A Comparison of COVID-19 Epidemiology, Pathophysiology, and Impact on Vulnerable Populations in Two States within the USA
Main Article Content
Abstract
Since late 2019, SARS-CoV-2 has differentially impacted geographies and population demographics as it spread. As of June 30, 2020, two hotspots within the United States of America—the states of Georgia and Michigan—exhibited similar numbers of cases while Michigan had over twice the case fatality rate (CFR) of Georgia. Given the similar populations, land areas, and pandemic timelines of these states, such a large difference is unexpected. The primary goal of this paper is to examine why Michigan experienced much higher COVID-19 mortality than Georgia, which may point to at-risk comorbidities and vulnerable populations.
We examined publicly available data on demographics, rates of comorbidities, environmental factors, and other population differences at the state and local levels (the cities of Detroit, Michigan; Atlanta, Georgia; and Albany, Georgia) that have known or identified associations with health outcomes. We also outlined the timeline of the pandemic in each state to determine if the actions of state governments may have contributed to the observed difference in CFR.
While the difference in state CFR may imply that Michigan handled the pandemic poorly, the data show that inherent characteristics of Detroit may have led to the higher statewide CFR. Notable differences between the states include elderly populations, agricultural statistics, and drinking habits. Notable differences between the cities included population density, health system quality, per capita income, race, education, media access, and air pollution. Hypertension (among blacks), diabetes (at the city level), chronic kidney disease, asthma, heart disease, and cancer differed in prevalence by location and were associated with increased severity and/or mortality of COVID-19. There were more deaths due to COVID-19 in African American communities and nursing homes in Michigan. A combination of these factors likely explains the differential impact between these two states.
Article Details
How to Cite
ELENGICKAL, Joseph A. et al.
A Comparison of COVID-19 Epidemiology, Pathophysiology, and Impact on Vulnerable Populations in Two States within the USA.
Medical Research Archives, [S.l.], v. 8, n. 10, oct. 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2238>. Date accessed: 18 nov. 2024.
doi: https://doi.org/10.18103/mra.v8i10.2238.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;215:108427. doi:10.1016/j.clim.2020.108427
2. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
3. Martines RB, Ritter JM, Matkovic E, et al. Pathology and pathogenesis of SARS-CoV-2 associated with fatal coronavirus disease, United States. [Published online ahead of print May 21, 2020]. Emerg Infect Dis. 2020;26(9):10.3201/eid2609.202095. doi:10.3201/eid2609.202095.
4. Common Human Coronaviruses. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/general-information.html. Published February 13, 2020. Accessed July 28, 2020.
5. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-192. doi:10.1007/s11684-020-0754-0.
6. Qi F, Qian S, Zhang S, Zhang Z. Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochem Biophys Res Commun. 2020;526(1):135-140. doi:10.1016/j.bbrc.2020.03.044.
7. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052.
8. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.
9. COVID-19 United States Cases by County. Johns Hopkins University. https://coronavirus.jhu.edu/us-map. Published June 30, 2020. Accessed July 29, 2020.
10. Executive Office of the President, Office of Management and Budget. OMB Bulletin 20-01, Revised Delineations of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and Guidance on Uses of the Delineations of These Areas.
https://www.whitehouse.gov/wp-content/uploads/2020/03/Bulletin-20-01.pdf?#. Published March 6, 2020. Accessed July 26, 2020.
11. QuickFacts: Michigan; Georgia. U.S. Census Bureau. https://www.census.gov/quickfacts/fact/table/MI,GA/PST045219. Accessed July 26, 2020.
12. U.S. Census Bureau. Metropolitan and Micropolitan Statistical Areas Population Totals and Components of Change: 2010-2019. https://www.census.gov/data/tables/time-series/demo/popest/2010s-total-metro-and-micro-statistical-areas.html. Published June 18, 2020. Accessed July 26, 2020.
13. U.S. Census Bureau. County Population Totals: 2010-2019. https://www.census.gov/data/tables/time-series/demo/popest/2010s-counties-total.html#par_textimage. Published June 22, 2020. Accessed July 28, 2020.
14. Newton J, Nepveux M. Feeding the Economy: Agricultural Jobs by State. American Farm Bureau Federation. https://www.fb.org/market-intel/feeding-the-economy-agricultural-jobs-by-state. Published March 21, 2019. Accessed July 22, 2020.
15. U.S. Department of Agriculture, National Agricultural Statistics Service. Quick Stats. https://quickstats.nass.usda.gov/results/ECF49B01-4293-3DBA-ABCD-AB9517B5B8B7. Accessed July 22, 2020.
16. Vaidya A. States ranked by hospital beds per 1,000 population. Becker’s Hospital Review. https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-hospital-beds-per-1-000-population.html. Published March 18, 2020. Accessed July 22, 2020.
17. American Nightlife Association. Market Summary: Nightlife Industry Overview. https://www.nightlifeassociation.org/market-overview/. Accessed July 22, 2020.
18. United Health Foundation, America’s Health Rankings. Annual Report: Excessive Drinking in Michigan. https://www.americashealthrankings.org/explore/annual/measure/ExcessDrink/state/MI. Accessed July 22, 2020.
19. United Health Foundation, America’s Health Rankings. Annual Report: Excessive Drinking in Georgia. https://www.americashealthrankings.org/explore/annual/measure/ExcessDrink/state/GA. Accessed July 22, 2020.
20. Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study. [Published online ahead of print April 27, 2020]. medRxiv. 2020. doi:10.1101/2020.04.05.20054502.
21. Becker U, Deis A, Sørensen TI, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996;23(5):1025-1029. doi:10.1002/hep.510230513.
22. Liver Disease Statistics. American Liver Foundation. https://liverfoundation.org/liver-disease-statistics/#alcohol-related-liver-disease-and-cirrhosis. Published October 26, 2017. Accessed July 22, 2020.
23. Center for Disease Control and Prevention, National Center for Health Statistics. Chronic Liver Disease/Cirrhosis Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/liver_disease_mortality/liver_disease.htm. Accessed July 24, 2020.
24. Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int. 2000;40(6):1278-1281. doi:10.1111/liv.14470.
25. Michigan Land area in square miles, 2010 by County. IndexMundi. https://www.indexmundi.com/facts/united-states/quick-facts/michigan/land-area#table. Accessed July 22, 2020.
26. U.S. Census Bureau. 2017 Gazeteer. https://www2.census.gov/geo/docs/maps-data/data/gazetteer/2017_Gazetteer/2017_gaz_place_26.txt. Accessed July 22, 2020.
27. U.S. Census Bureau. Metropolitan and Micropolitan Statistical Areas Population Totals and Components of Change: 2010-2019. https://www.census.gov/data/tables/time-series/demo/popest/2010s-total-metro-and-micro-statistical-areas.html. Published June 18, 2020. Accessed July 26, 2020.
28. Georgia Land area in square miles, 2010 by County. IndexMundi. https://www.indexmundi.com/facts/united-states/quick-facts/georgia/land-area#table. Accessed July 22, 2020.
29. U.S. Census Bureau. Annual Estimates of the Resident Population for Incorporated Places of 50,000 or More, Ranked by July 1, 2019 Population: April 1, 2010 to July 1, 2019. https://www2.census.gov/programs-surveys/popest/tables/2010-2019/cities/totals/SUB-IP-EST2019-ANNRNK.xlsx. Accessed July 22, 2020.
30. U.S. Census Bureau. 2018 Gazeteer. https://www2.census.gov/geo/docs/maps-data/data/gazetteer/2018_Gazetteer/2018_gaz_place_13.txt. Accessed July 22, 2020.
31. U.S. Department of Commerce, Bureau of Economic Analysis. Personal Income by County, Metro, and Other Areas: Metropolitan Area Table. https://www.bea.gov/data/income-saving/personal-income-county-metro-and-other-areas. Published November 14, 2019. Accessed July 22, 2020.
32. QuickFacts: Albany city, Georgia; Detroit city, Michigan; Atlanta city, Georgia. U.S. Census Bureau. https://www.census.gov/quickfacts/fact/table/albanycitygeorgia,detroitcitymichigan,atlantacitygeorgia/PST045219. Accessed July 22, 2020.
