Streamlining Test-to-Treat: A Novel Care Delivery Model for Covid-19 Oral Antiviral Access to Close the Equity Divide in Los Angeles County

The Los Angeles County Department of Public Health, in collaboration with Healthvana, a well-established private-sector partner, was able to quickly stand up a program to target patients in socially and economically disadvantaged communities for access to time-sensitive oral antiviral remedies. The Covid-19 pandemic has revealed the urgent need for a new care model that serves socially and economically disadvantaged communities by providing timely and widespread access to therapeutics that is free of cost to the patient and agnostic to insurance status, provider, and physical location of Covid-19-positive individuals. The Los Angeles County Department of Public Health (LAC DPH) - in partnership with Healthvana, a Health Insurance Portability and Accountability Act of 1996-compliant patient engagement platform that digitally delivers test results directly to patients and providers - piloted an innovative treatment-dispensing model cost-free to the patient to address both inequitable access and the time-sensitive nature of Covid-19 medication prescriptions - in particular, oral antivirals such as Pfizer's Paxlovid. The intervention combined confidential digital delivery of Covid-19 test results, antiviral education, and direct access to therapeutics within hours of a positive polymerase chain reaction (PCR) result for severe acute respiratory syndrome coronavirus 2 infection. Between April 5 and July 5, 2022, this care model delivered 25,237 PCR-positive test results from 77 LAC DPH Covid-19 test sites and enabled patients to connect with a clinician within hours of receiving a positive test result to receive a free Covid-19 screening and prescription for Covid-19 antiviral treatment. During that 3-month period, 1,471 prescriptions for oral antivirals were prescribed through the LAC DPH telehealth line, and 1,177 of those patients who were contacted via a follow-up survey had filled their prescriptions. Success was attributable to rapid rollout, leveraging Healthvana's existing infrastructure and brand recognition built over the preceding 2 years of the pandemic, and provision of an instant-access medical consult and prescription cost-free to patients. This intervention demonstrates the potential for digital health technologies to facilitate more equitable interventions at the intersection of public health and clinical practice.

Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.

Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19 - United States, January-February 2020.

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, began in Wuhan, China (1). The disease spread widely in China, and, as of February 26, 2020, COVID-19 cases had been identified in 36 other countries and territories, including the United States. Person-to-person transmission has been widely documented, and a limited number of countries have reported sustained person-to-person spread.* On January 20, state and local health departments in the United States, in collaboration with teams deployed from CDC, began identifying and monitoring all persons considered to have had close contact† with patients with confirmed COVID-19 (2). The aims of these efforts were to ensure rapid evaluation and care of patients, limit further transmission, and better understand risk factors for transmission.