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BACKGROUND AND AIM: Suggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS-C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS). METHOD(S): This was a retrospective study on 356 hospitalized MIS-C patients from 03/20-9/21 (28 U.S. sites) in the SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry. The effect of IVIG and steroids initiated in the first two days of admission, alone or in combination, on LOS was analyzed using intention to treat analysis. Adjustment for confounders was made by multivariable mixed regression with a random intercept for the site. RESULT(S): Median age of the study population was 8.8 (IQR 4.0, 13) years. 247/356 (70%) patients required ICU admission during hospitalization. Of the total patients, 153 (43%) received IVIG and steroids, 33 (9%) received IVIG only, 43 (12%) received steroids only, and 127 (36%) received neither within first two days. After adjustment of confounders, only combination therapy showed a significant decrease of ICU LOS by 1.6 days compared to no therapy (exponentiated coefficient 0.71 [95% CI 0.51, 0.97, p=0.03]). No significant difference was observed in hospital LOS or the secondary outcome variables. CONCLUSION(S): Combination therapy with IVIG and steroids initiated in the first 2 days of admission favorably impacts ICU LOS in children with MIS-C.
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Background The rapid expansion of internet and social media use has meant that both useful and potentially harmful health information can spread rapidly. Groups experiencing barriers to health systems may be more reliant on social media as a source of health information. We did a systematic review to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake. Methods We reviewed published and grey literature following PRISMA guidelines (PROSPERO registered CRD42021259190). Global research was included that reported on the use of social media by migrants and/or ethnic minority groups in relation to COVID-19. Results 1849 unique records were screened, and 21 data sources included in our analysis involving studies from the UK, US, China, Jordan, Qatar, and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. There were positive and negative associations with social media use reported, with some evidence suggesting circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings of which are likely relevant to multiple population groups. Conclusions Urgent actions and further research are now needed to better understand the use of social media platforms for accessing health information by groups who may be marginalised from health systems, effective approaches to tackling circulating misinformation, and to seize on opportunities to make better use of social media platforms to support public health communication. Key messages We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations. Further research is needed to better understand the use of social media platforms for accessing health information by groups who may be marginalised from health systems.
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STATEMENT OF PROBLEM/QUESTION: Despite accounting for only 34% of the population in Austin, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized patients, 40% had never seen a primary care physician (PCP), had high rates of previously undiagnosed health conditions and significant health-related social needs (HRSNs). DESCRIPTION OF PROGRAM/INTERVENTION: We implemented an interdisciplinary pilot program at a local academic teaching hospital to improve community outcomes and address HRSNs. The intervention is led by a bilingual community health worker (CHW), and includes discharge follow-up with patients hospitalized with COVID-19. As the pandemic ebbed and flowed across multiple surges, we expanded the intervention to Latinx patients with other complex health conditions. The full sample was included in the analysis. MEASURES OF SUCCESS: This is a mixed-method evaluation, which includes quantitative patient data (n=96), as well as qualitative data from hospital-based, healthcare professionals (n=26) that collaborated with the CHW. Quantitative data includes patient demographics (age, gender, race, education & insurance), HRSNs, community referrals and primary care followup. Qualitative data was collected via focus groups with case managers, hospitalists, residents and palliative care team members. Focus groups were approximately 60 minutes long, and we used content analysis to identify themes. FINDINGS TO DATE: The majority of patients were hospitalized for COVID-19 (n= 67, 70%) while the rest were diagnosed with other acute conditions. Average length of stay (LOS) was 13.8 days and the median LOS was 8 days. Mean age was 50.6 years, 66% of patients were male and 79% spoke Spanish. Half of the patients had less than a high school education, while 20% had more than a high school education. One-third of patients were employed while the rest were either seeking employment (16%) or nonworking (50%). The majority of patients were either uninsured (42%) or had county-based health coverage for the uninsured (30%). The top HRSNs included food (47%), rental assistance (36%) and utility assistance (36%). Almost half of patients attended a follow up with a PCP. Initial qualitative themes fall into three categories: 1) the role of a CHW, 2) the benefits of a CHW in the hospital and 3) growth opportunities. KEY LESSONS FOR DISSEMINATION: This pilot program demonstrated the capacity for CHWs to raise the hospital scope of care, particularly within the context of COVID-19. CHWs are experts in assessing and addressing HRSNs and can provide complementary services to inpatient care teams. CHWs provide culturally appropriate, transitional care to patients with chronic illnesses, which directly addresses the socioeconomic barriers to receiving continuity of care. Additional and diverse funding mechanism are needed to expand the presence of CHWs in hospital settings and increase the capacity to serve more patients.
