> top > projects > LitCovid-sentences > docs > PMC:7675688 > annotations
LitCovid-sentences  

PMC:7675688 JSONTXT 9 Projects

Annnotations TAB TSV DIC JSON TextAE-old TextAE

Id Subject Object Predicate Lexical cue
T1 0-46 Sentence denotes An Outbreak of Covid-19 on an Aircraft Carrier
T2 48-56 Sentence denotes Abstract
T3 58-68 Sentence denotes Background
T4 69-142 Sentence denotes An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S.
T5 143-228 Sentence denotes Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel.
T6 230-237 Sentence denotes Methods
T7 238-402 Sentence denotes We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR).
T8 403-518 Sentence denotes All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms.
T9 520-527 Sentence denotes Results
T10 528-626 Sentence denotes The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S.
T11 627-655 Sentence denotes Navy standards for sea duty.
T12 656-946 Sentence denotes Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection.
T13 947-1136 Sentence denotes An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result).
T14 1137-1341 Sentence denotes Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course.
T15 1342-1482 Sentence denotes Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died.
T16 1483-1566 Sentence denotes Crew members who worked in confined spaces appeared more likely to become infected.
T17 1568-1579 Sentence denotes Conclusions
T18 1580-1634 Sentence denotes SARS-CoV-2 spread quickly among the crew of the U.S.S.
T19 1635-1654 Sentence denotes Theodore Roosevelt.
T20 1655-1774 Sentence denotes Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members.
T21 1775-1849 Sentence denotes Nearly half of those who tested positive for the virus never had symptoms.
T22 1851-1861 Sentence denotes The U.S.S.
T23 1862-2050 Sentence denotes Theodore Roosevelt was conducting operations in the western Pacific Ocean when an outbreak of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred on board.
T24 2051-2115 Sentence denotes On identification of the outbreak, the ship was diverted to U.S.
T25 2116-2132 Sentence denotes Naval Base Guam.
T26 2133-2260 Sentence denotes The base hospital, a 42-bed inpatient facility, provides medical care for U.S. military beneficiaries and others in the region.
T27 2261-2417 Sentence denotes Although the initial response was handled by the medical staffs of the ship and Naval Hospital Guam, it was quickly augmented by a joint medical task force.
T28 2418-2465 Sentence denotes This report provides key findings from the U.S.
T29 2466-2528 Sentence denotes Navy response and epidemiologic investigation of the outbreak.
T30 2529-2600 Sentence denotes Over the course of the response, every member of the crew of the U.S.S.
T31 2601-2736 Sentence denotes Theodore Roosevelt was evaluated, tested, placed in isolation or quarantine, and monitored on a daily basis to ensure their well-being.
T32 2737-2895 Sentence denotes Our findings offer insights into the epidemiology and outcomes of SARS-CoV-2 infection in healthy, fit, military-aged adults who are housed in close quarters.
T33 2897-2904 Sentence denotes Methods
T34 2906-2952 Sentence denotes Initial Response to the Outbreak and Follow-Up
T35 2953-3114 Sentence denotes The ship had been at sea for 13 days when three crew members presented to the medical department with symptoms suggestive of coronavirus disease 2019 (Covid-19).
T36 3115-3259 Sentence denotes All three underwent testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) and were found to be positive for SARS-CoV-2.
T37 3260-3392 Sentence denotes Over the next 24 hours, additional symptomatic crew members and approximately 400 close contacts were identified by contact tracing.
T38 3393-3487 Sentence denotes Four days after the first positive test result was reported, the ship reached Naval Base Guam.
T39 3488-3602 Sentence denotes Crew members with confirmed cases of Covid-19 were placed in isolation on Naval Base Guam or in the base hospital.
T40 3603-3726 Sentence denotes Persons with one or more negative Covid-19 tests and no symptoms were quarantined in hotels off base or on Naval Base Guam.
T41 3727-3811 Sentence denotes In addition, essential personnel who were uninfected stayed aboard the ship in port.
T42 3812-3914 Sentence denotes All members of the crew underwent screening for signs and symptoms of Covid-19 and testing by rRT-PCR.
T43 3915-4054 Sentence denotes Those who tested positive for SARS-CoV-2 were placed in isolation and received twice-daily symptom, temperature, and pulse oximetry checks.
