Long-Term Fine Particulate Matter Concentrations and Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2: Differential Relationships by Socioeconomic Status Among Pregnant Individuals in New York City.

We aimed to determine whether long-term ambient concentrations of fine particulate matter (particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM2.5)) were associated with increased risk of testing positive for coronavirus disease 2019 (COVID-19) among pregnant individuals who were universally screened at delivery and whether socioeconomic status (SES) modified this relationship. We used obstetrical data collected from New-York Presbyterian Hospital/Columbia University Irving Medical Center in New York, New York, between March and December 2020, including data on Medicaid use (a proxy for low SES) and COVID-19 test results. We linked estimated 2018-2019 PM2.5 concentrations (300-m resolution) with census-tract-level population density, household size, income, and mobility (as measured by mobile-device use) on the basis of residential address. Analyses included 3,318 individuals; 5% tested positive for COVID-19 at delivery, 8% tested positive during pregnancy, and 48% used Medicaid. Average long-term PM2.5 concentrations were 7.4 (standard deviation, 0.8) µg/m3. In adjusted multilevel logistic regression models, we saw no association between PM2.5 and ever testing positive for COVID-19; however, odds were elevated among those using Medicaid (per 1-µg/m3 increase, odds ratio = 1.6, 95% confidence interval: 1.0, 2.5). Further, while only 22% of those testing positive showed symptoms, 69% of symptomatic individuals used Medicaid. SES, including unmeasured occupational exposures or increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to concurrent social and environmental exposures, may explain the increased odds of testing positive for COVID-19 being confined to vulnerable pregnant individuals using Medicaid.

Association between neighborhood socioeconomic status, built environment and SARS-CoV-2 infection among cancer patients treated at a Tertiary Cancer Center in New York City.

BACKGROUND: Racial and ethnic minority groups experience a disproportionate burden of SARS-CoV-2 illness and studies suggest that cancer patients are at a particular risk for severe SARS-CoV-2 infection. AIMS: The objective of this study was examine the association between neighborhood characteristics and SARS-CoV-2 infection among patients with cancer. METHODS AND RESULTS: We performed a cross-sectional study of New York City residents receiving treatment for cancer at a tertiary cancer center. Patients were linked by their address to data from the US Census Bureau's American Community Survey and to real estate tax data from New York's Department of City Planning. Models were used to both to estimate odds ratios (ORs) per unit increase and to predict probabilities (and 95% CI) of SARS-CoV2 infection. We identified 2350 New York City residents with cancer receiving treatment. Overall, 214 (9.1%) were infected with SARS-CoV-2. In adjusted models, the percentage of Hispanic/Latino population (aOR = 1.01; 95% CI, 1.005-1.02), unemployment rate (aOR = 1.10; 95% CI, 1.05-1.16), poverty rates (aOR = 1.02; 95% CI, 1.0002-1.03), rate of >1 person per room (aOR = 1.04; 95% CI, 1.01-1.07), average household size (aOR = 1.79; 95% CI, 1.23-2.59) and population density (aOR = 1.86; 95% CI, 1.27-2.72) were associated with SARS-CoV-2 infection. CONCLUSION: Among cancer patients in New York City receiving anti-cancer therapy, SARS-CoV-2 infection was associated with neighborhood- and building-level markers of larger household membership, household crowding, and low socioeconomic status. NOVELTY AND IMPACT: We performed a cross-sectional analysis of residents of New York City receiving treatment for cancer in which we linked subjects to census and real estate date. This linkage is a novel way to examine the neighborhood characteristics that influence SARS-COV-2 infection. We found that among patients receiving anti-cancer therapy, SARS-CoV-2 infection was associated with building and neighborhood-level markers of household crowding, larger household membership, and low socioeconomic status. With ongoing surges of SARS-CoV-2 infections, these data may help in the development of interventions to decrease the morbidity and mortality associated with SARS-CoV-2 among cancer patients.

