key: cord-1056094-op8sfnmh
authors: Gopalsami, A.; Torbati, S.
title: 25 Correlations Between Community COVID-19 Prevalence, Vaccine Availability and Emergency Department Non-COVID-19 Utilization
date: 2021-08-31
journal: Annals of Emergency Medicine
DOI: 10.1016/j.annemergmed.2021.07.026
sha: 5d05597c0f349f592f9e590a604445501d5a8ecc
doc_id: 1056094
cord_uid: op8sfnmh

Study Obectives: The coronavirus disease 2019 pandemic has resulted in decreased ED volumes across the country. Our objective was to better characterize how the impact of COVID-19 prevalence in the community affected public utilization of ED resources for non-COVID-19 encounters during the pandemic. Methods: This was a retrospective cross-sectional study performed at a single urban quaternary care academic medical center with 95,000 annual visits in Los Angeles County (LAC). Weekly ED COVID-19 and non-COVID-19 (NC) volumes were abstracted from May 2, 2019 through April 24, 2021;other data parameters obtained included age (<18, 18-64, 65+), arrival mode (walk-in, ambulance), Emergency Severity Index (ESI), and ED disposition (discharge, admit/transfer, psych transfer, death). COVID-19 encounters were queried by any ED diagnosis of “COVID” or “coronavirus.” SARS-CoV-2 testing and vaccination data were obtained from LAC from March 10, 2020 through May 1, 2021. We calculated LAC SARS-CoV-2 testing positivity rates and cumulative vaccination rates per week and examined daily ED NC volumes in relation to LAC testing positivity rates and vaccination rates. Paired t-tests were conducted to compare ED NC volumes before and after the start of the pandemic. Pearson correlation coefficients were used to compare ED NC volumes to LAC testing positivity and vaccination rates. Results: ED NC volumes reduced by an average of 29% one year prior to and after March 2020 when the COVID-19 pandemic began;there was a significant difference in volume before (M=1803, SD 53) and after (M=1284, SD 214), t(51)=2.01, P=<.001. The week of April 3 had the largest relative volume decrease of 61% with state of emergency and stay-at-home orders issued in the preceding two weeks. NC volumes regained pre-pandemic levels by the week of April 10, 2021 and sustained through May 2021. On April 10, 2021 47% of the eligible population age 16 and over in LAC had received at least 1 COVID-19 vaccination dose. Figure 1 represents trend lines of ED NC volume over time in relation to LAC COVID test positivity rate and vaccination percentage. The age breakdown showed pediatric <18 NC volumes had the highest relative reduction, but this volume only accounted for 5% of ED NC visits in our study period. Age groups 18-64 and 65+ had NC relative reductions of 20% and 22% respectively. The ESI levels 1-5 breakdown showed similar distributions pre and post pandemic;ESI-4 had the largest relative decrease of 37% with ESI-2 and ESI-3 decreasing by 27% and 15% respectively. The arrival method of patients was largely unchanged with walk-ins accounting for 80% and 79% pre and post pandemic. ED NC admission rates increased from 38% to 43% with corresponding decrease in discharges;psychiatric transfers and deaths were unchanged. ED NC volume and LAC COVID test positivity rates were found to have a very strong negative correlation (r(113) = -0.88, p<.001). Conversely ED NC volumes and cumulative LAC 16+ vaccination rates had a very strong positive correlation (r(113) = 0.94, p<.001). Conclusions: The higher the prevalence of COVID-19 in the community, the more hesitant patients behaved in seeking ED care for non-COVID-19 reasons. Lower disease prevalence and increasing vaccination rates correlate with a return of NC volumes back to pre-pandemic levels. [Formula presented]