T44 4055-4107 Sentence denotes Those who tested negative were placed in quarantine.
T45 4108-4222 Sentence denotes Ultimately, 4079 SARS-CoV-2–negative crew members who did not have symptoms were quarantined in 11 hotels in Guam.
T46 4223-4265 Sentence denotes All were placed in single-occupancy rooms.
T47 4266-4346 Sentence denotes A surveillance model was implemented that relied on in-person health screenings.
T48 4347-4471 Sentence denotes These screenings were supplemented by self-reporting with the use of a symptom checker developed by Defense Digital Service.
T49 4472-4599 Sentence denotes Health screenings and symptom-checker data were collated and analyzed each morning by 9 a.m. and again in the evening by 9 p.m.
T50 4600-4779 Sentence denotes Crew members who had progressive symptoms or were deemed to have conditions potentially placing them at higher risk for poorer outcomes were followed up with additional screening.
T51 4780-4935 Sentence denotes Any crew members who were determined by on-site medical providers to need closer observation or treatment were transported to Naval Hospital Guam for care.
T52 4936-5107 Sentence denotes In addition to Covid-19–related health surveillance, crew members received primary care, pharmacy, and psychiatric services to ensure a complete scope of medical coverage.
T53 5108-5236 Sentence denotes On completion of prespecified periods of isolation or quarantine, all personnel were required to undergo repeat rRT-PCR testing.
T54 5237-5350 Sentence denotes To be eligible for exit testing, a crew member had to remain in isolation or quarantine for a minimum of 14 days.
T55 5351-5439 Sentence denotes Those in isolation were also required to be symptom-free for 3 days before exit testing.
T56 5440-5563 Sentence denotes Any crew member in quarantine in whom symptoms developed was tested and moved to isolation for at least 14 additional days.
T57 5564-5661 Sentence denotes All crew members were followed up for a minimum of 10 weeks, regardless of their Covid-19 status.
T58 5663-5681 Sentence denotes Laboratory Testing
T59 5682-5804 Sentence denotes Nasopharyngeal swab specimens were obtained from all members of the crew with the use of viral transport medium swab kits.
T60 5805-5966 Sentence denotes The presence of SARS-CoV-2 infection was determined by rRT-PCR testing with the Thermo Fisher ABI 7500 or the Bio-Rad CFX96 Touch Real-Time PCR Detection System.
T61 5967-6371 Sentence denotes Samples were processed with either the Qiagen QIAamp Viral RNA Mini Kit or the Roche MagNA Pure 96 instrument for automated nucleic acid extraction, and testing was performed with the Seegene Allplex 2019-nCOV assay test kit or the Centers for Disease Control and Prevention (CDC) emergency-use-authorization assay.1 These assays included the detection of two targets in the nucleocapsid gene, N1 and N2.
T62 6372-6471 Sentence denotes Surveillance testing for influenza-like illness was conducted with the Biofire Respiratory 2 Panel.
T63 6473-6500 Sentence denotes Collection of Outbreak Data
T64 6501-6705 Sentence denotes The Navy and Marine Corps Public Health Center was tasked with providing public health support for the outbreak investigation and conducting data analysis in alignment with its core public health mission.
T65 6706-6984 Sentence denotes Data were collected as part of a coordinated public health outbreak investigation conducted by the Navy to bring the outbreak under control, ensure the well-being of the crew, assess the spread and effects of SARS-CoV-2, and implement measures to return the crew to work safely.
T66 6985-7214 Sentence denotes Under Navy public health support criteria, the intent of the outbreak investigation was to mitigate spread, inform decision making, gather information for use in other outbreaks, and decrease the effect on the health of the crew.
T67 7215-7424 Sentence denotes This project was deemed to be nonresearch with respect to the use of human subject information and was exempt from review by the institutional review board as an emergency public health outbreak investigation.
T68 7425-7689 Sentence denotes A roster of Electronic Data Interchange Personal Identifiers for the shipboard population was matched to Defense Manpower Data Center personnel rosters from February 2020 to identify demographic information for each crew member and to confirm personal identifiers.
T69 7690-7857 Sentence denotes Civilian personnel and anyone with an Electronic Data Interchange Personal Identifier that did not match with Defense Manpower Data Center were excluded from analysis.
T70 7858-7974 Sentence denotes The Defense Enrollment Eligibility Reporting System was used to identify race and ethnic group for all crew members.
