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Chen AS, Brown M, Arekelyan A, Wennemann S, Shamie N, Holly L, Liu JC, Wang JC, Buser Z. A Tale of Two Institutions: COVID-19 Positive Rates in Asymptomatic Patients Pre-Screened for Spine Procedures and Surgeries in Los Angeles, California. Global Spine J 2023; 13:1865-1870. [PMID: 34870486 PMCID: PMC10556893 DOI: 10.1177/21925682211057489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The coronavirus disease (COVID-19), caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an unprecedented global public health emergency. The aim of the current study was to report on COVID-19 rates in an asymptomatic population prior to undergoing spine procedures or surgeries at two large Los Angeles healthcare systems. METHODS Elective spine procedures and surgeries from May 1, 2020 to January 31, 2021 were included. Results from SARS-CoV-2 virus RT-PCR nasopharyngeal testing within 72 hours prior to elective spine procedures were recorded. Los Angeles County COVID-19 rates were calculated using data sets from Los Angeles County Department of Public Health. Chi-squared test and Stata/IC were used for statistical analysis. RESULTS A total of 4,062 spine procedures and surgeries were scheduled during this time period. Of these, 4,043 procedures and surgeries were performed, with a total of 19 patients testing positive. Nine positive patients were from UCLA, and 10 from USC. The overall rate of positive tests was low at .47% and reflected similarities with Los Angeles County COVID-19 rates over time. CONCLUSIONS The current study shows that pre-procedure COVID-19 testing rates remains very low, and follows similar patterns of community rates. While pre-procedure testing increases the safety of elective procedures, universal COVID-19 pre-screening adds an additional barrier to receiving care for patients and increases cost of delivering care. A combination of pre-screening, pre-procedure self-quarantine, and consideration of overall community COVID-19 positivity rates should be further studied.
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Affiliation(s)
- Allen S. Chen
- Department of Orthopaedic Surgery, UCLA Spine Center, Santa Monica, CA, USA
| | - Matthew Brown
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anush Arekelyan
- Department of Neurological Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Sophie Wennemann
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern CaliforniaLos Angeles, CA, USA
| | - Nick Shamie
- Department of Orthopaedic Surgery, UCLA Spine Center, Santa Monica, CA, USA
| | - Langston Holly
- Department of Neurological Surgery, UCLA Spine Center, Santa Monica, CA, USA
| | - John C. Liu
- Department of Neurological Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern CaliforniaLos Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern CaliforniaLos Angeles, CA, USA
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Panameno M, Blanco LR, Hernandez AM, Escobar R, Zendejas B, Rafaela S, Castellon-Lopez YM. Using Digital Technology to Build COVID-19 Vaccine Confidence: A Qualitative Study among Latinx Parents of Children Aged 5-11 in Under-Resourced Communities across Los Angeles County. Vaccines (Basel) 2023; 11:1042. [PMID: 37376431 DOI: 10.3390/vaccines11061042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Latinx school-aged children are more than twice as likely to be infected with and die from COVID-19 as non-Latinx White children in Los Angeles. Although COVID-19 vaccination has the potential to mitigate health disparities exacerbated by the pandemic, vaccination uptake among Latinx children remains limited. MiVacunaLA (MVLA) is a mobile-phone-delivered digital intervention that improved vaccination rates in 12- to 17-year-old Latinx children and parental intention to vaccinate 2- to 11-year-old children. Since piloting MVLA, the COVID-19 vaccine became available to children aged 5-11. We sought to understand parental experiences with the MVLA intervention and their attitudes and beliefs about vaccinating their young children to improve vaccination confidence in the Latinx community. Methods: We conducted six virtual focus groups with 47 parents/caregivers of children aged 5-11 who participated in the MVLA intervention. We used standard qualitative content analysis methods and rigid and accelerated data reduction to identify and analyze major themes discussed in the sessions. Results: Each salient theme from our focus groups was mapped to one of the 5Cs constructs. The themes included the parents' need for more contemplation about vaccinating their children than about vaccinating themselves; the parents' need for trusted sources of vaccine information; the parents' motivations to vaccinate their children against COVID-19; parental concern about short- and long-term effects of the vaccine in children; digital technology and videos as useful engagement tools; and age and health stratification as an approach to parental vaccination decision-making. Conclusions: The results of this study clarify the key factors that influence the decision of Latinx parents and caregivers to vaccinate their children against COVID-19. Our findings can inform efforts to increase COVID-19 vaccination rates among children in underserved Latinx communities, especially regarding the use of digital technologies for promoting vaccine confidence.
