Racial Disparity and Temporal Patterns in Time to Invasive Ventilation During the COVID-19 Pandemic (Jan 2020 to Feb 2022) (preprint)

· Background: The COVID-19 pandemic has significantly stressed the healthcare system since January 2020. There are questions whether there were racial disparities in the use of resources and procedures during this period and if so, did the disparities change over the pandemic. We focus on invasive ventilation (Mechanical Ventilation/MV and Extracorporeal Membrane Oxygenation/ECMO) and racial identity of the patient for the pre-Delta and Delta timeframes. · Methods: We used data available from the National COVID Cohort Collaborative (N3C) of COVID positive patients across the US. Cox regression models were used to estimate time to MV and ECMO as the dependent variables and race, age, gender, Comorbidity index as covariates. · Results: We did not find systematic patterns of racial disparity in time to MV. Asian and Hispanic patients, but not Black patients, received MV in a delayed manner compared to White patients in the pre-Delta period. These differences were not evident in the Delta period. · Conclusions: The results show a temporal change from the pre-Delta and Delta timeframes for the time to invasive ventilation implying that any observed racial disparities improved over time. We did not find statistically significant differences in the time to ECMO across the races or over timeframes.

Symptoms of COVID-19 in a population-based cohort study (preprint)

Accurate diagnosis of potential SARS-CoV-2 infections by symptoms is one strategy for continuing global surveillance, particularly in low-resource communities. We conducted a prospective, population-based cohort study, the Arizona CoVHORT, among Arizona residents to elucidate the symptom profile of laboratory-confirmed COVID-19 participants(16.2%) compared to laboratory-confirmed negative(22.4%) and untested general population participants(61.4%). Among the 1514 study participants, those who were COVID-19 positive were more likely to be Hispanic(33.5%) and more likely to report obesity > 30 kg/m2(34.7%) compared to COVID-19 negative participants(19.2%; 31.0%) and untested CoVHORT participants(13.8%; 23.8%). Of the 245 laboratory-confirmed COVID-19 cases, 15.0% reported having had no symptoms. Of those that did report symptoms, the most commonly-reported first symptoms were sore throat(19.0%), headache(15.5%), cough(12.7%), runny nose/cold-like symptoms(12.1%), and fatigue(12.0%). In adjusted logistic regression models, COVID-19 positive participants were more likely than negative participants to experience loss of taste and smell(OR:35.7; 95% CI 18.4-69.5); bone or nerve pain(OR:17.9; 95% CI 6.7-47.4), vomiting(OR:10.8; 95% CI 3.1-37.5), nausea(OR:10.5; 95% CI 5.5-19.9), and headache(OR:8.4; 95% CI 5.6-12.8). When comparing confirmed COVID-19 cases with confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.