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STATEMENT OF PROBLEM/QUESTION: The COVID-19 pandemic highlights the disproportionate burden of disease on communities made vulnerable by structural inequities. The pandemic has increased economic hardship, including housing instability, food insecurity and ability to pay bills. Hospitalization for COVID-19 is an opportunity to address unmet healthrelated social needs (HRSNs) and connect patients with community resources. DESCRIPTION OF PROGRAM/INTERVENTION: Community health workers (CHWs) play a critical role in response to public health crises. To address the inequitable burden of COVID-19 on Austin's Latinx population, we implemented a pilot program at an academic hospital where a CHW helps patients navigate care transitions and address unmet HRSNs. The care team referred patients with COVID-19 to the CHW, who met with patients to establish rapport, provide language-concordant communication between the care team and patient/family, deliver health promotion education, and assess HRSNs. MEASURES OF SUCCESS: This includes three typical cases describing key components of the CHW pilot program. CHWs connected patients and families to community resources and facilitated discharge planning and connection with primary care providers. The CHWs continued to follow patients for at least 45 days after discharge to assist with care coordination. We provide qualitative data from patients and healthcare professionals. FINDINGS TO DATE: Patient 1 is a 38-year-old day laborer with hypertension hospitalized with COVID-19 pneumonia. His family of four is undocumented and faced economic insecurity due to loss of work from the pandemic. The CHW assisted with utilities, bills, food and rent through coordination with local organizations to provide direct financial assistance to the family. Patient 2 is a 45-year-old woman with diabetes hospitalized with COVID-19 pneumonia. She is a mother of three children, two with disabilities. In addition to financial insecurity, she identified transportation as a primary HRSN. The CHW arranged financial resources to fix their car, which allowed the family to access school and clinic resources. Patient 3 is a 36-year-old man hospitalized with COVID-19 pneumonia. The CHW connected the family, including three children, with their school social worker, enabling access to financial support for utilities, food and clothes. The CHW arranged free food delivery to their home for four months. The CHW also secured county-based indigent care coverage for the patient, enabling hospital follow-up with a primary care provider. The patient's wife noted, because of the CHW, “We never felt alone” and now feel “capable of navigating a health system that we never felt we had access to.” KEY LESSONS FOR DISSEMINATION: CHWs, as patient advocates and skilled care navigators, build trust, establish longitudinal relationships with patients and address unmet HRSNs that can enable successful care transitions. CHWs can alleviate the disproportionate burden of COVID-19 on individuals with unmet HRSNs. Supporting the work of CHWs within hospital care teams can improve care transitions.
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COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19–associated morbidity and mortality (1);however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC’s Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020–May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson And Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020–May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18–24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19. VSD is a collaboration between CDC’s Immunization Safety Office and eight integrated health care organizations in six U.S. states.† VSD captures information on COVID-19 vaccine doses administered, regardless of where they are received, based on an automated search within the organizations’ facilities (outpatient and inpatient records) and external systems (e.g., health insurance claims and state or local immunization What is already known about this topic? Non-Hispanic Black and Hispanic persons experience higher COVID-19–associated morbidity and mortality, yet COVID-19 vaccination coverage is lower in these groups. What is added by this report? As of May 15, 2021, 48.3% of persons identified in CDC’s Vaccine Safety Datalink aged ≥16 years had received ≥1 COVID-19 vaccine dose and 38.3% were fully vaccinated. Coverage with ≥1 dose was lower among non-Hispanic Black (40.7%) and Hispanic persons (41.1%) than among non-Hispanic White persons (54.6%);coverage was highest (57.4%) among non-Hispanic Asian persons. What are the implications for public health practice? Continued monitoring of vaccination coverage and efforts to improve equity in vaccination coverage are critical, especially among populations disproportionately affected by COVID-19. © 2021 Department of Health and Human Services. All rights reserved.
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We prospectively compared health care worker-collected nasopharyngeal swabs (NPS) to self-collected anterior nasal swabs (ANS) and straight saliva for the diagnosis of coronavirus disease 2019 (COVID-19) in 354 patients. The percent positive agreement between NPS and ANS or saliva was 86.3% (95% confidence interval [CI], 76.7 to 92.9%) and 93.8% (95% CI, 86.0 to 97.9%), respectively. The percent negative agreement was 99.6% (95% CI, 98.0 to 100.0%) for NPS versus ANS and 97.8% (95% CI, 95.3 to 99.2%) for NPS versus saliva. More cases were detected by the use of NPS (n = 80) and saliva (n = 81) than by the use of ANS (n = 70), but no single specimen type detected all severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.