Do social determinants of health explain racial/ethnic disparities in COVID-19 infection?

Racial/ethnic minorities have experienced higher COVID-19 infection rates than whites, but it is unclear how individual-level housing, occupational, behavioral, and socioeconomic conditions contribute to these disparities in a nationally representative sample. In this study, we assess the extent to which social determinants of health contribute to racial/ethnic differences in COVID-19 infection. Data are from the Understanding America Study's Understanding Coronavirus in America survey (UAS COVID-19 waves 7-29). UAS COVID-19 is one of the only nationally representative longitudinal data sources that collects information on household, work, and social behavioral context during the pandemic. We analyze onset of COVID-19 cases, defined as a positive test or a diagnosis of COVID-19 from a healthcare provider since the previous survey wave, over a year of follow-up (June 2020-July 2021). We consider educational attainment, economic resources, work arrangements, household size, and social distancing as key social factors that may be structured by racism. Cox hazard models indicate that Hispanic people have 48% higher risk of experiencing a COVID-19 infection than whites after adjustment for age, sex, local infection rate, and comorbidities, but we do not observe a higher risk of COVID-19 among Black respondents. Controlling for engagement in any large or small social gathering increases the hazard ratio for Hispanics by 9%, suggesting that had Hispanics had the same social engagement patterns as whites, they may have had even higher risk of COVID-19. Other social determinants-lower educational attainment, working away from home, and number of coresidents-all independently predict higher risk of COVID-19, but do not explain why Hispanic Americans have higher COVID-19 infection risk than whites.

Long COVID and symptom trajectory in a representative sample of Americans in the first year of the pandemic.

People who have COVID-19 can experience symptoms for months. Studies on long COVID in the population lack representative samples and longitudinal data focusing on new-onset symptoms occurring with COVID while accounting for pre-infection symptoms. We use a sample representing the U.S. community population from the Understanding America Study COVID-19 Survey, which surveyed around 8000 respondents bi-weekly from March 2020 to March 2021. Our final sample includes 308 infected individuals who were interviewed one month before, around the time of, and 12 weeks after infection. About 23% of the sample experienced new-onset symptoms during infection which lasted for more than 12 weeks, and thus can be considered as having long COVID. The most common new-onset persistent symptoms among those included in the study were headache (22%), runny or stuffy nose (19%), abdominal discomfort (18%), fatigue (17%), and diarrhea (13%). Long COVID was more likely among obese individuals (OR = 5.44, 95% CI 2.12-13.96) and those who experienced hair loss (OR = 6.94, 95% CI 1.03-46.92), headache (OR = 3.37, 95% CI 1.18-9.60), and sore throat (OR = 3.56, 95% CI 1.21-10.46) during infection. There was a lack of evidence relating risk to age, gender, race/ethnicity, education, current smoking status, or comorbid chronic conditions. This work provides national estimates of long COVID in a representative sample after accounting for pre-infection symptoms.

Do social determinants of health explain racial/ethnic disparities in COVID-19 infection?

Racial/ethnic minorities have experienced higher COVID-19 infection rates than whites, but it is unclear how individual-level housing, occupational, behavioral, and socioeconomic conditions contribute to these disparities in a nationally representative sample. In this study, we assess the extent to which social determinants of health contribute to racial/ethnic differences in COVID-19 infection. Data are from the Understanding America Study's Understanding Coronavirus in America survey (UAS COVID-19 waves 7–29). UAS COVID-19 is one of the only nationally representative longitudinal data sources that collects information on household, work, and social behavioral context during the pandemic. We analyze onset of COVID-19 cases, defined as a positive test or a diagnosis of COVID-19 from a healthcare provider since the previous survey wave, over a year of follow-up (June 2020–July 2021). We consider educational attainment, economic resources, work arrangements, household size, and social distancing as key social factors that may be structured by racism. Cox hazard models indicate that Hispanic people have 48% higher risk of experiencing a COVID-19 infection than whites after adjustment for age, sex, local infection rate, and comorbidities, but we do not observe a higher risk of COVID-19 among Black respondents. Controlling for engagement in any large or small social gathering increases the hazard ratio for Hispanics by 9%, suggesting that had Hispanics had the same social engagement patterns as whites, they may have had even higher risk of COVID-19. Other social determinants—lower educational attainment, working away from home, and number of coresidents—all independently predict higher risk of COVID-19, but do not explain why Hispanic Americans have higher COVID-19 infection risk than whites.

Adherence to Social-Distancing and Personal Hygiene Behavior Guidelines and Risk of COVID-19 Diagnosis: Evidence From the Understanding America Study.

Objectives. To assess the association between individual-level adherence to social-distancing and personal hygiene behaviors recommended by public health experts and subsequent risk of COVID-19 diagnosis in the United States. Methods. Data are from waves 7 through 26 (June 10, 2020-April 26, 2021) of the Understanding America Study COVID-19 survey. We used Cox models to assess the relationship between engaging in behaviors considered high risk and risk of COVID-19 diagnosis. Results. Individuals engaging in behaviors indicating lack of adherence to social-distancing guidelines, especially those related to large gatherings or public interactions, had a significantly higher risk of COVID-19 diagnosis than did those who did not engage in these behaviors. Each additional risk behavior was associated with a 9% higher risk of COVID-19 diagnosis (hazard ratio [HR] = 1.09; 95% confidence interval [CI] = 1.05, 1.13). Results were similar after adjustment for sociodemographic characteristics and local infection rates. Conclusions. Personal mitigation behaviors appear to influence the risk of COVID-19, even in the presence of social factors related to infection risk. Public Health Implications. Our findings emphasize the importance of individual behaviors for preventing COVID-19, which may be relevant in contexts with low vaccination. (Am J Public Health. 2022;112(1):169-178. https://doi.org/10.2105/AJPH.2021.306565).

