key: cord-0068915-hg2gxxgr
authors: Purakal, J.; Silva, L.; Tupetz, A.; Seidenfeld, J.; Limkakeng, A.; Staton, C.; Vissoci, J.
title: 403(EMF) Social Determinants of Health and COVID-19 Infection in North Carolina: A Geospatial Analysis
date: 2021-10-22
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2021.09.418
sha: 215f2b85b33942de1710e624335a25b016c6fc31
doc_id: 68915
cord_uid: hg2gxxgr

nan

Study Objective: With COVID-19 cases and fatalities increasing nationally, health officials implemented policies and restrictions to keep the positivity rate in check. In California, a statewide stay at home order was issued on March 19, 2020 and again on December 7, 2020. The objective of this study was to assess the impact each stay at home order had on ED utilization.

Methods: We conducted a multi-center, retrospective study among adult patients (18 years) presenting to two emergency departments (urban level 1 trauma center and suburban academic hospital with combined annual census of w80,000). We compared ED utilization over a two-week period both prior to and following each statewide stay at home order (March and December, 2020), as well as similar periods in 2019. We calculated the percent change in ED volume and admissions for each.

Results: Prior to the first stay at home order, there were only 70 confirmed COVID-19 cases in the county, compared to 94,169 cases prior to the subsequent stay at home order. Compared to 2019, ED volume and admissions during the two-week period following the initial stay at home order decreased by 30.7% and 28.4%, respectively. Following the second stay at home order, ED volume was only down 12.4% from 2019, while admissions were up 4.4%. Similarly, compared to the two week period prior to the initial stay at home order, ED volume and admissions decreased by 22.8% and 14.0% in the following 2-week period, respectively. However, ED volume and admissions remained similar following the second stay at home order, with an increase by 0.8% in ED visits and 1.6% increase in admissions between the two weeks before and after the order began.

Conclusion: This study of ED utilization trends during the COVID-19 pandemic demonstrated that ED volume and admissions decreased dramatically during the initial stay at home order. However, despite the large differences in the number county-wide positive cases, ED utilization and admissions were largely unaffected by the second stay at home order. Study Objectives: Thousands of people are admitted to the hospital each year with burns. Many such burns are deep partial or full-thickness and require some form of debridement to allow burn depth assessment, enhance healing and reduce scarring. At present, most deep burns are treated surgically, with a minority of patients treated with the only commercially available enzymatic debridement agent in the US, collagenase. However, there are few if any studies that demonstrate the efficacy of a collagenasebased enzymatic agent. In contrast, based on extensive preclinical and clinical data, a bromelain based enzymatic agent is now approved in Europe for treating deep burns. This agent is derived from the stems of pineapples and enriched with bromelain. No study has directly compared the debriding efficacy of a collagenase-based versus bromelain-based enzymatic agent. In this study, we hypothesize that a bromelain-based enzymatic agent will be more effective at debriding partial thickness burns compared with the collagenase based agent. We further hypothesize that the bromelain based agent will completely debride the burns after a single 4-hour application while the collagenase-based agent will be less effective and will require multiple daily applications. Finally, we hypothesize that burns debrided with the bromelain-based agent will heal faster than those debrided with the collagenase-based agent. Supportive results may lead to a major advance in how we provide therapy to hundreds of thousands of burn victims each year.

Methods: This study will be conducted in an accredited medical center with 2 female domestic pigs. Our method of creating burns results in standardized and reproducible partial thickness burns based on a previously validated model. Burn wounds will be followed for a period of 28 days. Digital imaging and full thickness skin biopsies will be obtained at 4 hours, and at 10, 14, 18 and 28 days. Biopsies will be subjected to blinded histomorphometric analysis.

Results: None currently available. To date we are awaiting the bromelain and collagenase product which is being shipped internationally to our location (delayed due to COVID19).

Conclusion: Although we cannot draw any conclusions presently, preliminary data from the mentor's lab concluded that a single 4-hour application of a bromelain-based enzymatic agent completely debride deep partial thickness burns in a validated porcine model. If the bromelain-based enzymatic agent shows to be more efficacious than collagenase, it may replace both collagenase mediated and surgical debridement. Ultimately, this could lead to fewer consequences from the injury to the patient, better aesthetic outcomes at the site of injury, and potentially a decreased financial burden.

Purakal J, Silva L, Tupetz A, Seidenfeld J, Limkakeng A, Staton C, Vissoci J/ Duke University School of Medicine, Durham, NC Study Objectives: The COVID-19 pandemic has demonstrated that social determinants of health (SDOH) are profoundly linked to the spread and outcomes of COVID-19. However, the relationships between these SDOH and COVID-19 spatial outbreaks have yet to be determined. We conducted spatial analyses with geographic

Methods: We analyzed the geospatial associations of COVID-19 infections and SDOH to identify areas of overlap. Our sample comprised all patients in a North Carolina healthcare system's registry who tested positive for COVID-19 from

Kruskal-Wallis and Dunn's Post-Hoc adjusted with Bonferroni were utilized to verify any difference in the proportion of patients residing in the different clusters (significance p<0.05). Results: A total of 13,733 patients were included in the study. The patients predominantly reside in Durham County (55.4%), are women (56.96%), and between 40 and 69 years old (41.9%). Further, patients are predominantly White (38.7%), non-Hispanic (79.63%), and single (49.6%). The concomitant analysis of KDE and MCA showed an overlap of COVID-19 hotspots with areas of ISD (Image B). The MCA revealed that there are 308 census tracts constituted by six counties

The ISD cluster was the most densely populated and was significantly more densely populated from the ESD and DSD clusters (p¼0.01). Conclusion: In this sampling of COVID-19 patients, a disproportionate amount of patients come from areas with increased social disparities, suggesting further research and health policy will need to be directed towards addressing negative and vulnerability SDOH to curtail pandemic