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Affiliation(s)
- Michael Panameno
- David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90069, USA
| | - Luisa R Blanco
- Pepperdine School of Public Policy, Pepperdine University, Malibu, CA 90069, USA
| | - Ann Marie Hernandez
- David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Renato Escobar
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Brittney Zendejas
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Susana Rafaela
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90069, USA
| | - Yelba M Castellon-Lopez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, PDC Green, G500, West Hollywood, CA 90069, USA
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Srinivasan V, Weinstein SE, Bhimani A, Clemons NC, Dinolfo M, Shin CS, Grier J, Lopez A, Braggs J, Boucher J, Batiste QN, Garner OB, Yang S, Vijayan T. On variants and vaccines: The effectiveness of Covid-19 monoclonal antibody therapy during two distinct periods in the pandemic. PLoS One 2022; 17:e0278394. [PMID: 36454767 PMCID: PMC9714735 DOI: 10.1371/journal.pone.0278394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While Covid-19 monoclonal antibody therapies (Mab) have been available in the outpatient setting for over a year and a half, little is known about the impact of emerging variants and vaccinations on the effectiveness of Mab therapies. We sought to determine the effectiveness of Covid-19 Mab therapies during the first two waves of the pandemic in Los Angeles County and assess the impact of vaccines, variants, and other confounding factors. METHODS AND FINDINGS We retrospectively examined records for 2209 patients of with confirmed positive molecular SARS-CoV2 test either referred for outpatient Mab therapy or receiving Mab treatment in the emergency department (ED) between December 2020 and 2021. Our primary outcome was the combined 30-day incidence of ED visit, hospitalization, or death following the date of referral. Additionally, SARS-CoV2 isolates of hospitalized patients receiving Mabs were sequenced. The primary outcome was significantly reduced with combination therapy compared to bamlanivimab or no treatment (aHR 0·60; 95% CI ·37, ·99), with greater benefit in unvaccinated, moderate-to-high-risk patients (aHR ·39; 95% CI ·20, ·77). Significant associations with the primary outcome included history of lung disease (HR 7·13; 95% CI 5·12, 9·95), immunocompromised state (HR 6·59; 95% CI 2·91-14·94), and high social vulnerability (HR 2·29, 95% CI 1·56-3·36). Two predominant variants were noted during the period of observation: the Epsilon variant and the Delta variant. CONCLUSIONS Only select monoclonal antibody therapies significantly reduced ED visits, hospitalizations, and death due to COVID-19 during. Vaccination diminished effectiveness of Mabs. Variant data and vaccination status should be considered when assessing the benefit of novel COVID-19 treatments.
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Affiliation(s)
- Vinay Srinivasan
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Stacey E. Weinstein
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Azra Bhimani
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Nathan C. Clemons
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Melissa Dinolfo
- Ambulatory and Community Practices, UCLA Health, Los Angeles, California, United States of America
| | - Christina S. Shin
- Department of Pharmaceutical Services, Ronald Reagan UCLA Medical Center, Los Angeles, California, United States of America
| | - Jacqueline Grier
- Faculty Practice Group–Ambulatory Care Coordination, UCLA Health, Los Angeles, California, United States of America
| | - Antonio Lopez
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Jamia Braggs
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Joni Boucher
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Quanna N. Batiste
- Department of Ambulatory Nursing, UCLA Health, Los Angeles, California, United States of America
- School of Nursing, UCLA, Los Angeles, California, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Tara Vijayan
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
- * E-mail:
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Filosa JN, Botello-Mares A, Goodman-Meza D. COVID-19 needs no passport: the interrelationship of the COVID-19 pandemic along the U.S.-Mexico border. BMC Public Health 2022; 22:1081. [PMID: 35641957 PMCID: PMC9153860 DOI: 10.1186/s12889-022-13513-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the impact of the COVID-19 pandemic along the U.S.-Mexico border region and evaluate the relationship of COVID-19 related mortality, socioeconomic status, and vaccination. METHODS We used indirect standardization to age-adjust mortality rates and calculate standardized mortality ratios [SMR] in both countries. To examine the impact of socioeconomic factors, we calculated the Human Development Index (HDI) by county/municipality. We performed linear regression to understand the relationship between mortality, vaccination, and HDI. We used choropleth maps to visualize the trends seen in the region. RESULTS Between January 22nd, 2020 and December 1st, 2021, surges of cases and deaths were similar in dyad cities along the U.S.