Hepatitis C Virus Screening among Baby Boomers: The Positive Benefits of Health Education and Outreach during the COVID-19 Pandemic.

In 2019, 2020, and 2021, Sendero Health Plans, an ACA health insurance company, implemented Hepatitis C Virus (HCV) health education and outreach screening campaigns. Chi-square goodness-of-fit and tests of independence were performed to assess and compare the uptake of HCV screening among baby boomers in 2019, 2020, and 2021. In 2019, 2020, and 2021, 17.9% (308/1,718), 10.9% (93/852), and 8.5% (37/435) of eligible members were screened, respectively. Individuals were more likely to be screened for HCV in 2019 than in 2020 and 2021 (p < 0.0001). In 2019, 2020, and 2021, 39.9%, 26.9%, and 48.6% of annual screenings occurred during the health campaign months, respectively. Annual HCV screening rates were lower during the COVID-19 pandemic period than in the pre-pandemic cohort. However, screening rates during the months of outreach and education contributed to nearly 50% of annual screenings in the pandemic year 2021, thus representing a positive impact on preventive screening uptake despite the pandemic. Missed screening opportunities affect HCV transmission, diagnosis, and treatment. Yet, health education and outreach continue to work, even during a pandemic.

COVID-19 Vaccine Acceptors, Refusers, and the Moveable Middle: A Qualitative Study from Central Texas.

COVID-19 has caused excessive morbidity and mortality worldwide. COVID-19 vaccines, including the two mRNA vaccines, were developed to help mitigate COVID-19 and to move society towards herd immunity. Despite the strong efficacy and effectiveness profile of these vaccines, there remains a degree of vaccine hesitancy among the population. To better understand hesitancy associated with COVID-19 vaccines and to delineate between those who are vaccine acceptors, vaccine refusers, and the moveable middle, we conducted a cross-sectional survey to understand respondents' decision to receive, or not, a COVID-19 vaccine at the onset of mRNA vaccine availability in Central Texas. A total of 737 individuals responded, with 685 responses classified to one of eight domains: A: End to the Pandemic (n = 48); B: Trust in Medical Community (n = 27); C: Illness-Focused Perceptions (n = 331); D: Social Motivation (n = 54); E: Vaccine-Focused Perceptions (n = 183); F: Knowledge Gap (n = 14); G: Underlying Health Concern (n = 9); and H: Undecided (n = 19). Vaccine acceptors (n = 535) were primarily represented in domains A-E, while vaccine refusers (n = 26) were primarily represented in domains C, E, G, and H. The moveable middle (n = 124) was primarily represented by domains C-H. These findings show clear delineations between vaccine acceptors, vaccine refusers, and the moveable middle across eight domains that can assist public health professionals in addressing vaccine hesitancy.

Patient factors associated with SARS-CoV-2 in an admitted emergency department population.

Background: The SARS-CoV-2 (COVID-19) virus has wide community spread. The aim of this study was to describe patient characteristics and to identify factors associated with COVID-19 among emergency department (ED) patients under investigation for COVID-19 who were admitted to the hospital. Methods: This was a retrospective observational study from 8 EDs within a 9-hospital health system. Patients with COVID-19 testing around the time of hospital admission were included. The primary outcome measure was COVID-19 test result. Patient characteristics were described and a multivariable logistic regression model was used to identify factors associated with a positive COVID-19 test. Results: During the study period from March 1, 2020 to April 8, 2020, 2182 admitted patients had a test resulted for COVID-19. Of these patients, 786 (36%) had a positive test result. For COVID-19-positive patients, 63 (8.1%) died during hospitalization. COVID-19-positive patients had lower pulse oximetry (0.91 [95% confidence interval, CI], [0.88-0.94]), higher temperatures (1.36 [1.26-1.47]), and lower leukocyte counts than negative patients (0.78 [0.75-0.82]). Chronic lung disease (odds ratio [OR] 0.68, [0.52-0.90]) and histories of alcohol (0.64 [0.42-0.99]) or substance abuse (0.39 [0.25-0.62]) were less likely to be associated with a positive COVID-19 result. Conclusion: We observed a high percentage of positive results among an admitted ED cohort under investigation for COVID-19. Patient factors may be useful in early differentiation of patients with COVID-19 from similarly presenting respiratory illnesses although no single factor will serve this purpose.

Sociodemographic Factors Associated with Vaccine Hesitancy in Central Texas Immediately Prior to COVID-19 Vaccine Availability.

Vaccine-induced herd immunity remains the best opportunity for ending the COVID-19 pandemic. However, COVID-19 vaccine hesitancy is a real concern. In this paper, we report on vaccine hesitancy in Central Texas immediately prior to the release of the two mRNA COVID-19 vaccines in late December 2020. A total of 1648 individuals 18 years or older with health insurance living in Central Texas completed a survey on sociodemographic factors and plans to obtain the COVID-19 vaccine. Of the respondents, 64.1% planned to obtain the COVID-19 vaccine. Logistic regression identified the following sociodemographic factors associated with vaccine hesitancy: Black or African American race (POR: 0.351, p < 0.001, 95% CI: 0.211, 0.584), female sex (POR: 0.650, p < 0.001, 95% CI: 0.518, 0.816), age of 35-49 years old (POR: 0.689, p = 0.004, 95% CI: 0.534, 0.890), annual household income of less than US$10,000 (POR: 0.565, p = 0.041, 95% CI: 0.327, 0.976), a high school education or less (POR: 0.565, p = 0.001, 95% CI: 0.401, 0.795), and a high school education but less than a 4-year college degree (POR: 0.572, p < 0.001, 95% CI: 0.442, 0.739). Real-world evidence provided by individuals on plans to get vaccinated can reveal COVID-19 vaccine hesitancy associated heterogeneity.