T71 7975-8076 Sentence denotes Ages of crew members at time of the outbreak were calculated from the date of birth to March 3, 2020.
T72 8077-8340 Sentence denotes Medical surveillance data collected by the ship medical department, Naval Hospital Guam, and the joint medical task force were collated with the roster to create a data set that included dates of symptom onset, daily clinical signs and symptoms, and test results.
T73 8341-8461 Sentence denotes Data from the Defense Digital Service MySymptoms symptom-tracker application were also collated into the final data set.
T74 8462-8608 Sentence denotes For the purpose of this analysis, fever is defined as subjective fever reported by the crew member or a measured temperature of 100.0°F or higher.
T75 8609-8662 Sentence denotes All other symptoms were reported by the crew members.
T76 8663-8885 Sentence denotes Data on health-related factors were obtained from a number of existing clinical Military Health System data sources, including the Armed Forces Health Longitudinal Technology Application and Military Health System Genesis.
T77 8886-9013 Sentence denotes A confirmed case of Covid-19 was defined as one in which a nasopharyngeal swab specimen was positive for SARS-CoV-2 by rRT-PCR.
T78 9014-9182 Sentence denotes A suspected case of Covid-19 was defined as one that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result.
T79 9183-9468 Sentence denotes Confirmed cases were further classified as symptomatic (with symptom onset before the first positive laboratory test), presymptomatic (with the first positive laboratory test before subsequent symptom onset), and asymptomatic (positive laboratory test but clinical criteria never met).
T80 9469-9637 Sentence denotes Patients with confirmed or suspected infection were classified as having been hospitalized for Covid-19 if the admission diagnosis suggested a Covid-19–related illness.
T81 9639-9659 Sentence denotes Statistical Analysis
T82 9660-9761 Sentence denotes Data collation and analysis were performed with the use of SAS software, version 9.4 (SAS Institute).
T83 9762-9974 Sentence denotes Baseline characteristics among crew members who were infected and those who were not infected were compared and univariate odds ratios with 95% confidence intervals were calculated with OpenEpi (www.openepi.com).
T84 9975-10041 Sentence denotes For denominators of less than 20, odds ratios were not calculated.
T85 10042-10109 Sentence denotes All reported odds ratios are not adjusted for multiple comparisons.
T86 10111-10118 Sentence denotes Results
T87 10120-10144 Sentence denotes Timeline of the Outbreak
T88 10145-10260 Sentence denotes Between March 23 and May 18, 2020, a total of 1271 crew members (26.6% of the crew) tested positive for SARS-CoV-2.
T89 10261-10325 Sentence denotes An additional 60 crew members had suspected Covid-19 (Figure 1).
T90 10326-10602 Sentence denotes Of the 1271 crew members with laboratory-confirmed Covid-19, 572 (43.0%) remained asymptomatic throughout the outbreak, 293 (22.0%) were symptomatic at the time that they tested positive, and an additional 406 (30.5%) were presymptomatic at the time that they tested positive.
T91 10603-10820 Sentence denotes In all, 978 (76.9%) of the 1271 crew members with laboratory-confirmed Covid-19 did not have symptoms at the time that they tested positive, and 699 (55.0%) had symptoms develop at any time during the clinical course.
T92 10821-10953 Sentence denotes Testing for influenza-like illnesses had been conducted on a limited number of specimens before and after the start of the outbreak.
T93 10954-11212 Sentence denotes Testing of specimens obtained from 5 crew members during the week before the outbreak identified 3 crew members who were positive for human rhinovirus or enterovirus, 1 who was positive for respiratory syncytial virus (RSV), and 1 with no pathogens detected.
T94 11213-11303 Sentence denotes After the outbreak was identified on March 23, specimens from 16 crew members were tested:
T95 11304-11523 Sentence denotes 10 crew members had no pathogens detected, 3 were positive for human rhinovirus or enterovirus, 2 were positive for coronavirus OC43 (not SARS-CoV-2), and 1 was positive for both human rhinovirus or enterovirus and RSV.
T96 11524-11573 Sentence denotes The outbreak epidemic curve is shown in Figure 2.
T97 11574-11764 Sentence denotes In retrospect, crew members with symptomatic confirmed or suspected Covid-19 had symptoms as early as March 11, 2020, and continued to receive diagnoses up to the end of the analysis period.