33. Race. U.S. Census Bureau. https://data.census.gov/cedsci/table?cid=P001001&tid=ACSDT1Y2018.B02001&hidePreview=true&t=Race%20and%20Ethnicity&vintage=2018&g=310M400US19820,12060_310M200US10500. Accessed July 22, 2020.
34. Educational Attainment. U.S. Census Bureau.https://data.census.gov/cedsci/table?g=310M400US12060,19820_310M200US10500&tid=ACSST1Y2018.S1501&t=Education%3AEducational%20Attainment&hidePreview=true&vintage=2018&layer=VT_2018_310_M4_PY_D1&cid=S1501_C01_001E. Accessed July 22, 2020.
35. U.S. Department of Commerce, National Oceanic and Atmospheric Administration, National Centers for Environmental Information. Data Tools: 1981-2010 Normals. https://www.ncdc.noaa.gov/cdo-web/datatools/normals. Accessed July 22, 2020.
36. U.S. Department of Commerce, National Oceanic and Atmospheric Administration, National Centers for Environmental Information. Average Relative Humidity - Morning (M), Afternoon (A). Accessed July 22, 2020.
37. Almanac: Historical Information. MyForecast. http://myforecast.co/bin/climate.m?city=13608&metric=true. Accessed July 22, 2020.
38. Tolbert C, Mossberger K. U.S. Current Population Survey & American Community Survey Geographic Estimates of Internet Use, 1997-2016. Arizona State University, Center on Technology, Data and Society. https://techdatasociety.asu.edu/broadband-data-portal/dataaccess/metrodata. Published 2018. Accessed July 22, 2020.
39. National Digital Inclusion Alliance. Worst Connected Cities 2018. https://www.digitalinclusion.org/worst-connected-2018/. Accessed July 22, 2020.
40. Federal Aviation Administration, Air Carrier Activity Information System. Commercial Service Airports (Rank Order) based on Calendar Year 2019 Preliminary. https://www.faa.gov/airports/planning_capacity/passenger_allcargo_stats/passenger/media/preliminary-cy19-commercial-service-enplanements.pdf. Published July 1, 2020. Accessed July 22, 2020.
41. Church Attendance Patterns by Zip Code. CityFlourish. https://cityflourish.com/church-attendance-patterns-by-zip-code/. Accessed July 26, 2020.
42. U.S. Environmental Protection Agency. Air Quality - Cities and Counties. https://www.epa.gov/air-trends/air-quality-cities-and-counties. Published May 5, 2020. Updated June 6, 2020. Accessed July 22, 2020.
43. Laden F, Schwartz J, Speizer FE, Dockery DW. Reduction in fine particulate air pollution and mortality. Am J Respir Crit Care Med. 2006;173(6):667-672. doi:10.1164/rccm.200503-443OC.
44. Pope CA III. Epidemiology of Fine Particulate Air Pollution and Human Health: Biologic Mechanisms and Who's at Risk? Environ Health Perspect. 200;108(Suppl 4):713-723. doi:10.1289/ehp.108-1637679.p
45. Wu Y, Jing W, Liu J, et al. Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries. Sci Total Environ. 2020;729:139051. doi:10.1016/j.scitotenv.2020.139051.
46. Center for Disease Control and Prevention, Center for Disease Control and Prevention WONDER. Multiple Cause of Death File 2018, Series 20, No. 2X, 2020. https://wonder.cdc.gov/controller/datarequest/D76 Accessed July 20, 2020.
47. Agency for Healthcare Research and Quality. 2018 National Healthcare Quality and Disparities Report. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr.pdf. Published September 2019. Accessed July 23, 2020.
48. Agency for Healthcare Research and Quality. National Healthcare Quality and Disparities Reports. https://nhqrnet.ahrq.gov/inhqrdr/Georgia/benchmark/summary/All_Measures/All_Topics. Accessed July 23, 2020.
49. Agency for Healthcare Research and Quality. National Healthcare Quality and Disparities Reports. https://nhqrnet.ahrq.gov/inhqrdr/Michigan/benchmark/summary/All_Measures/All_Topics. Accessed July 23, 2020.
50. U.S. Census Bureau. Health Insurance Coverage in the United States: 2018. https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf. Published November 2019. Accessed July 18, 2020.
51. Georgia Department of Public Health Daily Status Report. Georgia Department of Public Health website. Updated June 30, 2020, Accessed June 30, 2020. https://dph.georgia.gov/covid-19-daily-status-report
52. Office of Governor Brain P. Kemp. Officials Confirm Two Cases of COVID-19 in Georgia. https://gov.georgia.gov/press-releases/2020-03-03/gov-kemp-officials-confirm-two-cases-covid-19-georgia. Accessed July 18, 2020.
53. Michigan Data. Michigan Disease Surveillance System and Vital Records. Updated June 30, 2020, Accessed June 30, 2020. https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html
54. State of Michigan. Michigan announces first presumptive positive cases of COVID-19. https://www.michigan.gov/coronavirus/0,9753,7-406-98158-521341--,00.html. Accessed July 27, 2020
55. Brian P. Kemp Office of the Governor. Executive Order 03.14.20.01. https://gov.georgia.gov/document/2020-executive-order/03142001/download Published March 14, 2020. Accessed July 24, 2020.
56. Brian P. Kemp Office of the Governor. Executive Order 03.23.20.01. https://gov.georgia.gov/document/2020-executive-order/03232001/download Published March 23, 2020. Accessed July 24, 2020.
57. Brian P. Kemp Office of the Governor. Executive Order 04.02.20.01. https://gov.georgia.gov/document/2020-executive-order/04022001/download Published April 2, 2020. Accessed July 24, 2020.
58. Governor Brian P. Kemp, Office of the Governor. Executive Order 04.23.20.02. https://gov.georgia.gov/document/2020-executive-order/04232002/download. Published April 23, 2020. Accessed July 22, 2020.
59. The Office of Governor Gretchen Whitmer. Executive Order 2020-04 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-521576--,00.html. Published March 10, 2020. Accessed July 24, 2020.
60. The Office of Governor Gretchen Whitmer. Executive Order 2020-05 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-521595--,00.html. Published March 13, 2020. Accessed July 24, 2020.
61. The Office of Governor Gretchen Whitmer. Executive Order 2020-11 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-521890--,00.html. Published March 16, 2020. Accessed July 24, 2020.
62. The Office of Governor Gretchen Whitmer. Executive Order 2020-17 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-522451--,00.html. Published March 21, 2020. Accessed July 24, 2020.
63. The Office of Governor Gretchen Whitmer. Executive Order 2020-21 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-522626--,00.html. Published March 24, 2020. Accessed July 24, 2020.
64. The Office of Governor Gretchen Whitmer. Executive Order 2020-42 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-525182--,00.html. Published April 9, 2020. Accessed July 24, 2020.
65. Governor Brian P. Kemp, Office of the Governor. Executive Order 04.20.20.01. https://gov.georgia.gov/document/2020-executive-order/04202001/download. Published April 20, 2020. Accessed July 20, 2020.
66. Governor Brian P. Kemp, Office of the Governor. Executive Order 05.28.20.02. https://gov.georgia.gov/document/2020-executive-order/05282002/download. Published May 28, 2020. Accessed July 22, 2020
67. Governor Brian P. Kemp, Office of the Governor. Executive Order 06.11.20.01. https://gov.georgia.gov/document/2020-executive-order/06112001/download. Published June 11, 2020. Accessed July 22, 2020.
68. The Office of Governor Gretchen Whitmer. Executive Order 2020-70 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-527847--,00.html Published May 1, 2020. Accessed July 24, 2020.
69. The Office of Governor Gretchen Whitmer. Executive Order 2020-92 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-529476--,00.html Published May 18, 2020. Accessed July 24, 2020.
70. The Office of Governor Gretchen Whitmer. Executive Order 2020-96 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-529860--,00.html Published May 21, 2020. Accessed July 24, 2020.