-Mexico border visualizing the interconnectedness of the region. Mortality was higher in U.S. counties along the border compared to the national average (SMR 1.17, 95% CI 1.15-1.19). In Mexico, border counties had a slightly lower mortality to the national average (SMR 0.94, 95% CI 0.93-0.95). In U.S. border states, SMR was shown to negatively correlate with human development index (HDI), a socioeconomic proxy, resulting in a higher SMR in the border region compared to the rest of the counties. Conversely in Mexican border states, there was no association between SMR and HDI. Related to vaccination, U.S. counties along the border were vaccinated at a greater percentage than non-border counties and vaccination was negatively correlated with HDI. In Mexico, states along the border had a higher ratio of vaccinations per person than non-border states. CONCLUSIONS The U.S.-Mexico border is a divide of incredible importance not only to immigration but as a region with unique social, economic, environmental, and epidemiological factors that impact disease transmission. We investigated how the COVID-19 pandemic followed trends of previously studied diseases in the corridor such as tuberculosis, HIV, and influenza H1N1. These data state how targeted intervention along the U.S.-Mexico border region is a necessity when confronting COVID-19 and have implications for future control of infectious diseases in the region.
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Affiliation(s)
- John N Filosa
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, Los Angeles, CA, 90095-1688, USA
| | - Adrian Botello-Mares
- Department of Population Studies, Colegio de la Frontera Norte, Sonora, Nogales, Mexico
| | - David Goodman-Meza
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, Los Angeles, CA, 90095-1688, USA. .,Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles (UCLA), CA, Los Angeles, USA.
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5
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Castellon-Lopez YM, Carson SL, Mansfield L, Garrison NA, Barron J, Morris D, Ntekume E, Vassar SD, Norris KC, Brown AF, Casillas A. "The System Doesn't Let Us in"-A Call for Inclusive COVID-19 Vaccine Outreach Rooted in Los Angeles Latinos' Experience of Pandemic Hardships and Inequities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5785. [PMID: 35627322 PMCID: PMC9141159 DOI: 10.3390/ijerph19105785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Latino adults in Los Angeles have experienced disproportionate cases, deaths, and socioeconomic impacts from the COVID-19 pandemic. This qualitative study aimed to explore community perspectives on readiness for COVID-19 vaccination and to identify culturally tailored vaccine outreach strategies. METHODS We conducted virtual focus groups with Los Angeles County Latino/a residents via Zoom between December 2020 to January 2021, as the first COVID-19 vaccines were receiving Emergency Use Authorization (EUA). Focus groups were facilitated in Spanish and English by bilingual members of the research team. Discussions were analyzed via Atlas.ti software using reflexive thematic analysis. RESULTS Three focus groups (n = 15; four to six people each; two Spanish focus groups; one English) were conducted. Thematic findings centered on Latino COVID-19 vaccine equity: (1) Disproportionate infection risk due to essential worker status and socioeconomic burdens, misinformation, and familial or cultural tensions (2) Concerns for inequitable vaccine access due to immigration fears and limited healthcare access, and (3) A need for community-centered COVID-19 vaccine outreach and access. CONCLUSIONS Our study on early Latino adult reactions to vaccine roll-out suggests the need for outreach strategies centering on validating community hardships, combating dis-/misinformation through trusted sources, and addressing socio-economic needs impacted by the pandemic.
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Affiliation(s)
- Yelba M. Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Lisa Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Nanibaa’ A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Stefanie D. Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
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Zheng M, Lui B, Komlan AGA, Bonaparte CR, White RS, Hoyler MM. Economic burden of lives lost due to COVID-19 in California State. J Comp Eff Res 2022; 11:489-498. [PMID: 35266408 PMCID: PMC8920028 DOI: 10.2217/cer-2021-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine the economic impact of lives lost due to the coronavirus pandemic across California and Los Angeles (LA) County. Patients & methods: Years of potential life lost (YPLL) and the value of statistical life (VSL) were calculated using mortality data from the California Department of Public Health, the LA County Department of Public Health and the Social Security Administration websites. Results: In California and LA County, the average YPLL per person were 14.3 and 14.7 and the VSLs were approximately US$219.9 billion and $82.7 billion, respectively. YPLL and VSL were greatest for Latinos aged 50-64. Conclusion: The economic burden of lives lost due to the coronavirus across California and LA County is substantial. Latinos aged 50-64 were most affected.