T98 11765-11860 Sentence denotes Epidemic curves according to sex and crew type show parallel infection rates for men and women.
T99 11861-11971 Sentence denotes Although the ship docked in Guam on March 27, 2020, the outbreak continued for at least an additional 6 weeks.
T100 11973-12008 Sentence denotes Characteristics of the Crew Members
T101 12009-12120 Sentence denotes The crew was predominantly young (mean age, 27 years) and male (78.3%) and was racially and ethnically diverse.
T102 12121-12209 Sentence denotes At the time of deployment, all crew members were in general good health and met the U.S.
T103 12210-12238 Sentence denotes Navy standards for sea duty.
T104 12239-12354 Sentence denotes Ultimately, Covid-19 cases were evenly distributed across sexes, races and ethnic groups, and crew types (Table 1).
T105 12355-12483 Sentence denotes Enlisted personnel (90% of the shipboard population) appeared more likely than officers to have confirmed or suspected Covid-19.
T106 12484-12539 Sentence denotes Data were analyzed to identify higher-risk work spaces.
T107 12540-12793 Sentence denotes Those working in tighter spaces (e.g., reactor, engineering, supply, and weapons departments) appeared more likely to have confirmed or suspected Covid-19 than those working in a combination of open-air and confined conditions (e.g., air and deck crew).
T108 12794-13087 Sentence denotes Members of the medical department, who wore personal protective equipment when evaluating crew members, had a somewhat lower attack rate (16.7% [8 cases among 48 personnel) than the overall crew, despite being at highest risk as a result of exposure to patients with Covid-19 in a small space.
T109 13089-13106 Sentence denotes Symptoms and Care
T110 13107-13398 Sentence denotes Among the crew members who had symptomatic Covid-19 (confirmed or suspected), headache was the most common symptom reported at any point during illness (occurring in 68.0%), followed by cough (59.5%), nasal or sinus congestion (43.8%), and altered sense of taste or smell (42.3%) (Figure 3).
T111 13399-13539 Sentence denotes The predominant symptoms reported at the onset of illness were cough (32.8%), headache (31.0%), and altered sense of taste or smell (24.1%).
T112 13540-13722 Sentence denotes Shortness of breath at any point during illness was reported by 20.3% of the crew members with symptomatic cases, and 7.0% noted shortness of breath as an initial presenting symptom.
T113 13723-13861 Sentence denotes In addition, 26.2% of the crew members with symptomatic Covid-19 reported chest pain or chest pressure at some point during their illness.
T114 13862-14029 Sentence denotes Fever was reported as an initial presenting symptom by 5.3% of the crew members with symptomatic Covid-19, and fever at any point during illness was reported by 13.2%.
T115 14030-14230 Sentence denotes Measured temperature readings showed that 2.8% of the crew members who had Covid-19 had a recorded temperature of 100.0°F or above, as compared with 0.3% of the crew members who did not have Covid-19.
T116 14231-14424 Sentence denotes Among the crew members with Covid-19 for whom pulse oximetry data were available, approximately 0.5% had readings below 95% while breathing ambient air, with 0.08% below 94% and none below 90%.
T117 14425-14601 Sentence denotes Of the 1271 crew members who tested positive for SARS-CoV-2 plus the 60 who had suspected Covid-19, 23 (1.7%) received hospital care, for a mean of 16 days after symptom onset.
T118 14602-14792 Sentence denotes Four crew members (0.3% of those with suspected or laboratory-confirmed Covid-19) were admitted to the intensive care unit, 1 of whom died from Covid-19–related cardiovascular complications.
T119 14793-14965 Sentence denotes Before hospitalization, crew members with Covid-19 who became hospitalized were more likely to report cough (68%), body aches (58%), and fever (32%) than those who did not.
T120 14966-15113 Sentence denotes One third of hospitalized patients reported fever before their hospitalization, as compared with 12% of nonhospitalized crew members with Covid-19.
T121 15114-15263 Sentence denotes During the outbreak, as a precautionary measure, admission criteria were revised to permit hospitalization of crew members with less severe symptoms.
T122 15265-15275 Sentence denotes Discussion
T123 15276-15420 Sentence denotes The epidemiology of SARS-CoV-2 infection in young, healthy populations has not been studied extensively.2 The outbreak of Covid-19 on the U.S.S.