71. The Office of Governor Gretchen Whitmer. Executive Order 2020-110 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-530620--,00.html Published June 1, 2020. Accessed July 24, 2020
72. Governor Brian P. Kemp, Office of the Governor. Executive Order 04.13.20.02. https://gov.georgia.gov/document/2020-executive-order/04132002/download. Published April 13, 2020. Accessed July 22, 2020.
73. Governor Brian P. Kemp, Office of the Governor. Executive Order 05.12.20.02. https://gov.georgia.gov/document/2020-executive-order/05122002/download. Published May 12, 2020. Accessed July 22, 2020.
74. Governor Brian P. Kemp, Office of the Governor. Executive Order 06.29.20.02. https://gov.georgia.gov/document/2020-executive-order/06292002/download. Published June 29, 2020. Accessed July 22, 2020.
75. The Office of Governor Gretchen Whitmer. Executive Order 2020-59 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-526894--,00.html/. Published April 24, 2020. Accessed July 20, 2020.
76. Georgia Department of Public Health. COVID-19 Testing in Georgia (2020). https://dph.georgia.gov/covidtesting. Accessed July 27, 2020.
77. U.S. Department of Health and Human Services. Community-Based Testing Sites for COVID-19. https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html. Published July 24, 2020. Accessed July 27, 2020.
78. State of Michigan. MDHHS Expands COVID-19 Testing Criteria to Better Protect Residents; Greater access is important as Michigan reopens state economy. (2020). https://www.michigan.gov/coronavirus/0,9753,7-406-98163-530157--,00.html. Accessed July 27, 2020.
79. Coronavirus disease 2019 (COVID-19) 2020 interim case definition, approved April 5, 2020. Centers for Disease Control and Prevention - National Notifiable Diseases Surveillance System (NNDSS). https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/. Accessed July 24, 2020.
80. Council of State and Territorial Epidemiologists. Standardized Surveillance Case Definition and National Notification for 2019 Novel Coronavirus Disease (COVID-19). https://cste.us6.list-manage.com/track/click?u=a74794e707a0d58b86a809758&id=355d54d3a6&e=dfdc1f26f1. Published April 5, 2020. Accessed July 24, 2020.
81. Michigan Department of Health and Human Services. Emergency order under MCL 333.2253 – COVID-19 death reporting. https://www.michigan.gov/documents/coronavirus/MDHHS_epidemic_order_-_handling_of_bodily_remains_signed_689331_7.pdf. Published April 4, 2020. Accessed July 28, 2020.
82. Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clin Proc. 2020;95(7):1445-1453. doi:10.1016/j.mayocp.2020.05.006.
83. Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). [Published online ahead of print June 26, 2020]. Diabetes Metab Res Rev. 2020;e3377. doi:10.1002/dmrr.3377.
84. Dugail I, Amri EZ, Vitale N. High prevalence for obesity in severe COVID-19: Possible links and perspectives towards patient stratification. [Published online ahead of print July 8, 2020]. Biochimie. 2020;S0300-9084(20)30155-3. doi:10.1016/j.biochi.2020.07.001.
85. Centers for Disease Control and Prevention, Overweight and Obesity. Adult Obesity Maps. https://www.cdc.gov/obesity/data/prevalence-maps.html#age. Accessed July 22, 2020.
86. Jamil HJ, Rajan AK, Grzybowski M, Fakhouri M, Arnetz B. Obesity and overweight in ethnic minorities of the Detroit metropolitan area of Michigan. J Community Health. 2014;39(2):301-309. doi:10.1007/s10900-013-9760-3.
87. Schiffrin EL, Flack JM, Ito S, Muntner P, Webb RC. Hypertension and COVID-19. Am J Hypertens. 2020;33(5):373-374. doi:10.1093/ajh/hpaa057
88. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115. DOI: 10.1161/HYP.0000000000000065.
89. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.
90. Centers for Disease Control and Prevention (CDC). COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity. https://www.cdc.gov/coronavirus/2019-ncov/covid data/covidview/index.html. Updated July 24, 2020. Accessed July 27, 2020.
91. Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020;21(2):1470320320926899. doi:10.1177/1470320320926899
92. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. DHDSP Data Trends & Maps [online]. 2015. [accessed Jul 20, 2020]. URL: https://www.cdc.gov/dhdsp/maps/dtm/index.html.
93. Ferdinand K, Batieste T, Fleurestil M. Contemporary and Future Concepts on Hypertension in African Americans: COVID-19 and Beyond. J Natl Med Assoc. 2020;112(3):315-323. doi:10.1016/j.jnma.2020.05.018
94. Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. doi:10.1016/j.diabres.2020.108142.
95. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? [published correction appears in Lancet Respir Med. 2020 Jun;8(6):e54]. Lancet Respir Med. 2020;8(4):e21. doi:10.1016/S2213-2600(20)30116-8.
96. Centers for Disease Control and Prevention. Diagnosed Diabetes. cdc.gov. https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html. Accessed July 24, 2020.
97. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-838. doi:10.1016/j.kint.2020.03.005
98. Pan XW, Xu D, Zhang H, Zhou W, Wang LH, Cui XG. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46(6):1114-1116. doi:10.1007/s00134-020-06026-1
99. Ding Y, He L, Zhang Q, et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol. 2004;203(2):622-630. doi:10.1002/path.1560
100. Yeung ML, Yao Y, Jia L, et al. MERS coronavirus induces apoptosis in kidney and lung by upregulating Smad7 and FGF2. Nat Microbiol. 2016;1(3):16004. Published 2016 Feb 22. doi:10.1038/nmicrobiol.2016.4
101. Adapa S, Chenna A, Balla M, et al. COVID-19 Pandemic Causing Acute Kidney Injury and Impact on Patients With Chronic Kidney Disease and Renal Transplantation. J Clin Med Res. 2020;12(6):352-361. doi:10.14740/jocmr4200
102. Martinez-Rojas MA, Vega-Vega O, Bobadilla NA. Is the kidney a target of SARS-CoV-2?. Am J Physiol Renal Physiol. 2020;318(6):F1454-F1462. doi:10.1152/ajprenal.00160.2020
103. Kidney Disease. National Kidney Foundation of Michigan. https://www.nkfm.org/help-information/kidney-disease. Accessed July 24, 2020.
104. Kidney Disease-Is Your State Hard Hit? National Kidney Foundation. https://www.kidney.org/news/newsroom/nr/KD_StateHardHit. Published June 5, 2020. Accessed July 28, 2020.
105. Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States. http://www.cdc.gov/ckd. Accessed July 22, 2020.
106. Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in metropolitan detroit. JAMA Netw Open. 2020;3(6):e2012270. Published 2020 Jun 1. doi:10.1001/jamanetworkopen.2020.12270
107. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 - Metropolitan Atlanta, Georgia, March-April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):790-794. Published 2020 Jun 26. doi:10.15585/mmwr.mm6925e1
108. Shah GH, Shankar P, Schwind JS, Sittaramane V. The Detrimental Impact of the COVID-19 Crisis on Health Equity and Social Determinants of Health. J Public Health Manag Pract. 2020;26(4):317-319. doi:10.1097/PHH.0000000000001200
109. Clarke NE, Belyaev ND, Lambert DW, Turner AJ. Epigenetic regulation of angiotensin-converting enzyme 2 (ACE2) by SIRT1 under conditions of cell energy stress. Clin Sci (Lond). 2014;126(7):507-516. doi:10.1042/CS20130291.
110. Saheb Sharif-Askari NS, Saheb Sharif-Askari F, Alabed M, et al. Airways expression of SARS-CoV-2 receptor, ACE2, and TMPRSS2 is lower in children than adults and increases with smoking and COPD. Mol Ther Methods Clin Dev. 2020 May 22;(18):1-6. doi:10.1016/j.omtm.2020.05.013.
111. Verdecchia P, Cavallini C, Spanevello A, Angeli F. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med. 2020;76:14-20. doi:10.1016/j.ejim.2020.04.037.
