ABSTRACT
Background: The COVID-19 pandemic has been marked by its disparate impacts on residents in lower income neighborhoods. To better understand reasons for disparities in disease severity, we asked: To what extent does the neighborhood built environment independently predict COVID-19 hospitalizations for people with SARS-CoV-2? Methods: Retrospective analysis of all cases of SARS-CoV-2 diagnosed within the University of Colorado Health and Denver Health healthcare systems from 3/1/2020-12/15/2020. Electronic health records were queried for positive SARS-CoV-2 PCR results for individuals aged ≥18 years during the study period. Demographic and health variables were extracted. Home addresses were matched with social vulnerability indices and built environment variables including population density and crowding, environmental hazards and amenities, and mobility options. Logistic regression was used to identify factors of the neighborhood built environment associated with hospitalization after a positive SARS-CoV-2 result. Results: Among the two systems, 39,304 individuals had positive SARS-CoV-2 tests;14,604 (37.16%) had full demographic data;4,101 (28%) were hospitalized. Odds of hospitalization were higher for individuals living in apartments and in census blocks with lower residential density and higher percentage of multi-family housing units. See Table. Higher particulate matter (PM2.5) levels were associated with higher odds of being hospitalized but living within mile of a highway was not. Living within 1/2 mile of a park and more park acreage in the neighborhood were associated with lower odds of hospitalization. Odds of being hospitalized were higher for individuals in neighborhoods with a lower Walk Score ®, lower Bike Score ®, and higher Transit Score ®. Effects were more pronounced for Latinx individuals. Conclusion: Among those with SARS-CoV-2 infection in Denver, living in areas with high levels of PM2.5, less park access, and lower Walk® and Bike Scores® were found to be independent risk factors for hospitalization when controlling for income and medical comorbidities.
ABSTRACT
Importance Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19. Objective To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. Design, Setting, and Participants Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57. Interventions Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200 mg (n = 588), or placebo (n = 587). Main Outcomes and Measures The primary outcome was incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase-polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. Results The prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years;722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5% vs 15.2%;odds ratio, 0.43 [95% CI, 0.28-0.68];P < .001;absolute risk difference, -6.6 [95% CI, -10.7 to -2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57;all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo). Conclusions and Relevance Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy. This randomized clinical trial assesses the effect of a single intravenous infusion of bamlanivimab vs placebo on incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. Question Among residents and staff of skilled nursing and assisted living facilities with high risk of SARS-CoV-2 exposure, what is the effect of bamlanivimab on the incidence of COVID-19? Findings This randomized phase 3 clinical trial included 966 participants who were residents and staff at US skilled nursing and assisted living facilities with at least 1 confirmed SARS-CoV-2 index case and who were negative at baseline for SARS-CoV-2 infection and serology, enrolled from August to November 2020. The incidence of COVID-19 infection among those treated with bamlanivimab vs placebo was 8.5% vs 15.2%, respectively, a difference that was statistically significant. Meaning Bamlanivimab monotherapy compared with placebo reduced the risk of COVID-19 in residents and staff of skilled nursing and assisted living facilities.