T124 15421-15552 Sentence denotes Theodore Roosevelt provided an unusual opportunity to assess an outbreak in a predominantly young, healthy, working-age population.
T125 15553-15665 Sentence denotes Approximately 69% of crew members were younger than 30 years of age, and no crew member was older than 65 years.
T126 15666-15711 Sentence denotes All were up to date with their immunizations.
T127 15712-15783 Sentence denotes Over the course of the outbreak and the subsequent response by the U.S.
T128 15784-15853 Sentence denotes Navy, every crew member underwent evaluation, testing, and follow-up.
T129 15854-15956 Sentence denotes This level of controlled evaluation and documentation is difficult to achieve in civilian populations.
T130 15957-16445 Sentence denotes On ships at sea, respiratory viruses such as influenza and enteric pathogens such as norovirus can spread quickly.3,4 In the early weeks of the pandemic, several outbreaks of Covid-19 occurred on cruise ships, most notably on the Diamond Princess.5,6 The medical department of a ship can be overwhelmed quickly by a major outbreak of disease, as is similarly seen with health care facilities in civilian communities.7 The shipboard environment on naval vessels is generally more confined.
T131 16446-16645 Sentence denotes Typically, enlisted crew members sleep in open bays packed with dozens of tightly spaced bunks, work in densely populated areas, and congregate in gathering points such as the gyms and galleys (Figs.
T132 16646-16745 Sentence denotes S1 and S2 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
T133 16746-16924 Sentence denotes These conditions probably facilitated the transmission of SARS-CoV-2, as evidenced by the higher likelihood of Covid-19 among enlisted crew members than among officers (Table 1).
T134 16925-17087 Sentence denotes Not surprisingly, crew members working in the engine room and other confined areas of the ship faced a higher risk of being infected than their shipmates on deck.
T135 17088-17199 Sentence denotes A study conducted by the Navy and Marine Corps Public Health Center and the CDC, involving 384 volunteer U.S.S.
T136 17200-17449 Sentence denotes Theodore Roosevelt crew members, showed similar results: those working in confined spaces had higher odds of contracting Covid-19.8 A majority of infected crew members did not note symptoms at the time that Covid-19 was diagnosed by rRT-PCR testing.
T137 17450-17831 Sentence denotes In addition, crew members with unusual or atypical symptoms may not have considered themselves to be infected with SARS-CoV-2.9 These observations suggest that nonsymptomatic or mildly symptomatic crew members played an important role in the rapid spread of the outbreak, much as young adults with asymptomatic infection appear to contribute to spread in civilian populations.10,11
T138 17832-17999 Sentence denotes Although cases of serious illness occur in younger persons, they are less frequent and typically less severe than those in older persons.9,11 In the case of the U.S.S.
T139 18000-18055 Sentence denotes Theodore Roosevelt, few crew members were hospitalized.
T140 18056-18413 Sentence denotes Certain coexisting conditions, such as hypertension, obesity, and diabetes, are associated with higher mortality.12-14 In our findings, we noted a number of coexisting conditions among hospitalized crew members, including uncomplicated, mild, and medically managed asthma, lung disease (e.g., bronchitis), hypertension, and liver disease–related conditions.
T141 18414-18608 Sentence denotes Although we were able to confirm the outcomes in all infected crew members, data collection was limited by the quality of records, particularly those generated in the early days of the outbreak.
T142 18609-18745 Sentence denotes Future studies involving longitudinal cohorts may provide greater insight into the epidemiology of SARS-CoV-2 infection in young adults.
T143 18746-18836 Sentence denotes Our observations within a military population may not be fully generalizable to civilians.
T144 18837-19038 Sentence denotes The CDC case definition for Covid-19, along with clinical criteria, changed over time (e.g., the outbreak began in March 2020, and the CDC-published case definition for Covid-19 changed in April 2020).
T145 19039-19154 Sentence denotes Multiplex testing by polymerase chain reaction identified other causes of influenza-like illness on board the ship.
T146 19155-19345 Sentence denotes Any effect that the case definition or other respiratory pathogens may have had on classifying a case of Covid-19 is limited, because the majority of cases were confirmed by rRT-PCR testing.
T147 19346-19377 Sentence denotes Finally, the crew of the U.S.S.