112. Rodrigues Prestes TR, Rocha NP, Miranda AS, Teixeira AL, Simoes-E-Silva AC. The anti-inflammatory potential of ACE2/angiotensin-(1-7)/Mas receptor axis: evidence from basic and clinical research. Curr Drug Targets. 2017;18(11):1301-1313. doi:10.2174/1389450117666160727142401.
113. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: Evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6049-6057. doi:10.18632/aging.103000.
114. Nandy K, Salunke A, Pathak SK, et al. Coronavirus disease (COVID-19): A systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events. [Published online ahead of print July 2, 2020]. Diabetes Metab Syndr. 2020;14(5):1017-1025.
115. Juhn YJ. Risks for infection in patients with asthma (or other atopic conditions): Is asthma more than a chronic airway disease?. J Allergy Clin Immunol. 2014;134(2):247-259. doi:10.1016/j.jaci.2014.04.024.
116. Zhu Z, Hasegawa K, Ma B, Fujiogi M, Camargo CA Jr, Liang L. Association of asthma and its genetic predisposition with the risk of severe COVID-19. [Published online ahead of print June 6, 2020]. J Allergy Clin Immunol. 2020;S0091-6749(20)30806-X. doi:10.1016/j.jaci.2020.06.001.
117. Brake SJ, Barnsley K, Lu W, McAlinden KD, et al. Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19). J Clin Med. 2020;9(3):841. Published 2020 Mar 20. doi:10.3390/jcm9030841
118. Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;18:20. Published 2020 Mar 20. doi:10.18332/tid/119324
119. Kaur, G., Lungarella, G., & Rahman, I. (2020). SARS-CoV-2 COVID-19 susceptibility and lung inflammatory storm by smoking and vaping. Journal of inflammation (London, England), 17, 21. https://doi.org/10.1186/s12950-020-00250-8
120. Strzelak, A., Ratajczak, A., Adamiec, A., & Feleszko, W. (2018). Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review. International journal of environmental research and public health, 15(5), 1033. https://doi.org/10.3390/ijerph15051033
121. Berlin, I., Thomas, D., Le Faou, A. L., & Cornuz, J. (2020). COVID-19 and smoking. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, ntaa059. Advance online publication. https://doi.org/10.1093/ntr/ntaa059
122. Centers for Disease Control and Prevention, National Center for Chronic Disease and Prevention, Division of Population Health. Chronic Disease Indicators (CDI) Data, Category: Chronic Obstructive Pulmonary Disease. https://nccd.cdc.gov/cdi/rdPage.aspx?rdReport=DPH_CDI.ExploreByTopic&islTopic=COPD&islYear=9999&go=GO. Accessed July 24, 2020.
123. Centers for Disease Control and Prevention, National Center for Environmental Health. 2018 Adult Asthma Data: BRFSS Prevalence Tables and Maps. https://www.cdc.gov/asthma/brfss/2018/brfssdata.html. Updated March 26, 2020. Accessed July 24, 2020.
124. Gosain R, Abdou Y, Singh A, Rana N, Puzanov I, Ernstoff MS. COVID-19 and Cancer: a Comprehensive Review. Curr Oncol Rep. 2020;22(5):53. Published 2020 May 8. doi:10.1007/s11912-020-00934-7
125. Al-Shamsi HO, Alhazzani W, Alhuraiji A, et al. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist. 2020;25(6):e936-e945. doi:10.1634/theoncologist.2020-0213
126. Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China [published online ahead of print, 2020 Mar 25]. JAMA Oncol. 2020;6(7):1108-1110. doi:10.1001/jamaoncol.2020.0980
127. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6
128. American Cancer Society, Cancer Statistics Center. Georgia. https://cancerstatisticscenter.cancer.org/#!/state/Georgia. Accessed July 22, 2020.
129. American Cancer Society, Cancer Statistics Center. Michigan. https://cancerstatisticscenter.cancer.org/#!/state/Michigan. Accessed July 22, 2020.
130. Centers for Disease Control and Prevention, National Center for Health Statistics. Cancer Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/cancer_mortality/cancer.htm. Updated April 29, 2020. Accessed July 22, 2020.
131. Mehra M, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Eng J Med. 2020;382(e102):NEJMoa2007621. doi:10.1056/NEJMoa2007621.
132. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648-1655. doi: 10.1161/CIRCULATIONAHA.120.046941.
133. Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):1-8. doi:10.1001/jamacardio.2020.1017.
134. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810. doi:10.1001/jamacardio.2020.0950.
135. United Health Foundation, America’s Health Rankings. Annual Report: Heart Disease in Georgia. https://www.americashealthrankings.org/explore/annual/measure/CHD/state/GA. Accessed July 22, 2020.
136. Centers for Disease Control and Prevention, National Center for Health Statistics. Heart Disease Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/heart_disease_mortality/heart_disease.htm. Updated April 27, 2020. Accessed July 22, 2020.
137. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
doi:10.1016/S0140-6736(20)30566-3.
138. Centers for Disease Control and Prevention, National Center for Health Statistics. Provisional Deaths Counts for Coronavirus Disease (COVID-19). https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#AgeAndSex. Updated July 22, 2020. Accessed July 24, 2020.
139. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. [Published online ahead of print February 7, 2020]. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585.
140. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. doi:10.1016/j.jinf.2020.03.005.
141. Svartengren M, Falk R, Philipson K. Long-term clearance from small airways decreases with age. Eur Respir J. 2005;26(4):609-615. doi:10.1183/09031936.05.00002105.
142. Mack J. Michigan is ramping up coronavirus testing - that’s easier said than done. MLive. https://www.mlive.com/public-interest/2020/04/michigan-is-ramping-up-coronavirus-testing-thats-easier-said-than-done.html. Published April 20, 2020. Accessed July 28, 2020.
143. Centers for Medicare and Medicaid Services. COVID-19 Nursing Home Data. https://data.cms.gov/stories/s/bkwz-xpvg Accessed July 15, 2020.
144. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686
145. U.S. Bureau of Labor Statistics. Labor force characteristics by race and ethnicity, 2018. https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm. Published October 2019. Accessed July 22, 2020.
146. Zhang J, Litvinova M, Liang Y, et al. Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. Science. 2020;368(6498):1481-1486. doi:10.1126/science.abb8001.
147. Wu Z, McGoogan JM. Characteristics of and important Lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648.
148. Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020 April 23;382(17):1663-1665. doi:10.1056/NEJMc2005073.
149. Wallace M, Hagan L, Curran KG, et al. COVID-19 in correctional and detention facilities - United States, February-April 2020. MMWR Morb Mortal Wkly Rep. 2020 May 15;69(19):587-590.
doi: 10.15585/mmwr.mm6919e1.
150. Wang J, Yang W, Pan L, et al. Prevention and control of COVID-19 in nursing homes, orphanages, and prisons. [Published online ahead of print on 2020 July 2] Environ Pollut. 2020;266(1):115161.
doi: 10.1016/j.envpol.2020.115161.
151. Hawks L, Woolhandler S, McCormick D. COVID-19 in prisons and jails in the United States. [Published online ahead of print on 2020 April 28] . JAMA Intern Med. 2020. doi:10.1001/jamainternmed.2020.1856.
152. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Prisoners in 2018. https://www.bjs.gov/content/pub/pdf/p18.pdf. Published 2020 April 30. Accessed 2020 July 22.
153. Saloner B, Parish K, Ward JA, et al. COVID-19 cases and deaths in federal and state prisons. [Published online ahead of print on 2020 July 8] JAMA. 2020;e2012528. doi: 10.1001/jama.2020.12528.
154. Boone C. DeKalb releases 103 inmates from jail; window dressing, critics say. Atlanta Journal Constitution. https://www.ajc.com/news/local/dekalb-releases-103-inmates-from-jail-window-dressing-critics-say/9Fkb485Fq3Fwq9XXD44peK/. Published 2020 April 14. Accessed 2020 July 22.
155. Erb R, Oosting J. Coronavirus outbreaks tied to migrant farm workers in Michigan. https://www.bridgemi.com/michigan-health-watch/coronavirus-outbreaks-tied-migrant-farm-workers-michigan. Published June 25, 2020. Accessed July 24, 2020.