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Affiliation(s)
- Michelle Zheng
- Cornell University, College of Human Ecology, Martha Van Rensselaer Hall, Ithaca, NY 14850, USA
| | - Briana Lui
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Axell-Giovanni A Komlan
- University of Notre Dame, College of Science, Candidate for Bachelor of Science in Science Preprofessional Studies, Notre Dame, IN 46556, USA
| | - Christina R Bonaparte
- Brown University, Candidate for Bachelor of Arts in Public Health with Honors, Providence, RI 02912, USA
| | - Robert S White
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Marguerite M Hoyler
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, Box 124, New York, NY 10065, USA
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Mustanski B, Saber R, Ryan DT, Benbow N, Madkins K, Hayford C, Newcomb ME, Schrock JM, Vaught LA, Reiser NL, Velez MP, Hsieh RR, Demonbreun AR, D'Aquila R, McNally EM, McDade TW. Geographic disparities in COVID-19 case rates are not reflected in seropositivity rates using a neighborhood survey in Chicago. Ann Epidemiol 2022; 66:44-51. [PMID: 34728335 PMCID: PMC8557112 DOI: 10.1016/j.annepidem.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022]
Abstract
To date, COVID-19 case rates are disproportionately higher in Black and Latinx communities across the US, leading to more hospitalizations, and deaths in those communities. These differences in case rates are evident in comparisons of Chicago neighborhoods with differing race and/or ethnicities of their residents. Disparities could be due to neighborhoods with more adverse health outcomes associated with poverty and other social determinants of health experiencing higher prevalence of SARS-CoV-2 infection or due to greater morbidity and mortality resulting from equivalent SARS-CoV-2 infection prevalence. We surveyed five pairs of adjacent ZIP codes in Chicago with disparate COVID-19 case rates for highly specific and quantitative serologic evidence of any prior infection by SARS-CoV-2 to compare with their disparate COVID-19 case rates. Dried blood spot samples were self-collected at home by internet-recruited participants in summer 2020, shortly after Chicago's first wave of the COVID-19 pandemic. Pairs of neighboring ZIP codes with very different COVID-19 case rates had similar seropositivity rates for anti-SARS-CoV-2 receptor binding domain IgG antibodies. Overall, these findings of comparable exposure to SARS-CoV-2 across neighborhoods with very disparate COVID-19 case rates are consistent with social determinants of health, and the co-morbidities related to them, driving differences in COVID-19 rates across neighborhoods.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Daniel T Ryan
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Krystal Madkins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Christina Hayford
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua M Schrock
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Lauren A Vaught
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nina L Reiser
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew P Velez
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ryan R Hsieh
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexis R Demonbreun
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard D'Aquila
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Thomas W McDade
- Department of Anthropology, Northwestern University Weinberg College of Arts and Sciences, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston, IL
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Micronutrient Deficiency as a Confounder in Ascertaining the Role of Obesity in Severe COVID-19 Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031125. [PMID: 35162148 PMCID: PMC8834257 DOI: 10.3390/ijerph19031125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023]
Abstract
Food insecurity in the United States has been exacerbated due to the socioeconomic strain of the coronavirus disease 2019 (COVID-19) pandemic. Populations experiencing poverty and, as a consequence, food insecurity in the United States are disproportionately affected by obesity, which was identified early in the pandemic as a major risk factor for increased susceptibility to COVID-19 infection and mortality. Given the focus on obesity and its role in immune dysregulation, it is also important to note the role of micronutrient deficiency, another sequalae of food insecurity. Micronutrients play an important role in the ability of the immune system to mount an appropriate response. Moreover, OBESE individuals are more likely to be micronutrient deficient. This review will explore the role of micronutrients, vitamin A, vitamin D, vitamin C, and zinc in respiratory immunity and COVID-19 and how micronutrient deficiency may be a possible confounder in obesity’s association with severe outcomes. By illuminating the role of micronutrients in COVID-19, this paper expands the discussion from food insecurity and obesity to include micronutrient deficiency and how all of these interact in respiratory illnesses such as COVID-19.
