ABSTRACT
BACKGROUND: The East Harlem Health Outreach Partnership (EHHOP) is a student-run clinic that serves a particularly vulnerable patient population lacking access to basic health insurance, largely because many do not meet USA residency requirements. COVID-19 has exacerbated the existing health disparities faced by our patients, who are predominantly Black and/or Hispanic/Latino living in East Harlem, one of the hardest hit neighborhoods in NYC. We hypothesized that high engagement in longitudinal care through the student-run clinic is associated with especially high rates of vaccine confidence and vaccine uptake. METHODS: This study included phone interviews with 63 EHHOP patients between 12/13/20 and 3/3/21. We asked 14 questions in order to measure vaccine confidence, COVID-19 sentiment, and patient trust. Patients were ages 21-78 with an even distribution of male and female patients. Most interviews were conducted in Spanish with professional translators, and the survey was created both in English and Spanish. All questions were scored on a 1-5 scale of agreement with a given. Patients were then followed through December of 2021 in order to ascertain vaccine uptake over time. RESULTS: 95.2% of those interviewed are now confirmed to be vaccinated (60/63), 3.2% have refused (2/63), and only 1.6% have unknown status (1/63). Both patients who chose not to be vaccinated had responded they were unlikely to get the COVID-19 vaccine. When comparing those likely to get the vaccine versus those who were not, the most highly significant differences in scores came when asking whether patients are more likely to take the vaccine due to their physician recommending it, and when asked whether they generally trusted those recommending they get the vaccine (p = 4.8E-5 and 4.3E-6 respectively). The next most significant differences were in perceptions of whether the vaccine would be effective and whether they felt the vaccine was created too quickly (p = 3.3E-2 and 5.3E-3 respectively). We also have precise day of first dose information for 51/60 vaccinated respondents. While there may be confounders, we found that choosing to be vaccinated earlier correlated most significantly with whether individuals were likely to take the vaccine, whether the trusted those recommending the vaccine, and whether they felt the vaccine was created too quickly (p = 3.6E-2, 1.5E-2, and 1.4E-2 respectively). CONCLUSIONS: These data indicate that the strongest predictors of vaccine uptake rate and timing are not just vaccine confidence in general, but specifically trust in those recommending the vaccine. This indicates that even in the context of marginalized populations often underserved by the healthcare system, longitudinal trust-building relationships may be a significant part of successful vaccine uptake. Those with the highest burden of disease should be given preferential treatment with high-quality, longitudinal care, and such care is shown to make a great difference in the context of vaccine uptake.
ABSTRACT
Background: SARS-Cov-2 (severe acute respiratory disease coronavirus 2) causes Coronavirus Disease 2019 (COVID19) and is associated with respiratory failure and death in severe disease. This is associated with high levels of cytokines such as IL-6, IL-8 and TNF-alpha which are predictors of severe outcomes. SARSCoV- 2 leads to activation of the NLRP3 inflammasome which results in secretion of the cytokine IL-1ß. While high levels of IL-1ß are not observed in most patients with severe COVID-19, there is a subset of patients with high IL-1ß levels. Here we sought to characterize these patients and determine whether high IL-1ß levels are associated with adverse outcomes and death in COVID-19. Methods: We identified 90 patients with high IL-1ß levels (greater or equal to 2 pg/ml) and laboratory confirmed COVID-19 hospitalized in our hospital system in New York March 12 and May 8, 2020. We collected baseline clinical characteristics, laboratory values, COVID-19 treatment, and outcomes from this group and the group with IL-1ß levels below 2 pg/ml. Baseline clinical characteristics and outcomes were compared. Results: Comparing patients by IL-1ß level had similar demographics (age, sex, race/ethnicity, smoking status and comorbid disease prevalence). The group had comparable levels of adverse markers of disease severity but the patients with high IL-1ß had increased inflammatory biomarkers including IL-8 (629 vs. 68 pg/ml, p< 0.0001), TNF-alpha (30 vs. 51 pg/ml, p< 0.0001), IL-6 (173 vs. 5075 pg/ml, p< 0.0001), CRP (141 vs. 178, p=0.0007), d-dimer (2.6 vs. 4 p=0.0002), and increased rates of death (30% vs. 20%, p=0.008). Conclusion: Demographic and comorbid conditions are not effective at predicting high IL-1ß serum levels in COVID-19 patients, however those individuals with high levels are at risk for adverse outcomes of severe disease and death. Further investigation is required to probe the mechanism of NLRP3 inflammasome activation and IL-1ß signaling and the role of this cytokine in mediated inflammation and death in COVID-19.