case surveillance, passive case surveillance and asymptomatic malaria parasite screening illustrate different age distribution, spatial clustering and seasonality in western Kenya. Malar J. 2015;14:41. DOIPubMedGoogle Scholar
  26. Mi  J, Zhong  W, Huang  C, Zhang  W, Tan  L, Ding  L. Gender, age and comorbidities as the main prognostic factors in patients with COVID-19 pneumonia. Am J Transl Res. 2020;12:653748.PubMedGoogle Scholar
  27. Ogedegbe  G, Ravenell  J, Adhikari  S, Butler  M, Cook  T, Francois  F, et al. Assessment of racial/ethnic disparities in hospitalization and mortality in patients with COVID-19 in New York City. JAMA Netw Open. 2020;3:e2026881. DOIPubMedGoogle Scholar
  28. Rubin-Miller  L, Alban  C. COVID-19 racial disparities in testing, infection, hospitalization, and death: analysis of epic patient data. 2020 Sep 16 [cited 2021 Jan 8]. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-racial-disparities-testing-infection-hospitalization-death-analysis-epic-patient-data
  29. Webb Hooper  M, Nápoles  AM, Pérez-Stable  EJ. COVID-19 and racial/ethnic disparities. JAMA. 2020;323:24667. DOIPubMedGoogle Scholar
  30. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). 2020 [cited 2021 Jan 9]. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
  31. Gover  AR, Harper  SB, Langton  L. Anti-Asian hate crime during the COVID-19 pandemic: exploring the reproduction of inequality. Am J Crim Justice. 2020;45:121. DOIPubMedGoogle Scholar
  32. Ng  E. The pandemic of hate is giving novel coronavirus disease (COVID-19) a helping hand. Am J Trop Med Hyg. 2020;102:11589. DOIPubMedGoogle Scholar
  33. World Health Organization. Social determinants of health [cited 2020 Dec 18]. https://www.who.int/westernpacific/health-topics/social-determinants-of-health

Main Article

Page created: July 23, 2021
Page updated: September 19, 2021
Page reviewed: September 19, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external