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9
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Vijayan T. Raining in Los Angeles. BMJ 2022; 376:o113. [PMID: 35031589 DOI: 10.1136/bmj.o113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tara Vijayan
- Division of Infectious Diseases, University of California, Los Angeles
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10
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The Rising Prevalence of SARS-CoV-2 Infection May Not be Due to Young Adults. Pediatr Infect Dis J 2021; 40:e213-e214. [PMID: 33591081 DOI: 10.1097/inf.0000000000003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ong PM, Pech C, Gutierrez NR, Mays VM. COVID-19 Medical Vulnerability Indicators: A Predictive, Local Data Model for Equity in Public Health Decision Making. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4829. [PMID: 33946561 PMCID: PMC8124803 DOI: 10.3390/ijerph18094829] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
This article reports the outcome of a project to develop and assess a predictive model of vulnerability indicators for COVID-19 infection in Los Angeles County. Multiple data sources were used to construct four indicators for zip code tabulation areas: (1) pre-existing health condition, (2) barriers to accessing health care, (3) built environment risk, and (4) the CDC's social vulnerability. The assessment of the indicators finds that the most vulnerable neighborhoods are characterized by significant clustering of racial minorities. An overwhelming 73% of Blacks reside in the neighborhoods with the two highest levels of pre-existing health conditions. For the barriers to accessing health care indicator, 40% of Latinx reside in the highest vulnerability places. The built environment indicator finds that selected Asian ethnic groups (63%), Latinx (55%), and Blacks (53%) reside in the neighborhoods designated as high or the highest vulnerability. The social vulnerability indicator finds 42% of Blacks and Latinx and 38% of selected Asian ethnic group residing in neighborhoods of high vulnerability. The vulnerability indicators can be adopted nationally to respond to COVID-19. The metrics can be utilized in data-driven decision making of re-openings or resource distribution such as testing, vaccine distribution and other pandemic-related resources to ensure equity for the most vulnerable.
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Affiliation(s)
- Paul M. Ong
- Department of Urban Planning, UCLA Center for Neighborhood Knowledge, UCLA Luskin School of Public Policy, Los Angeles, CA 90095, USA; (P.M.O.); (C.P.); (N.R.G.)
| | - Chhandara Pech
- Department of Urban Planning, UCLA Center for Neighborhood Knowledge, UCLA Luskin School of Public Policy, Los Angeles, CA 90095, USA; (P.M.O.); (C.P.); (N.R.G.)
| | - Nataly Rios Gutierrez
- Department of Urban Planning, UCLA Center for Neighborhood Knowledge, UCLA Luskin School of Public Policy, Los Angeles, CA 90095, USA; (P.M.O.); (C.P.); (N.R.G.)
| | - Vickie M. Mays
- Departments of Psychology and Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
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12
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Harris JE. Los Angeles County SARS-CoV-2 Epidemic: Critical Role of Multi-generational Intra-household Transmission. JOURNAL OF BIOECONOMICS 2021. [PMCID: PMC7934992 DOI: 10.1007/s10818-021-09310-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We observed wide variation in the incidence of confirmed COVID-19 cases in 300 communities making up Los Angeles County, the largest county by population in the United States. The surge in incidence from October 19, 2020 to January 10, 2021, accounting for two-thirds of all confirmed cases since the start of the epidemic, was concentrated in communities with a high prevalence of multi-generational households. This indicator of household structure was a more important predictor of the surge in incidence than the prevalence of households with low income or with at least one high-risk worker. Based upon a spatial adaptation of the standard SIR model, the cumulative incidence of COVID-19, adjusted for underascertainment of both asymptomatic and symptomatic cases, ranged from under 10% in low multi-generational communities to over 30% in high multi-generational communities.
