ABSTRACT
Purpose : The rapid spread of coronavirus (COVID-19) has changed the way eye care practitioners provide care. As an early response to the pandemic, the Department of Ophthalmology at the University of Illinois at Chicago created a tele-triage system to screen patients requesting an urgent visit. The aim of this study was to explore demographic and community factors associated with adherence of patients scheduled for recommended urgent eye visits. Methods : Surveys of all individuals requesting an acute same day in-person visit between April 6, 2020 and June 6, 2020 were reviewed, and medical chart review was completed for patients recommended an urgent visit. Demographic data and adherence to visit were examined. Using ArcGIS, address was geocoded and census tract level variables were appended from the U.S. Census American Community Survey between 2014 and 2018. COVID-19 related death data during the study period were also included from the Cook County Medical Examiner's Office. Descriptive statistics, t-tests and binary logistic regression were used to compare variables. A p-value of ≤ 0.05 was considered statistically significant. Data was analyzed using SAS Institute Inc. 2018 (SAS 9.4M6, Cary, NC, USA). Results : A total of 229 patients were recommended an urgent visit. Of 216 patients with matching criteria on chart review, mean age was 46.6 ± 18.6 years. The majority of patients were female (55.6%) and Black or African American (40.3%), and most common insurance was Medicaid (36.6%). 192 patients (88.9%) reported for their scheduled visit. When comparing personal characteristics by adherence to visit, there was no difference based on gender (p=0.94), race (p=0.56), insurance status (p=0.28), nor new versus established status (p=0.20). Community level data showed that individuals who did not adhere to their visit more commonly came from neighborhoods with a greater proportion of Blacks or African Americans (59.4% vs. 33.4%;p=0.03), greater unemployment rates (17.5% vs. 10.7%;p<0.01), and greater cumulative deaths from COVID-19 (56 vs. 31;p=0.01). Conclusions : The findings from this study suggest that, in our patient population, COVID19 itself disproportionately affects black communities in terms of mortality, but also affects adherence to appointments which, in return, increases gaps in health equity.
ABSTRACT
Purpose : SARS-CoV-2 virus can remain stable on surfaces for several days. This crosssectional analysis sought to determine the presence of SARS-CoV-2 virus on various surfaces that trainees and faculty of an academic eye clinic routinely came into contact with during the pandemic in New York City. Methods : Samples were collected by faculty and trainees from surfaces encountered during daily life. On 4 different days, teams collected at least two samples using sterile swabs (Puritan HydraFlock). Prior to collection, nasal swabs were obtained from all individuals to check for SARS-CoV-2. Collection sites were grouped into four zones depending on proximity and the amount of the time personnel spent there. Zones included: (1) Work microenvironment: Slit lamp;door handles;computers;waiting room;reception;bathrooms (2) Work macroenvironment: ICU, ED, inpatient units;elevators, bathrooms;cafeteria (3) Living microenvironment: Home doorknob;kitchen;car;sitting area (4) Living macroenvironment: Subway station;subway cars;car services;restaurants;bike stations;grocery stores. Samples were transported to the lab in transport medium and RNA extraction was conducted using the QIAamp DSP Viral RNA Mini Kit. Presence of viral RNA was investigated using Luna Universal Probe One-step RT-qPCR. Results : A total of 816 swabs were submitted. Only 2 (0.25%) samples were positive. The first was a sample from a patient bathroom sink handle in the main emergency room and the second was a nasal swab from a staff member who had been assigned to collect samples. Prior to this positive swab result, this staff member had tested positive for COVID-19, quarantined for two weeks, and had then received one prior negative test. Conclusions : Though COVID-19 is currently widespread in the United States, this study shows that the healthcare personnel working in New York City at Edward S. Harkness Eye Institute at the Columbia University Irving Medical Center have a low chance of encountering viral RNA on surfaces they are in close contact with during their daily life. Considering the 1.77-2.39% citywide test positivity during the time this study was conducted, the likelihood of faculty and trainees getting infected from contaminated surfaces is 100 times less likely than acquiring COVID-19 from an infected individual. This result may be a reflection of the efficacy of disinfection protocols or the limited viability of the virus on inorganic surfaces.