T148 19378-19477 Sentence denotes Theodore Roosevelt, like all members of the U.S. military forces, have equal access to health care.
T149 19478-19534 Sentence denotes This is not true for all civilians in the United States.
T150 19535-19573 Sentence denotes Since this outbreak occurred, the U.S.
T151 19574-19661 Sentence denotes Navy has incorporated lessons learned to enhance the safety and readiness of its crews.
T152 19662-19851 Sentence denotes To minimize the risk of deploying with asymptomatic carriers of SARS-CoV-2 on board, the Navy has initiated several procedures to create and sustain Covid-19–free environments on its ships.
T153 19852-19990 Sentence denotes Before deployment, all members of a ship’s crew are placed in “restriction of movement” and insulated from community exposure for 14 days.
T154 19991-20126 Sentence denotes To identify asymptomatic or presymptomatic carriers, the Navy added rRT-PCR testing at the end of the “restriction of movement” period.
T155 20127-20246 Sentence denotes Navy ships have sharply reduced shore leaves at foreign ports to prevent crew members from bringing the virus on board.
T156 20247-20538 Sentence denotes Since these policies (along with preventive measures of mask use, social distancing to the extent possible, small-group cohorting, strict hand hygiene, and regular cleaning of common spaces) were put in place, the Navy has deployed multiple ships without sustaining another serious outbreak.
T157 20539-20768 Sentence denotes The concept of creating virus-free “bubbles” is a strategy the Navy has used and has been mirrored by the National Basketball Association and Major League Soccer to enable competition while minimizing the risk of player exposure.
T158 20769-20947 Sentence denotes It is unlikely that this strategy is practical for all employers, much less the general population; however, creating bubbles or cohorts for select populations may be achievable.
T159 20948-21240 Sentence denotes Organizations seeking to safeguard their employees, customers, patients, or students may benefit from assuming that Covid-19 will be introduced into their populations and rigorously enforcing measures to minimize viral transmission by all, since persons may be unaware that they are infected.
T160 21242-21344 Sentence denotes Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
T161 21346-21360 Sentence denotes We thank Capt.
T162 21361-21406 Sentence denotes Ron Schoonover (3rd Medical Battalion), Capt.
T163 21407-21427 Sentence denotes Maria Young and Cdr.
T164 21428-21471 Sentence denotes Jackie McDowell (Naval Hospital Guam), Col.
T165 21472-21499 Sentence denotes William O’Connell (Brian D.
T166 21500-21720 Sentence denotes Allgood Army Community Hospital), Mr. Donald Brown (Vice President, Maritime Policy with Cruise Lines International Association), Ms. Beth Poitras and Ms. Jessica Newton (Navy and Marine Corps Public Health Center), Cdr.
T167 21721-21854 Sentence denotes Brian Legendre (Navy Environmental Preventive Medicine Unit 5), and all of those not listed who have responded to this outbreak; Col.
T168 21855-22135 Sentence denotes James Mancuso (Uniformed Services University of the Health Sciences) and Dr. Art Kellermann (Dean of the School of Medicine at the Uniformed Services University of the Health Sciences), for editorial assistance with an earlier version of the manuscript; and the crew of the U.S.S.
T169 22136-22288 Sentence denotes Theodore Roosevelt, who despite this unprecedented outbreak, demonstrated resilience in returning to sea and to their mission of protecting our country.
T170 22290-22523 Sentence denotes The views expressed in this article reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. government.
T171 22524-22585 Sentence denotes This article was published on November 11, 2020, at NEJM.org.
T172 22587-22609 Sentence denotes Supplementary Appendix
T173 22610-22646 Sentence denotes Click here for additional data file.
T174 22648-22664 Sentence denotes Disclosure Forms
T175 22665-22701 Sentence denotes Click here for additional data file.
T176 22703-22764 Sentence denotes Figure 1 Distribution of Personnel According to Case Status.
T177 22765-23019 Sentence denotes A confirmed case of coronavirus disease 2019 (Covid-19) was defined as one in which a nasopharyngeal swab specimen was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse-transcriptase polymerase chain reaction.
T178 23020-23176 Sentence denotes A suspected case was defined as one that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result.