156. Herbert C. Echols cases nearly triple after migrant worker testing. Valdosta Daily Times. https://www.valdostadailytimes.com/news/echols-cases-nearly-triple-after-migrant-worker-testing/article_d94166bc-9b67-11ea-a29a-a7e31eca372f.html. Published May 21, 2020. Accessed July 24, 2020.
157. Hansen E, Donohoe M. Health issues of migrant and seasonal farmworkers. J Health Care Poor Underserved. 2003;14(2):153-164. doi:10.1353/hpu.2010.0790.
158. United States Department of Agriculture Economic Research Service. State Fact Sheets: Georgia. USDA.gov. https://data.ers.usda.gov/reports.aspx?StateFIPS=13&StateName=Georgia&ID=17854 Updated May 13, 2020. Accessed July 24, 2020.
159. United States Department of Agriculture Economic Research Service. State Fact Sheets: Michigan. USDA.gov. https://data.ers.usda.gov/reports.aspx?StateFIPS=26&StateName=Michigan&ID=17854 Updated May 13, 2020. Accessed July 24, 2020.
2. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
3. Martines RB, Ritter JM, Matkovic E, et al. Pathology and pathogenesis of SARS-CoV-2 associated with fatal coronavirus disease, United States. [Published online ahead of print May 21, 2020]. Emerg Infect Dis. 2020;26(9):10.3201/eid2609.202095. doi:10.3201/eid2609.202095.
4. Common Human Coronaviruses. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/general-information.html. Published February 13, 2020. Accessed July 28, 2020.
5. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-192. doi:10.1007/s11684-020-0754-0.
6. Qi F, Qian S, Zhang S, Zhang Z. Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochem Biophys Res Commun. 2020;526(1):135-140. doi:10.1016/j.bbrc.2020.03.044.
7. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052.
8. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.
9. COVID-19 United States Cases by County. Johns Hopkins University. https://coronavirus.jhu.edu/us-map. Published June 30, 2020. Accessed July 29, 2020.
10. Executive Office of the President, Office of Management and Budget. OMB Bulletin 20-01, Revised Delineations of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and Guidance on Uses of the Delineations of These Areas.
https://www.whitehouse.gov/wp-content/uploads/2020/03/Bulletin-20-01.pdf?#. Published March 6, 2020. Accessed July 26, 2020.
11. QuickFacts: Michigan; Georgia. U.S. Census Bureau. https://www.census.gov/quickfacts/fact/table/MI,GA/PST045219. Accessed July 26, 2020.
12. U.S. Census Bureau. Metropolitan and Micropolitan Statistical Areas Population Totals and Components of Change: 2010-2019. https://www.census.gov/data/tables/time-series/demo/popest/2010s-total-metro-and-micro-statistical-areas.html. Published June 18, 2020. Accessed July 26, 2020.
13. U.S. Census Bureau. County Population Totals: 2010-2019. https://www.census.gov/data/tables/time-series/demo/popest/2010s-counties-total.html#par_textimage. Published June 22, 2020. Accessed July 28, 2020.
14. Newton J, Nepveux M. Feeding the Economy: Agricultural Jobs by State. American Farm Bureau Federation. https://www.fb.org/market-intel/feeding-the-economy-agricultural-jobs-by-state. Published March 21, 2019. Accessed July 22, 2020.
15. U.S. Department of Agriculture, National Agricultural Statistics Service. Quick Stats. https://quickstats.nass.usda.gov/results/ECF49B01-4293-3DBA-ABCD-AB9517B5B8B7. Accessed July 22, 2020.
16. Vaidya A. States ranked by hospital beds per 1,000 population. Becker’s Hospital Review. https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-hospital-beds-per-1-000-population.html. Published March 18, 2020. Accessed July 22, 2020.
17. American Nightlife Association. Market Summary: Nightlife Industry Overview. https://www.nightlifeassociation.org/market-overview/. Accessed July 22, 2020.
18. United Health Foundation, America’s Health Rankings. Annual Report: Excessive Drinking in Michigan. https://www.americashealthrankings.org/explore/annual/measure/ExcessDrink/state/MI. Accessed July 22, 2020.
19. United Health Foundation, America’s Health Rankings. Annual Report: Excessive Drinking in Georgia. https://www.americashealthrankings.org/explore/annual/measure/ExcessDrink/state/GA. Accessed July 22, 2020.
20. Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study. [Published online ahead of print April 27, 2020]. medRxiv. 2020. doi:10.1101/2020.04.05.20054502.
21. Becker U, Deis A, Sørensen TI, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996;23(5):1025-1029. doi:10.1002/hep.510230513.
22. Liver Disease Statistics. American Liver Foundation. https://liverfoundation.org/liver-disease-statistics/#alcohol-related-liver-disease-and-cirrhosis. Published October 26, 2017. Accessed July 22, 2020.
23. Center for Disease Control and Prevention, National Center for Health Statistics. Chronic Liver Disease/Cirrhosis Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/liver_disease_mortality/liver_disease.htm. Accessed July 24, 2020.
24. Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver Int. 2000;40(6):1278-1281. doi:10.1111/liv.14470.
25. Michigan Land area in square miles, 2010 by County. IndexMundi. https://www.indexmundi.com/facts/united-states/quick-facts/michigan/land-area#table. Accessed July 22, 2020.
26. U.S. Census Bureau. 2017 Gazeteer. https://www2.census.gov/geo/docs/maps-data/data/gazetteer/2017_Gazetteer/2017_gaz_place_26.txt. Accessed July 22, 2020.
27. U.S. Census Bureau. Metropolitan and Micropolitan Statistical Areas Population Totals and Components of Change: 2010-2019. https://www.census.gov/data/tables/time-series/demo/popest/2010s-total-metro-and-micro-statistical-areas.html. Published June 18, 2020. Accessed July 26, 2020.
28. Georgia Land area in square miles, 2010 by County. IndexMundi. https://www.indexmundi.com/facts/united-states/quick-facts/georgia/land-area#table. Accessed July 22, 2020.
29. U.S. Census Bureau. Annual Estimates of the Resident Population for Incorporated Places of 50,000 or More, Ranked by July 1, 2019 Population: April 1, 2010 to July 1, 2019. https://www2.census.gov/programs-surveys/popest/tables/2010-2019/cities/totals/SUB-IP-EST2019-ANNRNK.xlsx. Accessed July 22, 2020.
30. U.S. Census Bureau. 2018 Gazeteer. https://www2.census.gov/geo/docs/maps-data/data/gazetteer/2018_Gazetteer/2018_gaz_place_13.txt. Accessed July 22, 2020.
31. U.S. Department of Commerce, Bureau of Economic Analysis. Personal Income by County, Metro, and Other Areas: Metropolitan Area Table. https://www.bea.gov/data/income-saving/personal-income-county-metro-and-other-areas. Published November 14, 2019. Accessed July 22, 2020.
32. QuickFacts: Albany city, Georgia; Detroit city, Michigan; Atlanta city, Georgia. U.S. Census Bureau. https://www.census.gov/quickfacts/fact/table/albanycitygeorgia,detroitcitymichigan,atlantacitygeorgia/PST045219. Accessed July 22, 2020.
33. Race. U.S. Census Bureau. https://data.census.gov/cedsci/table?cid=P001001&tid=ACSDT1Y2018.B02001&hidePreview=true&t=Race%20and%20Ethnicity&vintage=2018&g=310M400US19820,12060_310M200US10500. Accessed July 22, 2020.
34. Educational Attainment. U.S. Census Bureau.https://data.census.gov/cedsci/table?g=310M400US12060,19820_310M200US10500&tid=ACSST1Y2018.S1501&t=Education%3AEducational%20Attainment&hidePreview=true&vintage=2018&layer=VT_2018_310_M4_PY_D1&cid=S1501_C01_001E. Accessed July 22, 2020.
35. U.S. Department of Commerce, National Oceanic and Atmospheric Administration, National Centers for Environmental Information. Data Tools: 1981-2010 Normals. https://www.ncdc.noaa.gov/cdo-web/datatools/normals. Accessed July 22, 2020.