Study Objective: Many studies to date have looked at reasons for patient hesitancy or refusal to vaccinate. Demographic and socioeconomic factors, safety concerns, and beliefs about vaccines impact a patient or parent's willingness to vaccinate. The speed of vaccine development and approval, divisive political climate surrounding COVID-19, underlying suspicion or lack of education about the virus, and effects of social media are factors that may make a COVID-19 vaccine uniquely contentious compared to other vaccines. Several studies have recently looked at vaccine hesitancy specifically related to COVID-19, exploring factors such as personal experience with COVID-19, personal knowledge about the virus, perception of virus severity, general confidence in vaccines, and trust in biomedical science and health care professionals. Recently, citywide studies have shown the disparities of vaccine uptake among various demographic groups; only 33% of Black adults have taken a vaccine dose while the rate for Hispanic adults is 4%; 50% for white adults, and 70% for Asian adults. We believe the emergency department provides the opportunity to investigate and close these gaps by addressing hesitancy and offering the vaccine in the emergency department.

Methods: We developed a questionnaire to evaluate patients' and caregivers' attitudes and knowledge of COVID-19 vaccine and investigate the reasons for the vaccine hesitancy amongst patients in the emergency department. Adult patients and caregivers of children 0-17 years were asked to complete this survey voluntarily using a QR code and a link to the questionnaire.

Results: To date, 66 respondents accessed and completed the survey (34 adults and 32 caregivers). Though 64% of adult patients and 81% of caregivers thought that the COVID vaccine would be beneficial to their community, many were unsure or reported they would not take the vaccine. 56% of adult patients and 59% of caregivers were hesitant to receive the vaccine for themselves and 48% of caregivers were hesitant to give the COVID-19 vaccine to their children. The most commonly cited reasons being concern about safety of the vaccine and its side effects and poor understanding of the vaccine. 90% of the adult patients and 83% of caregivers stated they would take the vaccine for themselves in the emergency department if offered, and 85% of caregivers would consider giving it to their children. Many respondents belonged to communities of color (Black 16-36%, Hispanic 73-82%), where vaccine uptake was the least.

Conclusion: The emergency department can address patients' vaccine hesitancy and alleviate the disparities by making vaccines available in the emergency department.

Prevalence, Vaccine Availability and Emergency Department Non-COVID-19 Utilization

Study Obectives: The coronavirus disease 2019 pandemic has resulted in decreased ED volumes across the country. Our objective was to better characterize how the impact of COVID-19 prevalence in the community affected public utilization of ED resources for non-COVID-19 encounters during the pandemic.

Methods: This was a retrospective cross-sectional study performed at a single urban quaternary care academic medical center with 95,000 annual visits in Los Angeles County (LAC). Weekly ED COVID-19 and non-COVID-19 (NC) volumes were abstracted from May 2, 2019 through April 24, 2021; other data parameters obtained included age (<18, 18-64, 65+), arrival mode (walk-in, ambulance), Emergency Severity Index (ESI), and ED disposition (discharge, admit/transfer, psych transfer, death). COVID-19 encounters were queried by any ED diagnosis of "COVID" or "coronavirus." SARS-CoV-2 testing and vaccination data were obtained from LAC from March 10, 2020 through May 1, 2021. We calculated LAC SARS-CoV-2 testing positivity rates and cumulative vaccination rates per week and examined daily ED NC volumes in relation to LAC testing positivity rates and vaccination rates. Paired t-tests were conducted to compare ED NC volumes before and after the start of the pandemic. Pearson correlation coefficients were used to compare ED NC volumes to LAC testing positivity and vaccination rates.

