1
|
Azofeifa A, Liu R, Dupont H, Reissman DB. Telemedicine Trends and Lessons Learned During the COVID-19 Pandemic-World Trade Center Health Program, 2020-2021. Public Health Rep 2024; 139:301-308. [PMID: 38298086 PMCID: PMC11037234 DOI: 10.1177/00333549231223143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
The World Trade Center (WTC) Health Program, a limited federal health care program for eligible people exposed to the terrorist attacks on September 11, 2001, expanded telemedicine services during the COVID-19 pandemic (2020-2021). We analyzed service use trends from January 2020 through December 2021 to describe how the program implemented telemedicine services. About three-quarters (75%) of telemedicine visits were for mental health-related services. In the second quarter of 2020 (April-June), the number of telemedicine visits per 1000 members (n = 367) increased, exceeding in-person visits (n = 152) by 1.4-fold. The number of telemedicine visits per 1000 members decreased gradually during the rest of the study period but still represented 38% of total visits by the end of 2021. Changes in telemedicine visits were offset by comparable changes for in-person visits, such that the rate of total visits was essentially constant during the study period. Multivariate logistic regression models showed differences in telemedicine visit rates by member type and by demographic characteristics. Survivor members (vs responder members), those self-identified as non-Hispanic Other races (vs non-Hispanic White), those with preferred language not English (vs preferred language English), and those not living in the New York metropolitan area (vs living in the New York metropolitan area) were less likely to use telemedicine. Implementing telemedicine services in the WTC Health Program during the COVID-19 pandemic underscored the importance of extensive collaboration among partners, the capacity to rapidly develop necessary technical guidance, and the flexibility to address frequent regulatory guidance updates in a timely fashion. These lessons learned may guide similar health care providers posed with time-sensitive disruptions of in-person services.
Collapse
Affiliation(s)
- Alejandro Azofeifa
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, USA
| | - Ruiling Liu
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, USA
| | - Hannah Dupont
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, USA
| | - Dori B. Reissman
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, USA
| |
Collapse
|
2
|
Lee A, Seo J, Park S, Cho Y, Kim G, Li J, Liang L, Park T, Chung W. Type 2 diabetes and its genetic susceptibility are associated with increased severity and mortality of COVID-19 in UK Biobank. Commun Biol 2024; 7:122. [PMID: 38267566 PMCID: PMC10808197 DOI: 10.1038/s42003-024-05799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
Type 2 diabetes (T2D) is known as one of the important risk factors for the severity and mortality of COVID-19. Here, we evaluate the impact of T2D and its genetic susceptibility on the severity and mortality of COVID-19, using 459,119 individuals in UK Biobank. Utilizing the polygenic risk scores (PRS) for T2D, we identified a significant association between T2D or T2D PRS, and COVID-19 severity. We further discovered the efficacy of vaccination and the pivotal role of T2D-related genetics in the pathogenesis of severe COVID-19. Moreover, we found that individuals with T2D or those in the high T2D PRS group had a significantly increased mortality rate. We also observed that the mortality rate for SARS-CoV-2-infected patients was approximately 2 to 7 times higher than for those not infected, depending on the time of infection. These findings emphasize the potential of T2D PRS in estimating the severity and mortality of COVID-19.
Collapse
Affiliation(s)
- Aeyeon Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea
| | - Jieun Seo
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea
| | - Seunghwan Park
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea
- Institute of Genetic Epidemiology, Basgenbio Co. Ltd., Seoul, 04167, Korea
| | - Youngkwang Cho
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea
| | - Gaeun Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea
| | - Jun Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Liming Liang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, 08826, Korea.
| | - Wonil Chung
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea.