COVID-19 and Pediatric Gastroenterology.

Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.

Respiratory syncytial virus and palivizumab prophylaxis in the COVID-19 era: CMAJ

Across Canada, both influenza and respiratory syncytial virus (RSV) have been almost completely absent during the 2020/21 winter. Data from the Southern hemisphere showed the same phenomenon following the implementation of public health measures for coronavirus disease 2019. Despite the low incidence of RSV, programs across Canada have continued to promote the administration of palivizumab (PVZ) prophylaxis to eligible infants at a cost of about $1500 per dose. Canadian taxpayers are currently on track to spend nearly $50 million on a drug unlikely to have any benefit this winter. Here, the effectiveness of PVZ prophylaxis for infants is examined.

Clinical characteristics and outcomes for 7,995 patients with SARS-CoV-2 infection.

OBJECTIVE: Severe acute respiratory syndrome virus (SARS-CoV-2) has infected millions of people worldwide. Our goal was to identify risk factors associated with admission and disease severity in patients with SARS-CoV-2. DESIGN: This was an observational, retrospective study based on real-world data for 7,995 patients with SARS-CoV-2 from a clinical data repository. SETTING: Yale New Haven Health (YNHH) is a five-hospital academic health system serving a diverse patient population with community and teaching facilities in both urban and suburban areas. POPULATIONS: The study included adult patients who had SARS-CoV-2 testing at YNHH between March 1 and April 30, 2020. MAIN OUTCOME AND PERFORMANCE MEASURES: Primary outcomes were admission and in-hospital mortality for patients with SARS-CoV-2 infection as determined by RT-PCR testing. We also assessed features associated with the need for respiratory support. RESULTS: Of the 28605 patients tested for SARS-CoV-2, 7995 patients (27.9%) had an infection (median age 52.3 years) and 2154 (26.9%) of these had an associated admission (median age 66.2 years). Of admitted patients, 2152 (99.9%) had a discharge disposition at the end of the study period. Of these, 329 (15.3%) required invasive mechanical ventilation and 305 (14.2%) expired. Increased age and male sex were positively associated with admission and in-hospital mortality (median age 80.7 years), while comorbidities had a much weaker association with the risk of admission or mortality. Black race (OR 1.43, 95%CI 1.14-1.78) and Hispanic ethnicity (OR 1.81, 95%CI 1.50-2.18) were identified as risk factors for admission, but, among discharged patients, age-adjusted in-hospital mortality was not significantly different among racial and ethnic groups. CONCLUSIONS: This observational study identified, among people testing positive for SARS-CoV-2 infection, older age and male sex as the most strongly associated risks for admission and in-hospital mortality in patients with SARS-CoV-2 infection. While minority racial and ethnic groups had increased burden of disease and risk of admission, age-adjusted in-hospital mortality for discharged patients was not significantly different among racial and ethnic groups. Ongoing studies will be needed to continue to evaluate these risks, particularly in the setting of evolving treatment guidelines.

Using Health Insurance Network Provider Data and Public Data Sets to Identify SARS-CoV-2 Vaccinators in the USA.

Objective: Mass vaccination planning is occurring at all levels of government in advance of regulatory approval and manufacture of a SARS-CoV-2 vaccine for distribution sometime in 2021. We outline a methodology in which both health insurance provider network data and publicly available data sources can be used to identify and plan for SARS-CoV-2 vaccinator capacity at the county level. Methods: Sendero Health Plans, Inc. provider network data, Texas State Board of Pharmacy data, US Census Bureau data, and H1N1 monovalent vaccine data were utilized to identify providers with demonstrated capacity to vaccinate the population in Travis County, Texas to achieve an estimated SARS-CoV-2 herd immunity target of 67%. Results: Within the Sendero network, 2,356 non-pharmacy providers were identified with 788 (33.4%) practicing in primary care and 1,569 (66.6%) practicing as specialists. Of the total, 686 (29.1%) provided at least one immunization between January 1, 2019 and September 30, 2020. There are 300 pharmacies with active licenses in Travis County with 161 (53.7%) classified as community pharmacies. We estimate that 1,707,098 doses of a 2-dose SARS-CoV-2 vaccine series will need to be administered within Travis County, Texas to achieve the estimated 67% herd immunity threshold to disrupt person-to-person transmission of the SARS-CoV-2 virus based on 2020 census data. Conclusion: A community-based health insurance plan can use data from its provider network and public data sources to support the CDC call to action to identify SARS-CoV-2 vaccinators in the community, including physicians, nurse practitioners, physician assistants, and pharmacies in order to provide macro level estimates of SARS-CoV-2 administration and throughput.

Telehealth in Palliative Care: Communication Strategies From the COVID-19 Pandemic.

Palliative care was once believed to be too high-touch to be delivered via telehealth. However, numerous studies have demonstrated the positive effects of palliative care delivered through telehealth. Because the COVID-19 pandemic has quickly shifted how health care is delivered to patients with cancer, particularly because of their immunocompromised status and the risks associated with unnecessary exposures in the clinic, previous lessons from palliative care research studies can be used to inform practice. This article presents a case study that illustrates evidence and best practices for continuing to deliver palliative care via telehealth after COVID-19 restrictions are lifted.