36. U.S. Department of Commerce, National Oceanic and Atmospheric Administration, National Centers for Environmental Information. Average Relative Humidity - Morning (M), Afternoon (A). Accessed July 22, 2020.
37. Almanac: Historical Information. MyForecast. http://myforecast.co/bin/climate.m?city=13608&metric=true. Accessed July 22, 2020.
38. Tolbert C, Mossberger K. U.S. Current Population Survey & American Community Survey Geographic Estimates of Internet Use, 1997-2016. Arizona State University, Center on Technology, Data and Society. https://techdatasociety.asu.edu/broadband-data-portal/dataaccess/metrodata. Published 2018. Accessed July 22, 2020.
39. National Digital Inclusion Alliance. Worst Connected Cities 2018. https://www.digitalinclusion.org/worst-connected-2018/. Accessed July 22, 2020.
40. Federal Aviation Administration, Air Carrier Activity Information System. Commercial Service Airports (Rank Order) based on Calendar Year 2019 Preliminary. https://www.faa.gov/airports/planning_capacity/passenger_allcargo_stats/passenger/media/preliminary-cy19-commercial-service-enplanements.pdf. Published July 1, 2020. Accessed July 22, 2020.
41. Church Attendance Patterns by Zip Code. CityFlourish. https://cityflourish.com/church-attendance-patterns-by-zip-code/. Accessed July 26, 2020.
42. U.S. Environmental Protection Agency. Air Quality - Cities and Counties. https://www.epa.gov/air-trends/air-quality-cities-and-counties. Published May 5, 2020. Updated June 6, 2020. Accessed July 22, 2020.
43. Laden F, Schwartz J, Speizer FE, Dockery DW. Reduction in fine particulate air pollution and mortality. Am J Respir Crit Care Med. 2006;173(6):667-672. doi:10.1164/rccm.200503-443OC.
44. Pope CA III. Epidemiology of Fine Particulate Air Pollution and Human Health: Biologic Mechanisms and Who's at Risk? Environ Health Perspect. 200;108(Suppl 4):713-723. doi:10.1289/ehp.108-1637679.p
45. Wu Y, Jing W, Liu J, et al. Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries. Sci Total Environ. 2020;729:139051. doi:10.1016/j.scitotenv.2020.139051.
46. Center for Disease Control and Prevention, Center for Disease Control and Prevention WONDER. Multiple Cause of Death File 2018, Series 20, No. 2X, 2020. https://wonder.cdc.gov/controller/datarequest/D76 Accessed July 20, 2020.
47. Agency for Healthcare Research and Quality. 2018 National Healthcare Quality and Disparities Report. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr.pdf. Published September 2019. Accessed July 23, 2020.
48. Agency for Healthcare Research and Quality. National Healthcare Quality and Disparities Reports. https://nhqrnet.ahrq.gov/inhqrdr/Georgia/benchmark/summary/All_Measures/All_Topics. Accessed July 23, 2020.
49. Agency for Healthcare Research and Quality. National Healthcare Quality and Disparities Reports. https://nhqrnet.ahrq.gov/inhqrdr/Michigan/benchmark/summary/All_Measures/All_Topics. Accessed July 23, 2020.
50. U.S. Census Bureau. Health Insurance Coverage in the United States: 2018. https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf. Published November 2019. Accessed July 18, 2020.
51. Georgia Department of Public Health Daily Status Report. Georgia Department of Public Health website. Updated June 30, 2020, Accessed June 30, 2020. https://dph.georgia.gov/covid-19-daily-status-report
52. Office of Governor Brain P. Kemp. Officials Confirm Two Cases of COVID-19 in Georgia. https://gov.georgia.gov/press-releases/2020-03-03/gov-kemp-officials-confirm-two-cases-covid-19-georgia. Accessed July 18, 2020.
53. Michigan Data. Michigan Disease Surveillance System and Vital Records. Updated June 30, 2020, Accessed June 30, 2020. https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html
54. State of Michigan. Michigan announces first presumptive positive cases of COVID-19. https://www.michigan.gov/coronavirus/0,9753,7-406-98158-521341--,00.html. Accessed July 27, 2020
55. Brian P. Kemp Office of the Governor. Executive Order 03.14.20.01. https://gov.georgia.gov/document/2020-executive-order/03142001/download Published March 14, 2020. Accessed July 24, 2020.
56. Brian P. Kemp Office of the Governor. Executive Order 03.23.20.01. https://gov.georgia.gov/document/2020-executive-order/03232001/download Published March 23, 2020. Accessed July 24, 2020.
57. Brian P. Kemp Office of the Governor. Executive Order 04.02.20.01. https://gov.georgia.gov/document/2020-executive-order/04022001/download Published April 2, 2020. Accessed July 24, 2020.
58. Governor Brian P. Kemp, Office of the Governor. Executive Order 04.23.20.02. https://gov.georgia.gov/document/2020-executive-order/04232002/download. Published April 23, 2020. Accessed July 22, 2020.
59. The Office of Governor Gretchen Whitmer. Executive Order 2020-04 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-521576--,00.html. Published March 10, 2020. Accessed July 24, 2020.
60. The Office of Governor Gretchen Whitmer. Executive Order 2020-05 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-521595--,00.html. Published March 13, 2020. Accessed July 24, 2020.
61. The Office of Governor Gretchen Whitmer. Executive Order 2020-11 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-521890--,00.html. Published March 16, 2020. Accessed July 24, 2020.
62. The Office of Governor Gretchen Whitmer. Executive Order 2020-17 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-522451--,00.html. Published March 21, 2020. Accessed July 24, 2020.
63. The Office of Governor Gretchen Whitmer. Executive Order 2020-21 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-522626--,00.html. Published March 24, 2020. Accessed July 24, 2020.
64. The Office of Governor Gretchen Whitmer. Executive Order 2020-42 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-525182--,00.html. Published April 9, 2020. Accessed July 24, 2020.
65. Governor Brian P. Kemp, Office of the Governor. Executive Order 04.20.20.01. https://gov.georgia.gov/document/2020-executive-order/04202001/download. Published April 20, 2020. Accessed July 20, 2020.
66. Governor Brian P. Kemp, Office of the Governor. Executive Order 05.28.20.02. https://gov.georgia.gov/document/2020-executive-order/05282002/download. Published May 28, 2020. Accessed July 22, 2020
67. Governor Brian P. Kemp, Office of the Governor. Executive Order 06.11.20.01. https://gov.georgia.gov/document/2020-executive-order/06112001/download. Published June 11, 2020. Accessed July 22, 2020.
68. The Office of Governor Gretchen Whitmer. Executive Order 2020-70 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-527847--,00.html Published May 1, 2020. Accessed July 24, 2020.
69. The Office of Governor Gretchen Whitmer. Executive Order 2020-92 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-529476--,00.html Published May 18, 2020. Accessed July 24, 2020.
70. The Office of Governor Gretchen Whitmer. Executive Order 2020-96 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-529860--,00.html Published May 21, 2020. Accessed July 24, 2020.
71. The Office of Governor Gretchen Whitmer. Executive Order 2020-110 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-530620--,00.html Published June 1, 2020. Accessed July 24, 2020
72. Governor Brian P. Kemp, Office of the Governor. Executive Order 04.13.20.02. https://gov.georgia.gov/document/2020-executive-order/04132002/download. Published April 13, 2020. Accessed July 22, 2020.
73. Governor Brian P. Kemp, Office of the Governor. Executive Order 05.12.20.02. https://gov.georgia.gov/document/2020-executive-order/05122002/download. Published May 12, 2020. Accessed July 22, 2020.
74. Governor Brian P. Kemp, Office of the Governor. Executive Order 06.29.20.02. https://gov.georgia.gov/document/2020-executive-order/06292002/download. Published June 29, 2020. Accessed July 22, 2020.
75. The Office of Governor Gretchen Whitmer. Executive Order 2020-59 (COVID-19). https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-526894--,00.html/. Published April 24, 2020. Accessed July 20, 2020.
76. Georgia Department of Public Health. COVID-19 Testing in Georgia (2020). https://dph.georgia.gov/covidtesting. Accessed July 27, 2020.