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13
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Garcia E, Eckel SP, Chen Z, Li K, Gilliland FD. COVID-19 mortality in California based on death certificates: disproportionate impacts across racial/ethnic groups and nativity. Ann Epidemiol 2021; 58:69-75. [PMID: 33746033 PMCID: PMC8005258 DOI: 10.1016/j.annepidem.2021.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022]
Abstract
Purpose To examine characteristics of coronavirus disease 2019 (COVID-19) decedents in California (CA) and evaluate for disproportionate mortality across race/ethnicity and ethnicity/nativity. Methods COVID-19 deaths were identified from death certificates. Age-adjusted mortality rate ratios (MRR) were compared across race/ethnicity. Proportionate mortality rates (PMR) were compared across race/ethnicity and by ethnicity/nativity. Results We identified 10,200 COVID-19 deaths in CA occurring February 1 through July 31, 2020. The most frequently observed characteristics among decedents were age 65 years or above, male, Hispanic, foreign-born, and educational attainment of High School or below. MRR indicated elevated COVID-19 morality rates among Asian/Pacific Islander, Black, and Hispanic groups compared with the White group, with Black and Hispanic groups having the highest MRR at 2.75 (95%CI: 2.54–2.97) and 4.18 (95%CI: 3.99–4.37), respectively. Disparities were larger at younger ages. Similar results were observed with PMR, and patterns of age-racial/ethnic disparities remained in analyses stratified by education. Elevated PMR were observed in all ethnicity/nativity groups, especially foreign-born Hispanic individuals, relative to U.S.-born non-Hispanic individuals. These were generally larger at younger ages and persisted after stratifying by education. Conclusions Differential COVID-19 mortality was observed in California across racial/ethnic groups and by ethnicity/nativity groups with evidence of greater disparities among younger age groups. Identifying COVID-19 disparities is an initial step toward mitigating disease impacts in vulnerable communities.
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Affiliation(s)
- Erika Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.
| | - Sandrah P Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Zhanghua Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Kenan Li
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA
| | - Frank D Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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14
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Newhouse CN, Saleh T, Fuller T, Kerin T, Cambou MC, Swayze EJ, Le C, Seo W, Trejo M, Garner OB, Chandrasekaran S, Nielsen-Saines K. Predictors of SARS-CoV-2 Infection in Youth at a Large, Urban Healthcare Center in California, March-September 2020. Front Pediatr 2021; 9:752247. [PMID: 34869107 PMCID: PMC8635702 DOI: 10.3389/fped.2021.752247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: To understand which social, epidemiologic, and clinical risk factors are associated with SARS-CoV-2 infection in youth accessing care in a large, urban academic institution. Methods: We conducted a prospective cohort study with case-control analyses in youth who received testing for SARS-CoV-2 at our academic institution in Los Angeles during the first wave of the COVID-19 pandemic (March-September 2020). Results: A total of 27,976 SARS-CoV-2 assays among 11,922 youth aged 0-24 years were performed, including 475 youth with positive SARS-CoV-2 results. Positivity rate was higher among older, African American, and Hispanic/Latinx youth. Cases were more likely to be from non-English-speaking households and have safety-net insurance. Zip codes with higher proportion of Hispanic/Latinx and residents living under the poverty line were associated with increased SARS-CoV-2 cases. Youth were more likely to have positive results if tested for exposure (OR 21.5, 95% CI 14.6-32.1) or recent travel (OR 1.5, 95% CI 1.0-2.3). Students were less likely to have positive results than essential worker youth (OR 0.5, 95% CI 0.3-0.8). Patterns of symptom presentation varied significantly by age group; number of symptoms correlated significantly with age in SARS-CoV-2 cases (r = 0.030, p < 0.001). SARS-CoV-2 viral load did not vary by symptom severity, but asymptomatic youth had lower median viral load than those with symptoms (21.5 vs. 26.7, p = 0.009). Conclusions: Socioeconomic factors are important drivers of SARS-CoV-2 infection in youth. Presence of symptoms, exposure, and travel can be used to drive testing in older youth. Policies for school reopening and infection prevention should be tailored differently for elementary schools and universities.
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Affiliation(s)
- Caitlin N Newhouse
- Department of Medicine, Preventive Medicine Program, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Tawny Saleh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Trevon Fuller
- Institute of the Environment & Sustainability, University of California, Los Angeles, Los Angeles, CA, United States.,Laboratorio de Doenças Febris Agudas, Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Tara Kerin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Mary C Cambou
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Emma J Swayze
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Catherine Le
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Wonjae Seo
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Marisol Trejo
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Sukantha Chandrasekaran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Karin Nielsen-Saines
- Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
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