Results: ED NC volumes reduced by an average of 29% one year prior to and after March 2020 when the COVID-19 pandemic began; there was a significant difference in volume before (M¼1803, SD 53) and after (M¼1284, SD 214), t(51)¼2.01, P¼<.001. The week of April 3 had the largest relative volume decrease of 61% with state of emergency and stay-at-home orders issued in the preceding two weeks. NC volumes regained pre-pandemic levels by the week of April 10, 2021 and sustained through May 2021. On April 10, 2021 47% of the eligible population age 16 and over in LAC had received at least 1 COVID-19 vaccination dose. Figure 1 represents trend lines of ED NC volume over time in relation to LAC COVID test positivity rate and vaccination percentage. The age breakdown showed pediatric <18 NC volumes had the highest relative reduction, but this volume only accounted for 5% of ED NC visits in our study period. Age groups 18-64 and 65+ had NC relative reductions of 20% and 22% respectively. The ESI levels 1-5 breakdown showed similar distributions pre and post pandemic; ESI-4 had the largest relative decrease of 37% with ESI-2 and ESI-3 decreasing by 27% and 15% respectively. The arrival method of patients was largely unchanged with walk-ins accounting for 80% and 79% pre and post pandemic. ED NC admission rates increased from 38% to 43% with corresponding decrease in discharges; psychiatric transfers and deaths were unchanged. ED NC volume and LAC COVID test positivity rates were found to have a very strong negative correlation (r(113) ¼ -0.88, p<.001). Conversely ED NC volumes and cumulative LAC 16+ vaccination rates had a very strong positive correlation (r(113) ¼ 0.94, p<.001).

Conclusions: The higher the prevalence of COVID-19 in the community, the more hesitant patients behaved in seeking ED care for non-COVID-19 reasons. Lower disease prevalence and increasing vaccination rates correlate with a return of NC volumes back to pre-pandemic levels. Background: The COVID-19 pandemic has been one of the greatest modern health challenges to date. The administration of COVID-19 vaccines, rapidly and widely across all communities, is key to halting the spread of the virus. One significant challenge in promoting a large-scale immunization program is the threat of vaccine hesitancy, particularly in underrepresented minority communities (URM).

Study Objective: This project aimed to assess reasons for local vaccine hesitancy in an urban emergency department (ED) and to provide targeted education on the safety and efficacy of the COVID-19 vaccines to patients.

Methods: An interprofessional team was formed of medical students, physicians, social works, and community outreach coordinators to develop an educational intervention addressing COVID-19 vaccine safety for eligible patients receiving treatment in the ED at a urban academic affiliated community hospital with over 70% of patients coming from underserved URM backgrounds. A survey was conducted to elucidate their concerns surrounding the COVID-19 vaccine. Upon completion of the survey, up-to-date safety information was provided by trained medical students and a follow up survey was conducted to assess for impact of the education. Surveys were developed using standardized scoring systems from the Oxford OCEANS II study and the Kaiser Foundation COVID-19 Vaccine Monitor. Hesitancy scores before and after education delivery were tabulated to assess the impact of the quality improvement education intervention.

Results: A convenience sample of 58 subjects (76% URM) cited a variety of concerns surrounding the COVID-19 vaccine. The three most common reasons for declining vaccines were potential side effects (67.3% of respondents said they were concerned to extremely concerned), the concept that COVID-19 vaccines are neither effective nor safe (64.5% said they were concerned to extremely concerned), and the risk of developing COVID-19 infection from vaccine (38.8% said they were concerned to extremely concerned). While this project remains ongoing, this information was used to address these concerns directly with patients, answer questions, clarify information, and encourage patients to get their vaccines. Through the education program, vaccine hesitancy scores improved by an average of 29% indicating an increased likelihood they will get vaccinated in the future. 38% of patients receiving education agreed to sign up for a vaccine appointment during survey interview.

Conclusion: The ED often serves vulnerable patient populations. As such, its role in public health in these communities cannot be underestimated. This pilot quality improvement project is a novel method that hospital systems can use to develop and implement public health education programs to address specific community needs through the ED. These results show that ED health care providers have the ability to provide measurable change in attitudes about vaccine safety.

EMF Social Determinants of Health and COVID-19 Infection in North Carolina: A Geospatial Analysis

Patients' addresses were geo-referenced and analyzed by Kernel Density Estimation (KDE) to identify population-dense outbreaks of COVID-19 (hotspots). A set of 12 SDOH variables for each county were collected from the American Community Survey (ACS-5) and the Economic Research Service. Principal Component Analysis was applied to SDOH variables in order to reduce dimensions down to 3 geographical SDOH categories: Protective SDOH, High-Risk SDOH and Increased Vulnerability for Infection (Table 1)