77. U.S. Department of Health and Human Services. Community-Based Testing Sites for COVID-19. https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html. Published July 24, 2020. Accessed July 27, 2020.
78. State of Michigan. MDHHS Expands COVID-19 Testing Criteria to Better Protect Residents; Greater access is important as Michigan reopens state economy. (2020). https://www.michigan.gov/coronavirus/0,9753,7-406-98163-530157--,00.html. Accessed July 27, 2020.
79. Coronavirus disease 2019 (COVID-19) 2020 interim case definition, approved April 5, 2020. Centers for Disease Control and Prevention - National Notifiable Diseases Surveillance System (NNDSS). https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/. Accessed July 24, 2020.
80. Council of State and Territorial Epidemiologists. Standardized Surveillance Case Definition and National Notification for 2019 Novel Coronavirus Disease (COVID-19). https://cste.us6.list-manage.com/track/click?u=a74794e707a0d58b86a809758&id=355d54d3a6&e=dfdc1f26f1. Published April 5, 2020. Accessed July 24, 2020.
81. Michigan Department of Health and Human Services. Emergency order under MCL 333.2253 – COVID-19 death reporting. https://www.michigan.gov/documents/coronavirus/MDHHS_epidemic_order_-_handling_of_bodily_remains_signed_689331_7.pdf. Published April 4, 2020. Accessed July 28, 2020.
82. Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clin Proc. 2020;95(7):1445-1453. doi:10.1016/j.mayocp.2020.05.006.
83. Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). [Published online ahead of print June 26, 2020]. Diabetes Metab Res Rev. 2020;e3377. doi:10.1002/dmrr.3377.
84. Dugail I, Amri EZ, Vitale N. High prevalence for obesity in severe COVID-19: Possible links and perspectives towards patient stratification. [Published online ahead of print July 8, 2020]. Biochimie. 2020;S0300-9084(20)30155-3. doi:10.1016/j.biochi.2020.07.001.
85. Centers for Disease Control and Prevention, Overweight and Obesity. Adult Obesity Maps. https://www.cdc.gov/obesity/data/prevalence-maps.html#age. Accessed July 22, 2020.
86. Jamil HJ, Rajan AK, Grzybowski M, Fakhouri M, Arnetz B. Obesity and overweight in ethnic minorities of the Detroit metropolitan area of Michigan. J Community Health. 2014;39(2):301-309. doi:10.1007/s10900-013-9760-3.
87. Schiffrin EL, Flack JM, Ito S, Muntner P, Webb RC. Hypertension and COVID-19. Am J Hypertens. 2020;33(5):373-374. doi:10.1093/ajh/hpaa057
88. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115. DOI: 10.1161/HYP.0000000000000065.
89. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.
90. Centers for Disease Control and Prevention (CDC). COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity. https://www.cdc.gov/coronavirus/2019-ncov/covid data/covidview/index.html. Updated July 24, 2020. Accessed July 27, 2020.
91. Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020;21(2):1470320320926899. doi:10.1177/1470320320926899
92. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. DHDSP Data Trends & Maps [online]. 2015. [accessed Jul 20, 2020]. URL: https://www.cdc.gov/dhdsp/maps/dtm/index.html.
93. Ferdinand K, Batieste T, Fleurestil M. Contemporary and Future Concepts on Hypertension in African Americans: COVID-19 and Beyond. J Natl Med Assoc. 2020;112(3):315-323. doi:10.1016/j.jnma.2020.05.018
94. Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. doi:10.1016/j.diabres.2020.108142.
95. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? [published correction appears in Lancet Respir Med. 2020 Jun;8(6):e54]. Lancet Respir Med. 2020;8(4):e21. doi:10.1016/S2213-2600(20)30116-8.
96. Centers for Disease Control and Prevention. Diagnosed Diabetes. cdc.gov. https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html. Accessed July 24, 2020.
97. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-838. doi:10.1016/j.kint.2020.03.005
98. Pan XW, Xu D, Zhang H, Zhou W, Wang LH, Cui XG. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46(6):1114-1116. doi:10.1007/s00134-020-06026-1
99. Ding Y, He L, Zhang Q, et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol. 2004;203(2):622-630. doi:10.1002/path.1560
100. Yeung ML, Yao Y, Jia L, et al. MERS coronavirus induces apoptosis in kidney and lung by upregulating Smad7 and FGF2. Nat Microbiol. 2016;1(3):16004. Published 2016 Feb 22. doi:10.1038/nmicrobiol.2016.4
101. Adapa S, Chenna A, Balla M, et al. COVID-19 Pandemic Causing Acute Kidney Injury and Impact on Patients With Chronic Kidney Disease and Renal Transplantation. J Clin Med Res. 2020;12(6):352-361. doi:10.14740/jocmr4200
102. Martinez-Rojas MA, Vega-Vega O, Bobadilla NA. Is the kidney a target of SARS-CoV-2?. Am J Physiol Renal Physiol. 2020;318(6):F1454-F1462. doi:10.1152/ajprenal.00160.2020
103. Kidney Disease. National Kidney Foundation of Michigan. https://www.nkfm.org/help-information/kidney-disease. Accessed July 24, 2020.
104. Kidney Disease-Is Your State Hard Hit? National Kidney Foundation. https://www.kidney.org/news/newsroom/nr/KD_StateHardHit. Published June 5, 2020. Accessed July 28, 2020.
105. Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States. http://www.cdc.gov/ckd. Accessed July 22, 2020.
106. Suleyman G, Fadel RA, Malette KM, et al. Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in metropolitan detroit. JAMA Netw Open. 2020;3(6):e2012270. Published 2020 Jun 1. doi:10.1001/jamanetworkopen.2020.12270
107. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 - Metropolitan Atlanta, Georgia, March-April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):790-794. Published 2020 Jun 26. doi:10.15585/mmwr.mm6925e1
108. Shah GH, Shankar P, Schwind JS, Sittaramane V. The Detrimental Impact of the COVID-19 Crisis on Health Equity and Social Determinants of Health. J Public Health Manag Pract. 2020;26(4):317-319. doi:10.1097/PHH.0000000000001200
109. Clarke NE, Belyaev ND, Lambert DW, Turner AJ. Epigenetic regulation of angiotensin-converting enzyme 2 (ACE2) by SIRT1 under conditions of cell energy stress. Clin Sci (Lond). 2014;126(7):507-516. doi:10.1042/CS20130291.
110. Saheb Sharif-Askari NS, Saheb Sharif-Askari F, Alabed M, et al. Airways expression of SARS-CoV-2 receptor, ACE2, and TMPRSS2 is lower in children than adults and increases with smoking and COPD. Mol Ther Methods Clin Dev. 2020 May 22;(18):1-6. doi:10.1016/j.omtm.2020.05.013.
111. Verdecchia P, Cavallini C, Spanevello A, Angeli F. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med. 2020;76:14-20. doi:10.1016/j.ejim.2020.04.037.
112. Rodrigues Prestes TR, Rocha NP, Miranda AS, Teixeira AL, Simoes-E-Silva AC. The anti-inflammatory potential of ACE2/angiotensin-(1-7)/Mas receptor axis: evidence from basic and clinical research. Curr Drug Targets. 2017;18(11):1301-1313. doi:10.2174/1389450117666160727142401.
113. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: Evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6049-6057. doi:10.18632/aging.103000.
114. Nandy K, Salunke A, Pathak SK, et al. Coronavirus disease (COVID-19): A systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events. [Published online ahead of print July 2, 2020]. Diabetes Metab Syndr. 2020;14(5):1017-1025.
115. Juhn YJ. Risks for infection in patients with asthma (or other atopic conditions): Is asthma more than a chronic airway disease?. J Allergy Clin Immunol. 2014;134(2):247-259. doi:10.1016/j.jaci.2014.04.024.
116. Zhu Z, Hasegawa K, Ma B, Fujiogi M, Camargo CA Jr, Liang L. Association of asthma and its genetic predisposition with the risk of severe COVID-19. [Published online ahead of print June 6, 2020]. J Allergy Clin Immunol. 2020;S0091-6749(20)30806-X. doi:10.1016/j.jaci.2020.06.001.
