The Impact of COVID-19 on Medical Legal Partnerships and Their Pediatric Patient clients

Background: Medical Legal Partnerships (MLPs) help address the social determinants of health or health-harming legal needs impacting the health and wellbeing of vulnerable pediatric patients and families. Methods: To examine the impact of COVID-19 on MLPs and the children and families they serve, we conducted 96 semi-structured interviews with 18 clients and 78 MLP staff including legal aid staff, attorneys, health and social workers, and health administrators from programs in 10 states representing 5 U.S. regions. Six of these MLPs have a children's hospital as a medical partner. Interviews were collected between March and November 2020, capturing the initial and long-term impact of COVID-19. Results: Initially, MLP partner clinics had reduced patient volumes in response to the pandemic resulting in decreased MLP referrals. Later in the pandemic, however, MLP's saw an increase in demand for assistance with employment, housing, education, food insecurity and access to healthcare. Of 81 interviews with statements related to the impact of COVID 19 on clients, over half identified employment issues due to COVID exposure and increased evictions as problems for their patient-clients. Nearly one third of the 81 interviews discussed how children's educational needs were impacted by COVID. They cited families experiencing difficulties accessing educational resources at home, trouble receiving IEP services, and behavioral problems related to the transition to non-traditional education. MLPs also noted increased food insecurity, inequities in internet access and subsequent educational outcomes, and an increased time to resolve issues due to closed schools and courts. Furthermore, several MLP sites were challenged with the shift to remote work. No longer being at the clinical site made it more difficult to coordinate referral intake and consults with medical partners and trainings had to become virtual. Programs also noted there were fewer resources available during the pandemic to help families meet their needs. A few MLPs also experience reduced funding in their own programs which sometimes resulted in a decrease in legal personnel to provide services. Conclusion: The COVID 19 pandemic exacerbated the need for civil legal services to address social determinants of health for low-income families while simultaneously creating new barriers to resolution of those legal needs and reducing access to resources for children and their families.

Head-to-head performance comparison of self-collected nasal versus professional-collected nasopharyngeal swab for a WHO-listed SARS-CoV-2 antigen-detecting rapid diagnostic test.

In 2020, the World Health Organization (WHO) recommended two SARS-CoV-2 lateral flow antigen-detecting rapid diagnostics tests (Ag-RDTs), both initially with nasopharyngeal (NP) sample collection. Independent head-to-head studies are necessary for SARS-CoV-2 Ag-RDT nasal sampling to demonstrate comparability of performance with nasopharyngeal (NP) sampling. We conducted a head-to-head comparison study of a supervised, self-collected nasal mid-turbinate (NMT) swab and a professional-collected NP swab, using the Panbio™ Ag-RDT (distributed by Abbott). We calculated positive and negative percent agreement between the sampling methods as well as sensitivity and specificity for both sampling techniques compared to the reference standard reverse transcription polymerase chain reaction (RT-PCR). A SARS-CoV-2 infection could be diagnosed by RT-PCR in 45 of 290 participants (15.5%). Comparing the NMT and NP sampling the positive percent agreement of the Ag-RDT was 88.1% (37/42 PCR positives detected; CI 75.0-94.8%). The negative percent agreement was 98.8% (245/248; CI 96.5-99.6%). The overall sensitivity of Panbio with NMT sampling was 84.4% (38/45; CI 71.2-92.3%) and 88.9% (40/45; CI 76.5-95.5%) with NP sampling. Specificity was 99.2% (243/245; CI 97.1-99.8%) for both, NP and NMT sampling. The sensitivity of the Panbio test in participants with high viral load (> 7 log10 SARS-CoV-2 RNA copies/mL) was 96.3% (CI 81.7-99.8%) for both, NMT and NP sampling. For the Panbio supervised NMT self-sampling yields comparable results to NP sampling. This suggests that nasal self-sampling could be used for to enable scaled-up population testing.Clinical Trial DRKS00021220.

Intersectoral online training and exchange during the covid-19 pandemic in a district: Component for intersectoral communication of care

In anticipation of the pressure of the rising numbers in COVID-19 cases on the regional health system, an exchange between the actors engaged in handling the pandemic from a medical perspective in the district of Rhein-Neckar/ Heidelberg was initiated in October 2020. The outpatient and inpatient sector as well as the public health office of the district and the Department of Family Medicine and Health Services Research of the University Hospital participated. A mutual online meeting was planned to enable bidirectional exchange at the intersection of primary care. The mutually identified topics, like criteria for admission, therapy and nursing homes were ver-ified via an online survey (n = 63 participants, 76 % family physicians). Additional topics that had been suggested were passed on to the intersectional actors and, wherever possible, included in the meeting. On 11 December 2020, 71 physicians attended the meeting. In addition to the presentations, 53 questions were asked and discussed by the presenters via chat. Demand for a follow-up meeting was high. In January, a follow-up event with n = 115 participants focusing on COVID-19 vaccinations war organized, again with an active participation and a high request for a follow-up meeting. So, the experiences encourage to continue this format, involving all the actors relevant for a medical management of the pan-demic. This could be a component for fostering a bilateral communication, on the one hand engaging the actors of the primary care sector and on the other hand providing continuing medical education in the dynamic pandemic.

A description and analysis of covid-19 in a populationrepresentative cohort

Background: Most data on COVID-19 was collected in hospitalized cases. Much less is known about the spectrum of disease in entire populations including nonhospitalized patients and minors. In this study, we examine a representative cohort in an administrative district in Southern Germany who tested positive for SARS-CoV-2 between February and June of 2020. Methods: We contacted all confirmed SARS-CoV-2 cases in an administrative district in southern Germany. Consenting participants answered a retrospective survey either via a telephone, electronically or via mail. Clinical and sociodemographic features were compared between hospitalized and non-hospitalized patients. Additionally, we assessed potential risk factors for hospitalization and time to hospitalization in a series of regression models. As predictors we assessed age as a continuous variable, sex, smoking as a continuous variable using pack years, living with children (age <18), hypertension (yes/no), coronary heart disease (CHD;yes/no), diabetes (type 1 or type 2;yes/no) and lung conditions (yes/no). Lung conditions were defined as a combined variable of either COPD, asthma treated with medications, any other lung disease or previously performed lung surgery. Secondly, we estimated the influence of the same covariates on the time from symptom onset to hospitalization with a Cox proportional hazard ratio (HR) model. Results: We included 897 participants in our study, 69% out of 1,305 total cases in the district with a mean age of 47 years (range 2-97), 51% of which were female and 47% had a pre-existing illness. The percentage of asymptomatic, mild (symptomatic, no hospitalization), moderate (leading to hospital admission) and critical illness (requiring mechanical ventilation) was 54 patients (6%), 713 (79%), 97 (11%) and 16 (2%), respectively. Seventeen patients (2%) died. The most prevalent symptoms were fatigue (65%), cough (62%) and dysgeusia (60%). The risk factors for hospitalization included older age (OR 1.05 per year increase;95% CI 1.04-1.07) preexisting lung conditions (OR 3.09;95% CI 1.62-5.88). Female sex was a protective factor (OR 0.51;95% CI 0.33-0.77). Conclusion: This population-representative analysis of COVID-19 cases confirms age, male sex and preexisting lung conditions but not cardiovascular disease as risk factors for severe illness. Almost 80% of infection take a mild course, whereas 13% of patients suffer moderate to severe illness.