Lived experience of women diagnosed with a gynecologic cancer in the height of the COVID-19 pandemic in New York City (508)

Objectives: The COVID-19 pandemic has had an unprecedented impact on cancer care delivery in New York City (NYC), as the primary care and oncology communities alike struggled to meet the needs of patients in a time of great uncertainty. The purpose of this study was to examine the lived experience and short-term cancer outcomes of patients in NYC who received new diagnoses of gynecologic cancer in the setting of COVID-19. Methods: We employed a mixed-methods research study design. Patients with a new diagnosis of a gynecologic malignancy on or after May 1, 2020, were identified from the review of inpatient and outpatient medical records. Demographic and clinical data were extracted from the electronic medical record. Participants were contacted by phone and recruited for 45-minute to 1-hour semi-structured qualitative phone interviews, which were recorded and transcribed. Initial codes were identified to organize the data. The transcripts were analyzed via close reading and memo notes, employing Braun and Clarke’s thematic analysis techniques to generate the initial set of codes. Using an inductive approach, these codes were then grouped, allowing for the identification of underlying themes. Certain themes were reviewed, collapsed and expanded, and placed into sub-themes based on their prevalence in the collected data. Results: Of the 72 patients meeting study criteria, 42 (58%) were diagnosed at either stage I or stage II (“early stage”), while the remaining 30 (42%) had progressed to stage III-IV by the time of diagnosis (“late-stage”). Primary uterine malignancy was most frequent, accounting for 50% of all subjects, followed by ovarian (25%), cervical (11%), vulvar (10%), and 1% each of vaginal, gestational trophoblastic neoplasia, and concurrent ovarian and uterine neoplasms. Uterine and cervical cancers were more likely to be diagnosed at an early stage, while ovarian cancer was more likely to be diagnosed at a late stage. Across all cancer types and all stages, an average of 5.25 months elapsed between the first symptom and first treatment. A total of five patients, all belonging to the late-stage subgroup, died within six months of their diagnosis. Three major themes arose from our interviews: 1) suboptimal gynecologic care pre-COVID-19, 2) lack of knowledge regarding gynecologic issues, and 3) heightened challenges during the COVID-19 pandemic in receiving care. All participants had not seen gynecologists for 2-10 years prior to their diagnosis. All were up to date on their primary care visits—all described friends and family who dismissed their concerns. Two patients reported seeking information on the internet and a lack of follow-up of abnormal tests. In the setting of the COVID-19 pandemic, patients reported economic challenges (employment instability, inability to pay rent), emotional challenges (no visits allowed during chemotherapy, no visitors in the home, personal connections to persons who died from COVID-19), and clinical challenges (delayed and canceled diagnostic testing and follow-up appointments, concern that an overwhelmed health system may have contributed to delay in diagnosis). Conclusions: Patients diagnosed with gynecologic malignancies in the height of the COVID-19 pandemic in NYC faced significant challenges in receiving care, exacerbating pre-existing barriers to care and contributing to delays in both diagnosis and treatment.

