ABSTRACT
Study Objectives: Emergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites and willingness to get the vaccine as part of ED care. Methods: Cross sectional survey conducted from 12/10/2020 to 3/7/21 at 15 safety net United States EDs. Primary outcomes were COVID-19 vaccine hesitancy, reasons for vaccine hesitancy, and sites (including EDs) for potential COVID-19 vaccine receipt. Results: Of 2575 patients approached, 2301 (89.4%) participated. Of the 18.4% of respondents who lacked a regular source of medical care, 65% used the ED as their usual source of health care. The overall rate of vaccine hesitancy was 39%;the range among the 15 sites was 28 to 58%. Respondents who lacked a regular source of medical care were more commonly vaccine hesitant than those who had a regular source of medical care (47 vs 38%, 9% difference, 95% CI 4 – 14%). Other characteristics associated with greater vaccine hesitancy were younger age (median 40 vs 52, p < 0.0001), (female sex (45% vs 33%;difference 12%, 95% CI 8 to 16%), African-American race (54% vs 30%;difference 24%, 95% CI 19 to 29%), Latinx ethnicity (39% vs 30%;difference 9%, 95% CI 4 to 14%), and not having a prior influenza vaccine in the past five years (58% vs 31%;difference 27%, 95% CI 23 to 32%). Homelessness and uninsured status were not associated with greater vaccine hesitancy. Fewer vaccine hesitant respondents reported that some or all of their family members would accept the COVID-19 vaccine if it was offered to them (29% vs 75%, 46% difference, 95% CI 42 to 50%). Of the 61% COVID-19 vaccine acceptors, 21% stated that they lacked a primary doctor or clinic to receive it. The vast majority (95%) of these respondents lacking primary care would accept the COVID-19 vaccine as part of their care in the ED. Conclusions: ED patients who lack a regular source of medical care are particularly hesitant to COVID-19 vaccination. Most COVID-19 vaccine acceptors would accept it as part of their care in the ED. EDs may have pivotal roles in COVID-19 vaccine messaging and delivery to highly vulnerable populations.
ABSTRACT
Study Objectives: During the COVID-19 pandemic, the use of facemasks by the general population has become a significant issue despite evidence that shows that facemask use is associated with reduced transmission of SARS-CoV-2, the causative organism of COVID-19. We assessed beliefs, access, and practices of mask wearing across an ED population. Methods: This was a cross sectional survey of ED patients conducted from 12/14/20 - 2/22/21 at 15 geographically diverse safety net EDs. The survey asked questions regarding COVID-19 vaccine and the use of facemasks. In this analysis, the primary outcome was reporting the responses to survey questions regarding mask wearing practice and patient access to masks. Results: Of 2513 patients approached, 2239 (89.1%) agreed to participate. The median age of respondents was 48 years (IQR 34 - 62). The race and ethnicity reported for participants were: 40% White, 29% Black, 24% Latinx and 5% Asian. All other categories each accounted for 1% or less of the respondents. 14.8% reported that they had previously been diagnosed with COVID-19. Most respondents (81%) had primary care doctors or clinics. Of those without primary care, 64% used the ED as their usual source of health care. 78% of respondents reported wearing masks “all of the time” and 17% reported wearing masks >50% of the time. Subjects with primary care providers (PCPs) were more likely to report wearing masks at least most of the time as compared to subjects without primary care (97% vs 92%) Those with no PCP reported more difficulties obtaining masks compared to those who have a PCP (13% vs 6%, p < 0.001). The primary reasons respondents cited for not wearing masks were that they do not believe that masks work, masks are uncomfortable, and masks make it hard to breathe. Subjects with a PCP and those without a PCP both reported that the most common source of masks was through purchasing at a store or pharmacy. Subjects without a PCP were more likely to get masks from a shelter or food bank as compared to those without a PCP (6.5% vs 2.1%). Surveys were administered exclusively in urban EDs, and there may be response bias towards mask wearing in the hospital setting. Conclusion: Overall, respondents in the study reported a high rate of facemask wearing. Having a PCP was associated with higher proportion of respondents who reported wearing a mask at least 50% of the time. Respondents without a PCP also reported greater barriers in obtaining masks than those with a PCP. The results of this study inform on the acceptance rate of facemask usage in a large population of ED patients primarily in an urban setting. Having a PCP provides opportunities for education and distribution of facemasks. There is an opportunity to increase facemask usage through increased education and availability.