COVID-19: Highlighting Health Disparities in the Los Angeles Latinx Community.

Objective: Characterization of COVID-19 in the Latinx community is necessary for guiding public health initiatives, health system policy, clinical management practices, and improving outcomes. Our aim was to describe the socioeconomic background and clinical profile of patients with COVID-19 at a large public hospital in Los Angeles to improve health disparities leading to poor outcomes during the pandemic.Design, Setting and Participants: A single center retrospective cross-sectional study of all patients with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to Los Angeles County (LAC)+University of Southern California (USC) Medical Center between March 15, 2020 and April 30, 2020.Methods: We describe patient characteristics, socioeconomic factors, laboratory findings, and outcomes of the first 278 patients to present to LAC+USC Medical Center with COVID-19.Results: Patients self-identified as Hispanic (82.4%) or non-Hispanic (17.6%). Hispanic patients presented later from symptom onset (6 days vs 3 days, P = 0.027) and had higher post-intubation mortality (40.9% vs. 33.3%, P = 1), intensive care unit (ICU) mortality (31.1% vs. 22.2%, P = 0.87), and overall mortality (11.1% vs 10.2%, P = 1). However, the difference in admission rates, mechanical ventilation rates, and overall mortality rates were not statistically significant. A majority of patients, 275/278 (98.9%), reported residency ZIP codes in areas of higher population density, higher percentage of Latinx, born outside the United States, lower median income, and lower high school graduation rate when compared to the rest of Los Angeles County. Regression analysis within the Hispanic cohort found that age, history of hypertension, history of diabetes, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were predictors of mechanical ventilation and mortality.Conclusion: We show the Latinx community has been disproportionally affected by the pandemic in Los Angeles and we identified multiple socioeconomic and clinical characteristics that predispose this population to COVID-19 infection. This study highlights the need for change in local and national strategies to protect vulnerable communities during public health outbreaks.

Do COVID-19 Apps Address Diabetes Mellitus and Health Equity Issues

Purpose: To evaluate if COVID-19 apps address risk factors such as diabetes, hypertension, race, gender, sexual orientation, language. Background: In 2019, there were 204 Billion app downloads and 3.7 billion downloads of ehealth apps. COVID-19 affects ethnic minority patients with diabetes, hypertension, and other risk factors. Spanish is the second most commonly used language after English in the U.S.. African Americans, Hispanic Americans, and Asian Americans are at an increased risk of COVID-19. LGBTQ+ communities are also at higher risk for COVID due to historically poor access to healthcare. Methods: The search term, “COVID,” in Google Play store and Apple App store was used to find the most popular COVID-19 apps. App inclusion criteria: 1) Contains COVID-19 information and/or COVID symptom tracker, 2) Marketed and designed for the general public, 3) Free, 4) Android (DROID): 100,000+ Downloads;Apple (iOS): highest star ratings. Apple does not provide a number of downloads. App features: COVID-19 information, COVID-19 symptom questionnaire (QN), Diabetes, Hypertension, Cardiovascular disease, Languages (Spanish, Chinese), Race, Gender, and Sexual Orientation. Results: The top 10 DROID apps in descending order are: 1) GuideSafe, 2) CO Exposure Notifications, 3) Care19 Diary, 4) Care19 Alert, 5) Crush COVID RI, 6) MI COVID Alert, 7) DC CAN, 8) CombatCOVID MDC, 9) CombatCOVID PBC, 10) Stronger than C19. The top 10 iOS apps in descending order are: 1) SlowCOVIDNC, 2) COVIDWISE, 3) COVID Alert Pennsylvania, 4) COVID Alert DE, 5) COVID Alert NY, 6) Covid Watch Arizona, 7) Apple COVID-19, 8) COVID Alert NJ, 9) COVID Trace Nevada, 10) CDC. Of the 20 apps: COVID 19 information: 20/20;COVID-19 symptom QN: 8/20;DM: 2/20;HTN: 1/20;CardioVasc: 2/20;Spanish: 11/20 (2/11 of the Spanish apps have Chinese as well). Race: 5/20. Gender: 8/20;Sexual Orientation: 3/20;Age: 10/20. Conclusion: 1) Most apps do not ask about important risk factors such as DM, HTN, and Race. 2) Smartphone apps are not uniform in their health education features. 3) Healthcare providers should continue to play an important role in public education despite the ubiquity of mobile apps.

Diabetes Apps: Information about COVID-19 and Risk Factors?

Background: Annually, there are 3.7 billion downloads of mobile health apps. There are 275.6 million smartphones in the US. Diabetes affects 34.2 million people and 88 million have prediabetes. Diabetes is a risk factor for COVID-19 and affects longterm health of the survivors. Other risk factors for COVID-19, include race and gender. There are also linguistic barriers to care in Diabetes and COVID-19. Both diabetes and COVID-19 have higher risks associated with race and ethnicity. With the pandemic, the US government, Google and Facebook, in March 2020, provided emergency grants for COVID-19 and dissemination of public education. Did the Diabetes apps meet this moment of public health crisis?. Purpose: Do Diabetes Apps provide information about COVID-19 and its risk factors? Methods: Using the search term “diabetes,” the top ten most downloaded android and iOS apps were assessed in the Google Play Store/Apple App Store, respectively. Inclusion criteria: 1) Android: Downloads >100,000;iOS: Reviews >300, star rating >4. Apple App store does not provide download information. 2) Free;3) Ability to track health data: HbA1C, FBS;4) Language Accessibility via in-app language settings. Results: In the Google Play Store(DROID), the top ten apps in descending order were: 1) mySugr, 2) Onetouch Reveal, 3) OneDrop Diabetes Management, 4) Diabetes: M, 5) Health2Sync - Diabetes Care, 6) Diabetes, 7) Ontrack Diabetes, 8) Blood Glucose Tracker, 9) Glucose Buddy Diabetes Tracker, and 10) Diabetes Connect. In the Apple App Store(iOS), the top ten apps in descending order were: 1) OneTouch Reveal, 2) Glucose Buddy Diabetes, 3) One Drop for Diabetes, 4) Glucose - Blood Sugar Tracker, 5) Blood Sugar Monitor by Dario, 6) mySugr, 7) Sugarmate, 8) DiabetesPal, 9) Diabetes:M, 10) Center Health - The Diabetes App. Of the 10 DROID apps: 0/10 had COVID symptom information in the app;3/10 had a COVID statement;In-app language settings: 2/10 had Spanish and 1/10 had Chinese. Gender: 7/10 Droid apps. Race/Ethnicity: 0/10. Of the ten iOS apps: 0/10 had COVID symptom information in the app;4/10 had a COVID statement (Only mySugr has CDC link for COVID information);In-app language settings: 1/10 had Spanish and 0/10 had Chinese settings. Gender: 9/10 Droid apps;7/10 iOS apps, Race/Ethnicty:1/10. Conclusion: Of the top 20 diabetes apps, none had information about COVID-19 and its symptoms within the app. Also, the overall language accessibility is limited. Despite popularity of ehealth, physicians can continue to play an important role in public education about Diabetes and COVID-19 during this important time of the pandemic.