Racial and ethnic disparities in pregnancy related to SARS-CoV-2 infection

Objective: To describe racial/ethnic differences in COVID-19 disease and perinatal outcomes among pregnant women delivering during the COVID-19 pandemic. Study Design: This is a retrospective cohort analysis of pregnant women delivering at a single institution in NYC who were universally tested for SARS-CoV-2 by RT-PCR or serology from March 13 to August 5, 2020. Women were classified by self-reported race/ethnicity into five groups - non-Hispanic Black ("Black"), non-Hispanic White ("White"), Hispanic, Asian and "other". Data on baseline characteristics, SARS-CoV-2 presentation and outcomes, and perinatal outcomes were collected and examined across groups of race/ethnicity in SARS-CoV-2 infected and uninfected women using Wilcoxon rank sum test for continuous variables and Fisher's exact test for categorical variables. The odds ratios (OR) for SARS-CoV-2 positivity and cesarean delivery were determined by logistic regression models with adjustment for demographic, medical and obstetric factors. Result(s): Of 2489 women who delivered, 1338 (53.8%) were Hispanic, 531 (21.3%) White, 252 (10.1%) Black, 127 (5.1%) Asian and 241 (9.7%) "other". The SARS-CoV-2 positivity rate was 11.1% (n=276). There was a significantly higher SARS-CoV-2 infection rate among Hispanic women compared to White women (15.6% vs 6.0%, p<=0.01), which persisted after controlling for confounders (OR 2.12, 95% CI 1.05, 4.27). The infection rate did not differ significantly among other racial/ethnic groups compared to White women. (Table 1) Hispanic and Black women were more likely to undergo cesarean (51% and 39% vs 28 %, p<=0.05), which persisted in Hispanic women after controlling for SARS-CoV-2 infection and confounders (OR 3.57, 95% CI 1.30, 9.80), but not in Black women. There were no differences in SARS-CoV-2 infection-associated outcomes or other perinatal complications. (Table 2) Conclusion(s): Hispanic women were disproportionately affected by SARS-CoV-2 in this population and were more likely to undergo cesarean compared to SARS-CoV-2-infected White women. This cesarean rate disparity could not be accounted for by SARS-CoV-2 infection. [Formula presented] [Formula presented]Copyright © 2020

Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures.

OBJECTIVE: To evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery. SUMMARY BACKGROUND DATA: Although COVID-19 infection is usually associated with mild disease, it can lead to severe respiratory complications. Little is known about the perioperative outcomes of patients with COVID-19. METHODS: We examined patients who underwent urgent and emergent surgery at 2 hospitals in New York City from March 17 to April 15, 2020. Elective surgical procedures were cancelled throughout and routine, laboratory based COVID-19 screening was instituted on April 1. Mortality, complications, and admission to the intensive care unit were compared between patients with COVID-19 detected perioperatively and controls. RESULTS: Among 468 subjects, 36 (7.7%) had confirmed COVID-19. Among those with COVID-19, 55.6% were detected preoperatively and 44.4% postoperatively. Before the routine preoperative COVID-19 laboratory screening, 7.7% of cases were diagnosed preoperatively compared to 65.2% after institution of screening (P = 0.0008). The perioperative mortality rate was 16.7% in those with COVID-19 compared to 1.4% in COVID-19 negative subjects [aRR = 9.29; 95% confidence interval (CI), 5.68-15.21]. Serious complications were identified in 58.3% of COVID-19 subjects versus 6.0% of controls (aRR = 7.02; 95%CI, 4.96-9.92). Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were more common in those with COVID-19. The intensive care unit admission rate was 36.1% in those with COVID-19 compared to 16.4% of controls (aRR = 1.34; 95%CI, 0.86-2.09). CONCLUSIONS: COVID-19 is associated with an increased risk for serious perioperative morbidity and mortality. A substantial number of patients with COVID-19 are not identified until after surgery.

Coronavirus Spectrum Infections (COVID-19, MERS, SARS) in Cancer Patients: A Systematic Review of the Literature.

BACKGROUND: Coronavirus 2019 (COVID-19) has spread rapidly around the world to become a global pandemic. There is limited data on the impact of COVID-19 among patients with cancer. METHODS: A systematic review was performed to determine outcomes of adult patients with cancer affected by coronavirus infections, specifically SARS, MERS, and COVID-19. Studies were independently screened by two reviewers and assessed for quality and bias. Outcomes measured included study characteristics, cancer type, phase of care at the time of diagnosis, and clinical presentation. Morbidity and mortality outcomes were analyzed to assess the severity of infection as compared to the general population. RESULTS: A total of 19 studies with 110 patients were included. Of these, 66.4% had COVID-19 infections, 32.7% MERS and only one patient with SARS. The majority of COVID-19 studies were based on studies in China. There was a 56.6% rate of a severe event, including ICU admission or requiring mechanical ventilation, with an overall 44.5% fatality rate. CONCLUSIONS: Patients with cancer with coronavirus infections may be more susceptible to higher morbidity and mortality.