T179 23177-23462 Sentence denotes Confirmed cases were further classified as symptomatic (with symptom onset before the first positive laboratory test), presymptomatic (with the first positive laboratory test before subsequent symptom onset), and asymptomatic (positive laboratory test but clinical criteria never met).
T180 23463-23544 Sentence denotes Figure 2 Numbers of Symptomatic Confirmed or Suspected Covid-19 Cases over Time.
T181 23545-23650 Sentence denotes Personnel, supplies, and mail are delivered to an aircraft carrier during carrier onboard delivery (COD).
T182 23651-23749 Sentence denotes Figure 3 Distribution of Symptomatic Confirmed or Suspected Covid-19 Cases According to Symptoms.
T183 23750-23844 Sentence denotes Table 1 Demographic and Health Characteristics of Crew Members According to Covid-19 Status.*
T184 23845-23934 Sentence denotes Characteristic Covid-19 Status Univariate Odds Ratio, Covid-19 vs. No Covid-19 (95% CI)
T185 23935-24032 Sentence denotes No Covid-19(N=3448) Confirmed or Suspected Covid-19 (N=1331) Hospitalization for Covid-19(N=23)
T186 24033-24060 Sentence denotes Demographic characteristics
T187 24061-24069 Sentence denotes Age — yr
T188 24070-24095 Sentence denotes Mean 27.2 27.1 29.3 —
T189 24096-24125 Sentence denotes Range 18–59 18–53 20–46 —
T190 24126-24169 Sentence denotes Interquartile range 22–32 22–31 23–34 —
T191 24170-24183 Sentence denotes Sex — no. (%)
T192 24184-24242 Sentence denotes Female 757 (22.0) 289 (21.7) 6 (26.1) 0.99 (0.85–1.15)
T193 24243-24295 Sentence denotes Male 2691 (78.0) 1042 (78.3) 17 (73.9) Reference
T194 24296-24307 Sentence denotes Rank status
T195 24308-24372 Sentence denotes Enlisted 3080 (89.3) 1231 (92.5) 23 (100.0) 1.48 (1.17–1.87)
T196 24373-24416 Sentence denotes Officer 363 (10.5) 98 (7.4) 0 Reference
T197 24417-24448 Sentence denotes Unknown 5 (0.1) 2 (0.2) 0 —
T198 24449-24480 Sentence denotes Race or ethnic group — no. (%)†
T199 24481-24543 Sentence denotes American Indian 75 (2.2) 34 (2.6) 1 (4.3) 1.21 (0.80–1.83)
T200 24544-24619 Sentence denotes Asian or Pacific Islander 327 (9.5) 106 (8.0) 4 (17.4) 0.86 (0.68–1.10)
T201 24620-24677 Sentence denotes Black 590 (17.1) 261 (19.6) 3 (13.0) 1.18 (0.99–1.40)
T202 24678-24738 Sentence denotes Hispanic 692 (20.1) 273 (20.5) 5 (21.7) 1.05 (0.89–1.25)
T203 24739-24790 Sentence denotes White 1513 (43.9) 568 (42.7) 7 (30.4) Reference
T204 24791-24845 Sentence denotes Other 250 (7.3) 88 (6.6) 3 (13.0) 0.94 (0.72–1.22)
T205 24846-24856 Sentence denotes Crew type‡
T206 24857-24915 Sentence denotes Ship’s crew 2086 (60.5) 786 (59.1) 13 (56.5) Reference
T207 24916-24983 Sentence denotes Augmented crew 1288 (37.4) 501 (37.6) 9 (39.1) 1.03 (0.90–1.18)
T208 24984-25038 Sentence denotes Unknown 74 (2.1) 44 (3.3) 1 (4.3) 1.58 (1.08–2.31)
T209 25039-25075 Sentence denotes Select work centers and departments§
T210 25076-25115 Sentence denotes Air 394 (11.4) 65 (4.9) — Reference
T211 25116-25181 Sentence denotes Combat support division 164 (4.8) 38 (2.9) — 0.88 (0.58–1.33)
T212 25182-25226 Sentence denotes Deck 82 (2.4) 4 (0.3) — 0.18 (0.07–0.52)
T213 25227-25280 Sentence denotes Engineering 137 (4.0) 67 (5.0) — 1.85 (1.29–2.67)
T214 25281-25328 Sentence denotes Medical 40 (1.2) 8 (0.6) — 0.76 (0.34–1.67)
T215 25329-25380 Sentence denotes Reactor 302 (8.8) 138 (10.4) — 1.73 (1.29–2.36)