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| |
Collapse
|
3
|
Sekendiz Z, Clouston SAP, Morozova O, Carr MA, Fontana A, Mehta N, Ali A, Jiang E, Luft B. ASSESSMENT AND CHARACTERIZATION OF COVID-19 RELATED COGNITIVE DECLINE: RESULTS FROM A NATURAL EXPERIMENT. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.06.23298101. [PMID: 37986906 PMCID: PMC10659478 DOI: 10.1101/2023.11.06.23298101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Cognitive impairment is the most common and disabling manifestation of post-acute sequelae of SARS-CoV-2. There is an urgent need for the application of more stringent methods for evaluating cognitive outcomes in research studies. Objective To determine whether cognitive decline emerges with the onset of COVID-19 and whether it is more pronounced in patients with Post-Acute Sequelae of SARS-CoV-2 or severe COVID-19. Methods This longitudinal cohort study compared the cognitive performance of 276 patients with COVID-19 to that of 217 controls across four neuroinflammation or vascular disease-sensitive domains of cognition using data collected both before and after the pandemic starting in 2015. Results The mean age of the COVID-19 group was 56.04±6.6 years, while that of the control group was 58.1±7.3 years. Longitudinal models indicated a significant decline in cognitive throughput ((β=-0.168, P=.001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. The effect sizes were large; the observed changes in throughput were equivalent to 10.6 years of normal aging and a 59.8% increase in the burden of mild cognitive impairment. Cognitive decline worsened with coronavirus disease 2019 severity and was concentrated in participants reporting post-acute sequelae of SARS-CoV-2. Conclusion COVID-19 was most likely associated with the observed cognitive decline, which was worse among patients with PASC or severe COVID-19. Monitoring patients with post-acute sequelae of SARS-CoV-2 for declines in the domains of processing speed and visual working memory and determining the long-term prognosis of this decline are therefore warranted.
Collapse
Affiliation(s)
- Zennur Sekendiz
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Sean A P Clouston
- Stony Brook University, Family, Population and Preventive Medicine, Program in Public Health
| | - Olga Morozova
- The University of Chicago, Department of Public Health Sciences
| | - Melissa A Carr
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Ashley Fontana
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Nikhil Mehta
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Alina Ali
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Eugene Jiang
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| | - Benjamin Luft
- Stony Brook University, Department of Medicine-World Trade Center Health Program
| |
Collapse
|
4
|
Waszczuk MA, Morozova O, Lhuillier E, Docherty AR, Shabalin AA, Yang X, Carr MA, Clouston SAP, Kotov R, Luft BJ. Polygenic risk scores for asthma and allergic disease associate with COVID-19 severity in 9/11 responders. PLoS One 2023; 18:e0282271. [PMID: 36893177 PMCID: PMC9997960 DOI: 10.1371/journal.pone.0282271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/10/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Genetic factors contribute to individual differences in the severity of coronavirus disease 2019 (COVID-19). A portion of genetic predisposition can be captured using polygenic risk scores (PRS). Relatively little is known about the associations between PRS and COVID-19 severity or post-acute COVID-19 in community-dwelling individuals. METHODS Participants in this study were 983 World Trade Center responders infected for the first time with SARS-CoV-2 (mean age at infection = 56.06; 93.4% male; 82.7% European ancestry). Seventy-five (7.6%) responders were in the severe COVID-19 category; 306 (31.1%) reported at least one post-acute COVID-19 symptom at 4-week follow-up. Analyses were adjusted for population stratification and demographic covariates. FINDINGS The asthma PRS was associated with severe COVID-19 category (odds ratio [OR] = 1.61, 95% confidence interval: 1.17-2.21) and more severe COVID-19 symptomatology (β = .09, p = .01), independently of respiratory disease diagnosis. Severe COVID-19 category was also associated with the allergic disease PRS (OR = 1.97, [1.26-3.07]) and the PRS for COVID-19 hospitalization (OR = 1.35, [1.01-1.82]). PRS for coronary artery disease and type II diabetes were not associated with COVID-19 severity. CONCLUSION Recently developed polygenic biomarkers for asthma, allergic disease, and COVID-19 hospitalization capture some of the individual differences in severity and clinical course of COVID-19 illness in a community population.
Collapse
Affiliation(s)
- Monika A. Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States of America
| | - Olga Morozova
- Department of Public Health Sciences, Biological Sciences Division, University of Chicago, Chicago, Illinois, United States of America
| | - Elizabeth Lhuillier
- World Trade Center Health and Wellness Program, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Anna R. Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Huntsman Mental Health Institute, Salt Lake City, Utah, United States of America
| | - Andrey A. Shabalin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Huntsman Mental Health Institute, Salt Lake City, Utah, United States of America
| | - Xiaohua Yang
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Melissa A. Carr
- World Trade Center Health and Wellness Program, Stony Brook University, Stony Brook, New York, United States of America
| | - Sean A. P. Clouston
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, United States of America
| | - Benjamin J. Luft
- World Trade Center Health and Wellness Program, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| |
Collapse
|