Association of E484K and L452R spike protein mutations with SARS-CoV-2 infection in vaccinated persons---Maryland, January - May 2021

Background. The E484K and L452R amino acid substitutions on the spike protein of SARS-CoV-2 are associated with reduced neutralization by antibodies from acquired immunity. This study examines the respective association of these mutations with infection in persons who had previously received a COVID-19 vaccine. Methods. Genetic sequences from SARS-CoV-2 specimens collected from Maryland residents and reported to Maryland Department of Health were linked to vaccination history. The prevalence of infections in fully vaccinated persons -- defined as being at least two weeks past receiving the final scheduled dose of a COVID-19 vaccine series -- was compared between infections caused by viruses carrying E484K to those not carrying E484K, and between infections caused by viruses carrying L452R to those not carrying L452R, using logistic regression to adjust for confounding. Results. Of 9,048 sequenced SARS-CoV-2 specimens examined, 265 (2.9%) were collected from fully vaccinated persons. In adjusted analysis, the E484K substitution was associated with an increase in the odds of the sequenced specimen being collected from a fully vaccinated person (OR 1.96, 95% CI, 1.36 to 2.83). The L452R mutation was not significantly associated with infections in vaccinated persons (OR 1.07, 95% CI, 0.69 to 1.68). Conclusion. Though more than 97% of SARS-CoV-2 infections were in persons who were not fully vaccinated, the E484K mutation was associated with increased odds of SARS-CoV-2 infection in vaccinated persons. Linking vaccination and sequencing data can help identify and estimate the impact SARS-CoV-2 mutations may have on vaccine effectiveness.

Improving Healthcare Access Among the Newly Decarcerated

The American opioid crisis has disproportionately affected our incarcerated population. Approximately two-thirds of inmates nationwide struggle with substance use disorders (Maryland Department of Health 2018; Cohn 2019). Though some receive treatment during incarceration, about 60% leave prison uninsured (Maryland Department of Health 2018). Without insurance, continuing treatment becomes improbable, significantly increasing the risk of overdosing in the two weeks following decarceration (Binswanger et al. 2007). The State of Maryland has addressed this problem by expanding Medicaid coverage under the Affordable Care Act in 2014. Today, an estimated 90% of Maryland prisoners qualify for Medicaid upon release (Hancock 2016). Despite Medicaid expansion and other measures, including a 2016 presumptive eligibility policy, most inmates still leave prison unable to access the healthcare for which they qualify (Cohn 2019). This memorandum highlights policy options that ensure eligible inmates leave with unencumbered access to healthcare. We recommend using Presumptive Eligibility to enroll all qualified inmates, which prevents a coverage lapse immediately following release, with implementation of full coverage for all state correctional facilities as the long-term goal.

Certain Characteristics of Unlicensed Tree Expert Companies Advertising in Maryland, U.S.

In 2005, Maryland’s tree expert licensing law, initially enacted in 1945, was amended to include tree removal as an activity requiring a tree expert license. The Maryland Department of Natural Resources (MD DNR) sought to identify and communicate with the potentially affected community regarding the pending changes in the law by a number of means, including a search of companies advertising tree services in Maryland by online phone listings. The majority of firms (69.91%) found to be advertising tree services online were unlicensed tree experts (UnLTEs). A significant number of those UnLTEs (40%) did not provide full contact information, including a street address, and no current address was available for over 25% of them. Only 21 of the UnLTEs studied had ever been the subject of a complaint to MD DNR and those firms accounted for only 18.2% of complaints MD DNR received regarding UnLTEs during a 10 year period. UnLTEs were found in approximately equal measure in one of three business types: incorporated, unincorporated, or unknown (sole proprietorships, general partnerships, or noncompliant). UnLTEs are fairly ubiquitous in small numbers across Maryland with the largest concentrations found close to the borders of adjacent states, in the northeast metropolitan area of Maryland’s largest city (Baltimore), and around the state capital (Annapolis).

Data Watch: Research Data from Transition Economies

This section will offer a description of data sources that may be of interest to economists. The purpose is to describe what data are available from those sources, what questions can be addressed because of the unique features of the data, and how an interested reader can gain access to the data. Suggestions for data sources that might be discussed here (or comments on past columns) can be sent to William N. Evans, c/o Data Watch, University of Maryland, Department of Economics, College Park, Maryland 20742, or they can be e-mailed to 〈 [email protected] 〉.