T216 25381-25431 Sentence denotes Supply 219 (6.4) 139 (10.4) — 2.41 (1.78–3.26)
T217 25432-25481 Sentence denotes Weapons 132 (3.8) 94 (7.1) — 2.70 (1.92–3.80)
T218 25482-25504 Sentence denotes Health characteristics
T219 25505-25582 Sentence denotes Tobacco or nicotine user 1002 (29.1) 382 (28.7) 8 (34.8) 0.98 (0.85–1.13)
T220 25583-25599 Sentence denotes Most recent BMI¶
T221 25600-25667 Sentence denotes Underweight or normal 1135 (32.9) 389 (29.2) 9 (39.1) Reference
T222 25668-25731 Sentence denotes Overweight 1450 (42.1) 570 (42.8) 6 (26.1) 1.15 (0.99–1.33)
T223 25732-25789 Sentence denotes Obese 584 (16.9) 267 (20.1) 8 (34.8) 1.33 (1.11–1.61)
T224 25790-25840 Sentence denotes Unknown 279 (8.1) 105 (7.9) 0 1.10 (0.85–1.41)
T225 25841-25882 Sentence denotes Preidentified health factors of interest‖
T226 25883-25938 Sentence denotes Asthma 236 (6.8) 95 (7.1) 5 (21.7) 1.05 (0.82–1.34)
T227 25939-25986 Sentence denotes Cancer 35 (1.0) 10 (0.8) 0 0.74 (0.36–1.50)
T228 25987-26029 Sentence denotes Cerebrovascular diseases 2 (0.1) 0 0 —
T229 26030-26097 Sentence denotes Chronic lung disease 30 (0.9) 11 (0.8) 2 (8.7) 0.95 (0.47–1.90)
T230 26098-26146 Sentence denotes Diabetes 12 (0.3) 4 (0.3) 0 0.86 (0.28–2.68)
T231 26147-26208 Sentence denotes Hypertension 226 (6.6) 96 (7.2) 5 (21.7) 1.11 (0.87–1.42)
T232 26209-26243 Sentence denotes Immunocompromise 3 (0.1) 0 0 —
T233 26244-26303 Sentence denotes Liver disease 20 (0.6) 8 (0.6) 2 (8.7) 1.04 (0.46–2.36)
T234 26304-26363 Sentence denotes Sleep apnea 135 (3.9) 50 (3.8) 2 (8.7) 0.96 (0.69–1.33)
T235 26364-26416 Sentence denotes Tuberculosis 20 (0.6) 6 (0.5) 0 0.78 (0.31–1.94)
T236 26417-26470 Sentence denotes * Percentages may not total 100 because of rounding.
T237 26471-26513 Sentence denotes Covid-19 denotes coronavirus disease 2019.
T238 26514-26633 Sentence denotes † The Defense Enrollment Eligibility Reporting System was used to identify race and ethnic group for all crew members.
T239 26634-26856 Sentence denotes ‡ Augmented crew reside on the ship only at certain times when a ship is under way and provide specialized capability such as air squadrons, submarine groups, destroyer squadrons, and helicopter maritime strike squadrons.
T240 26857-27048 Sentence denotes § Crew members in the departments of reactor, engineering, supply, weapons and in the combat support division tend to work in more confined spaces than those in the air and deck departments.
T241 27049-27160 Sentence denotes Crew members in the air and deck departments tend to work in a combination of open-air and confined conditions.
T242 27161-27271 Sentence denotes Medical personnel work in confined spaces but wear personal protective equipment when caring for crew members.
T243 27272-27506 Sentence denotes ¶ Underweight was defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of less than 18.5; normal or healthy weight, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30 or higher.
T244 27507-27625 Sentence denotes ‖ Conditions were identified from October 1, 2017, through March 1, 2020, with the use of the following data sources:
T245 27626-27917 Sentence denotes Theater Medical Data Store, Comprehensive Ambulatory/Professional Encounter Record, Standard Inpatient Data Record, Armed Forces Health Longitudinal Technology Application Clinical Data Repository, Military Health System (MHS) GENESIS, TRICARE Encounter Data, and Periodic Health Assessment.