ABSTRACT
The COVID-19 pandemic disproportionately impacted uninsured and minority populations, contributing to and reinforcing long-lasting health inequities. Clínica Esperanza/Hope Clinic (CEHC), a free clinic serving uninsured individuals, is one 'safety-net' clinic that improved access to COVID-19 testing and vaccinations for an at-risk population during the pandemic. A retrospective review was performed to quantify COVID-19 testing and vaccination rates for clinic participants, which were compared to rates in the general population. 51.7% of patients seeking COVID-related care at CEHC were uninsured, compared to 8% in Providence and 4.8% in Rhode Island. CEHC performed 5,623 COVID-19 tests for 4,498 unique individuals, a total of 15,783 vaccines were administered, and 10 to 20% of COVID-care participants reported food insecurity during the study period. The prevalence of COVID-19 in the uninsured population and the high demand for vaccines highlight the important role that free clinics can play in the pandemic setting.
ABSTRACT
Natural and vaccine-induced SARS-CoV-2 immunity in humans has been described but correlates of protection are not yet defined. T cells support the SARS-CoV-2 antibody response, clear virus-infected cells, and may be required to block transmission. In this study, we identified peptide epitopes associated with SARS-CoV-2 T-cell immunity. Using immunoinformatic methods, T-cell epitopes from spike, membrane, and envelope were selected for maximal HLA-binding potential, coverage of HLA diversity, coverage of circulating virus, and minimal potential cross-reactivity with self. Direct restimulation of PBMCs collected from SARS-CoV-2 convalescents confirmed 66% of predicted epitopes, whereas only 9% were confirmed in naive individuals. However, following a brief period of epitope-specific T-cell expansion, both cohorts demonstrated robust T-cell responses to 97% of epitopes. HLA-DR3 transgenic mouse immunization with peptides co-formulated with poly-ICLC generated a potent Th1-skewed, epitope-specific memory response, alleviating safety concerns of enhanced respiratory disease associated with Th2 induction. Taken together, these epitopes may be used to improve our understanding of natural and vaccine-induced immunity, and to facilitate the development of T-cell-targeted vaccines that harness pre-existing SARS-CoV-2 immunity.
ABSTRACT
The COVID-19 pandemic has exacerbated the effects of existing health disparities throughout the United States. While Hispanic/Latino individuals account for only 16% of the Rhode Island (RI) population, Rhode Island Department of Health (RIDOH) data show that 45% of COVID-19 cases and 36% of individuals who have been hospitalized identify as Hispanic/Latino. Clínica Esperanza/Hope Clinic (CEHC) mobilized a comprehensive effort to offer telehealth visits, health education and accessible, walk-up COVID-19 testing for low-income, uninsured and Spanish-speaking individuals living in Rhode Island. With support from CEHC volunteers, the City of Providence, the State of Rhode Island, and local foundations, CEHC has administered 1,649 individual COVID-19 tests as of October 2020. The overall COVID-19 test positivity rate at CEHC was 23%, peaking in April at 48%. Additionally, CEHC has distributed more than 1,600 meal boxes to patients experiencing food insecurity, provided emergency financial resources, while rapidly scaling up healthcare services for the increasing numbers of uninsured individuals in RI.