key: cord-1038179-a71i3yjx
authors: Paradis, Heather; Katrichis, Julie; Stevenson, Michael; Tomaro, Nicholas; Mukai, Rachel; Torres, Griselle; Bhattacharyya, Sanjib; Kowalik, Jeanette; Schlanger, Karen; Leidman, Eva
title: Notes from the Field: Public Health Efforts to Mitigate COVID-19 Transmission During the April 7, 2020, Election ― City of Milwaukee, Wisconsin, March 13–May 5, 2020
date: 2020-07-31
journal: MMWR Morb Mortal Wkly Rep
DOI: 10.15585/mmwr.mm6930a4
sha: ee1eb1ed8214c809c4e46c334c75ab03894d6aeb
doc_id: 1038179
cord_uid: a71i3yjx

nan

* https://content.govdelivery.com/attachments/WIGOV/2020/03/24/file_ attachments/1409408/Health%20Order%20%2312%20Safer%20At%20 Home.pdf. † https://elections.wi.gov/clerks/svrs. § https://www.jsonline.com/story/news/politics/elections/2020/04/07/ wisconsin-election-milwaukee-voters-brave-long-wait-lines-polls/2962228001/. decreased 43%, from 168,281 to 95,168, and the number of polling sites decreased from 181 to five.

Laboratory-confirmed COVID-19 cases and epidemiologic data were used to characterize SARS-CoV-2 transmission from March 13, when the first case was confirmed in Milwaukee, through May 5, or 4 weeks following the election. Case counts, hospitalizations, and exposure data (including voting method ascertained using a standardized voting module) were obtained from the Wisconsin Electronic Disease Surveillance System (WEDSS). ¶ Cases were reported by date of specimen collection or report if unavailable. Fatality data were obtained from the Milwaukee County Medical Examiner.

An estimated 95% of persons with COVID-19 develop symptoms within 2-14 days after exposure (2-4); therefore, persons infected at polls would be expected to develop symptoms during April 9-21. Among 2,789 COVID-19 cases, 642 related hospitalizations, and 137 COVID-19-associated deaths reported during March 13-May 5, 572 (21%) cases were reported during this expected incubation period (i.e., April 9-21) ( Figure) , compared with 693 (28%) cases reported during the 13 days preceding this incubation period (i.e., March 27-April 8). Among the 572 cases reported during April 9-21, 316 (55.2%) patients did not report their voting status, and 219 (38.3%) did not vote; 37 (6.5%) reported voting. Among these 37 COVID-19 patients who voted, 17 (45.9%) reported voting using an absentee mail-in ballot, 14 (37.8%) voted in person, and six (16.2%) voted curbside. During April 17-26 (the estimated interquartile range of the interval from illness onset to death for a person infected on election day), 24 deaths were reported, 33% fewer than the 36 deaths reported during the preceding 10 days (April 7-16) (Figure) Abbreviation: COVID-19 = coronavirus disease 2019. * Based on available evidence, for a person exposed to SARS-CoV-2 on election day, the estimated incubation period (2-14 days) was April 9-21; the estimated median interval from illness onset to death was estimated to be 10 days (corresponding with April 21).

These data provide preliminary evidence that CDC's interim guidance for ensuring various voting options, encouraging physical distancing, personal prevention practices, and employing environmental cleaning and disinfection lower COVID-19 transmission risk during elections (1). Further risk reduction can be achieved by fully implementing CDC interim guidance, which recommends longer voting periods, and other options such as increasing the number of polling locations to reduce the number of voters who congregate indoors in polling locations.

Corresponding author: Eva Leidman, eleidman@cdc.gov.

Considerations for election polling locations and voters: interim guidance to prevent spread of coronavirus disease (COVID-19)

The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application

Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19)

Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: a statistical analysis of publicly available case data

Characteristics of persons who died with COVID-19-United States

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.