117. Brake SJ, Barnsley K, Lu W, McAlinden KD, et al. Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19). J Clin Med. 2020;9(3):841. Published 2020 Mar 20. doi:10.3390/jcm9030841
118. Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;18:20. Published 2020 Mar 20. doi:10.18332/tid/119324
119. Kaur, G., Lungarella, G., & Rahman, I. (2020). SARS-CoV-2 COVID-19 susceptibility and lung inflammatory storm by smoking and vaping. Journal of inflammation (London, England), 17, 21. https://doi.org/10.1186/s12950-020-00250-8
120. Strzelak, A., Ratajczak, A., Adamiec, A., & Feleszko, W. (2018). Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review. International journal of environmental research and public health, 15(5), 1033. https://doi.org/10.3390/ijerph15051033
121. Berlin, I., Thomas, D., Le Faou, A. L., & Cornuz, J. (2020). COVID-19 and smoking. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, ntaa059. Advance online publication. https://doi.org/10.1093/ntr/ntaa059
122. Centers for Disease Control and Prevention, National Center for Chronic Disease and Prevention, Division of Population Health. Chronic Disease Indicators (CDI) Data, Category: Chronic Obstructive Pulmonary Disease. https://nccd.cdc.gov/cdi/rdPage.aspx?rdReport=DPH_CDI.ExploreByTopic&islTopic=COPD&islYear=9999&go=GO. Accessed July 24, 2020.
123. Centers for Disease Control and Prevention, National Center for Environmental Health. 2018 Adult Asthma Data: BRFSS Prevalence Tables and Maps. https://www.cdc.gov/asthma/brfss/2018/brfssdata.html. Updated March 26, 2020. Accessed July 24, 2020.
124. Gosain R, Abdou Y, Singh A, Rana N, Puzanov I, Ernstoff MS. COVID-19 and Cancer: a Comprehensive Review. Curr Oncol Rep. 2020;22(5):53. Published 2020 May 8. doi:10.1007/s11912-020-00934-7
125. Al-Shamsi HO, Alhazzani W, Alhuraiji A, et al. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist. 2020;25(6):e936-e945. doi:10.1634/theoncologist.2020-0213
126. Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China [published online ahead of print, 2020 Mar 25]. JAMA Oncol. 2020;6(7):1108-1110. doi:10.1001/jamaoncol.2020.0980
127. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6
128. American Cancer Society, Cancer Statistics Center. Georgia. https://cancerstatisticscenter.cancer.org/#!/state/Georgia. Accessed July 22, 2020.
129. American Cancer Society, Cancer Statistics Center. Michigan. https://cancerstatisticscenter.cancer.org/#!/state/Michigan. Accessed July 22, 2020.
130. Centers for Disease Control and Prevention, National Center for Health Statistics. Cancer Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/cancer_mortality/cancer.htm. Updated April 29, 2020. Accessed July 22, 2020.
131. Mehra M, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Eng J Med. 2020;382(e102):NEJMoa2007621. doi:10.1056/NEJMoa2007621.
132. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648-1655. doi: 10.1161/CIRCULATIONAHA.120.046941.
133. Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):1-8. doi:10.1001/jamacardio.2020.1017.
134. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810. doi:10.1001/jamacardio.2020.0950.
135. United Health Foundation, America’s Health Rankings. Annual Report: Heart Disease in Georgia. https://www.americashealthrankings.org/explore/annual/measure/CHD/state/GA. Accessed July 22, 2020.
136. Centers for Disease Control and Prevention, National Center for Health Statistics. Heart Disease Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/heart_disease_mortality/heart_disease.htm. Updated April 27, 2020. Accessed July 22, 2020.
137. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
doi:10.1016/S0140-6736(20)30566-3.
138. Centers for Disease Control and Prevention, National Center for Health Statistics. Provisional Deaths Counts for Coronavirus Disease (COVID-19). https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#AgeAndSex. Updated July 22, 2020. Accessed July 24, 2020.
139. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. [Published online ahead of print February 7, 2020]. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585.
140. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. doi:10.1016/j.jinf.2020.03.005.
141. Svartengren M, Falk R, Philipson K. Long-term clearance from small airways decreases with age. Eur Respir J. 2005;26(4):609-615. doi:10.1183/09031936.05.00002105.
142. Mack J. Michigan is ramping up coronavirus testing - that’s easier said than done. MLive. https://www.mlive.com/public-interest/2020/04/michigan-is-ramping-up-coronavirus-testing-thats-easier-said-than-done.html. Published April 20, 2020. Accessed July 28, 2020.
143. Centers for Medicare and Medicaid Services. COVID-19 Nursing Home Data. https://data.cms.gov/stories/s/bkwz-xpvg Accessed July 15, 2020.
144. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686
145. U.S. Bureau of Labor Statistics. Labor force characteristics by race and ethnicity, 2018. https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm. Published October 2019. Accessed July 22, 2020.
146. Zhang J, Litvinova M, Liang Y, et al. Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. Science. 2020;368(6498):1481-1486. doi:10.1126/science.abb8001.
147. Wu Z, McGoogan JM. Characteristics of and important Lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648.
148. Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020 April 23;382(17):1663-1665. doi:10.1056/NEJMc2005073.
149. Wallace M, Hagan L, Curran KG, et al. COVID-19 in correctional and detention facilities - United States, February-April 2020. MMWR Morb Mortal Wkly Rep. 2020 May 15;69(19):587-590.
doi: 10.15585/mmwr.mm6919e1.
150. Wang J, Yang W, Pan L, et al. Prevention and control of COVID-19 in nursing homes, orphanages, and prisons. [Published online ahead of print on 2020 July 2] Environ Pollut. 2020;266(1):115161.
doi: 10.1016/j.envpol.2020.115161.
151. Hawks L, Woolhandler S, McCormick D. COVID-19 in prisons and jails in the United States. [Published online ahead of print on 2020 April 28] . JAMA Intern Med. 2020. doi:10.1001/jamainternmed.2020.1856.
152. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Prisoners in 2018. https://www.bjs.gov/content/pub/pdf/p18.pdf. Published 2020 April 30. Accessed 2020 July 22.
153. Saloner B, Parish K, Ward JA, et al. COVID-19 cases and deaths in federal and state prisons. [Published online ahead of print on 2020 July 8] JAMA. 2020;e2012528. doi: 10.1001/jama.2020.12528.
154. Boone C. DeKalb releases 103 inmates from jail; window dressing, critics say. Atlanta Journal Constitution. https://www.ajc.com/news/local/dekalb-releases-103-inmates-from-jail-window-dressing-critics-say/9Fkb485Fq3Fwq9XXD44peK/. Published 2020 April 14. Accessed 2020 July 22.
155. Erb R, Oosting J. Coronavirus outbreaks tied to migrant farm workers in Michigan. https://www.bridgemi.com/michigan-health-watch/coronavirus-outbreaks-tied-migrant-farm-workers-michigan. Published June 25, 2020. Accessed July 24, 2020.
156. Herbert C. Echols cases nearly triple after migrant worker testing. Valdosta Daily Times. https://www.valdostadailytimes.com/news/echols-cases-nearly-triple-after-migrant-worker-testing/article_d94166bc-9b67-11ea-a29a-a7e31eca372f.html. Published May 21, 2020. Accessed July 24, 2020.
157. Hansen E, Donohoe M. Health issues of migrant and seasonal farmworkers. J Health Care Poor Underserved. 2003;14(2):153-164. doi:10.1353/hpu.2010.0790.
158. United States Department of Agriculture Economic Research Service. State Fact Sheets: Georgia. USDA.gov. https://data.ers.usda.gov/reports.aspx?StateFIPS=13&StateName=Georgia&ID=17854 Updated May 13, 2020. Accessed July 24, 2020.
159. United States Department of Agriculture Economic Research Service. State Fact Sheets: Michigan. USDA.gov. https://data.ers.usda.gov/reports.aspx?StateFIPS=26&StateName=Michigan&ID=17854 Updated May 13, 2020. Accessed July 24, 2020.