Long COVID and Symptom Trajectory in a Representative Sample of Americans.

People who have COVID-19 can experience symptoms for months. Studies on long COVID in the population lack representative samples and longitudinal data focusing on new-onset symptoms occurring with COVID while accounting for pre-infection symptoms. We use a sample representing the U.S. community population from the Understanding America Study COVID-19 Survey, which surveyed around 8,000 respondents bi-weekly from March 2020 to March 2021. Our final sample includes 308 infected individuals who were interviewed one month before, around the time of, and 12 weeks after infection. About 23% of the sample experienced new-onset symptoms during infection which lasted for more than 12 weeks, and thus can be considered as having long COVID. The most common persistent new-onset symptoms among those included in the study were headache (22%), runny or stuffy nose (19%), abdominal discomfort (18%), fatigue (17%), and diarrhea (13%). Long COVID was more likely among obese individuals (OR = 5.44, p < 0.001) and those who experienced hair loss (OR = 6.94, p < 0.05), headache (OR = 3.37, p < 0.05), and sore throat (OR = 3.56, p < 0.05) during infection. Risk was unrelated to age, gender, race/ethnicity, education, current smoking status, or comorbid chronic conditions. This work provides national estimates of long COVID in a representative sample after accounting for pre-infection symptoms.

Age Differences in Becoming COVID Long-Haulers and in Post-Acute Sequelae of SARS-CoV-2

People who have had COVID-19 can suffer from the continuation of Post-Acute Sequelae of SARS-CoV-2 (PASC), also known as “long COVID”, for months after infection. Understanding PASC is important for treatment, care, and projecting future health of the population. Since older adults are at higher risk of severe illness and consequences from COVID, we hypothesize that they are more likely to become COVID long-haulers and report more symptoms at the time of diagnosis and three months after. We use a nationally representative sample of adults from the Understanding America Study COVID-19 Survey, from March to December 2020, to estimate the prevalence of long COVID and identify the most common long-term symptoms and how they vary by age. We use multilevel models to examine the determinants of symptom count and change over time. Among the 608 people with a COVID diagnosis, 83 (13.7%) aged over 65;almost half (47.9%) reported symptoms three months after diagnosis;the proportion did not differ across age groups. The most common symptoms were fatigue (25.0%), runny/stuffy nose (18.9%), body aches (16.4%), sneezing (15.1%), and headache (13.6%). These symptoms were consistent across age groups, while people aged 65 and older reported significantly less cough (χ2=3.96;P=0.05) and headache (χ2=4.24;P=0.04) compared to their younger counterparts. Neither the mean at the time of the diagnosis nor the rate of change of the symptom count varied across age groups. Our analyses suggest that age is not a significant determinant of PASC symptom count or becoming a COVID long-hauler.

Night Nursing for Patients with Corona Virus Disease 2019

Abstract: Objective: To study on the existing nursing problems of patients with Corona Virus Disease 2019 (COVID-19) at night and discuss solutions. Method: 62 COVID-19 patients treated in the general ward of infectious diseases department of a infectious disease hospital in Wuhan on 13-25 February 2020 were selected. The night nursing problems were observed from night sickness, night safety, night medication and psychological support and targeted nursing was implemented. Results: 60 cases were cured and 2 were transferred to ICU for treatment. The patients were safe at night, there is no falling accidents and anxiety or depression was relieved in time. Conclusion: COVID-19 patients’ night care problems are special and it should be highly valued. Effective nursing can ensure patients’ night safety and promote their recovery.

COVID-19 Social Distancing Measures and Loneliness Among Older Adults.

OBJECTIVES: In response to the coronavirus disease 2019 (COVID-19) pandemic, older adults are advised to follow social distancing measures to prevent infection. However, such measures may increase the risk of loneliness. The current study aimed to investigate (a) whether social distancing measures, particularly limiting close social interactions, are associated with loneliness among older adults, and (b) whether the association between social distancing measures and loneliness is moderated by sociodemographic characteristics. METHOD: Data were from the fourth wave (April 29 to May 26, 2020) of the nationally representative Understanding America Study COVID-19 Survey. We used data on adults 50 years or older (N = 3,253). Logistic regression models of loneliness were performed. Five indicators of social distancing measures were considered: (a) avoiding public spaces, gatherings, or crowds; (b) canceling or postponing social activities; (c) social visits; (d) no close contact (within 6 feet) with people living together; and (e) with people not living together. RESULTS: Cancelling or postponing social activities and avoiding close contact with people living together were associated with 33% (odds ratio [OR] = 1.33, confidence interval [CI] = 1.06-1.68, p < .05) and 47% (OR = 1.47, CI = 1.09-1.99, p < .05) greater odds of loneliness, respectively. Furthermore, limiting close contact with coresidents increased the probability of loneliness more for males, non-Hispanic Whites, and those with higher levels of education and income. DISCUSSION: Efforts should be made to help older adults maintain social connectedness with close others by virtual communication methods. Our findings also call special attention to vulnerable groups at elevated risks of loneliness, emphasizing the need for tailored interventions.

Media trust and infection mitigating behaviours during the COVID-19 pandemic in the USA.

INTRODUCTION: The COVID-19 pandemic is an unprecedented public health crisis. It is becoming increasingly clear that people's behavioural responses in the USA during this fast-changing pandemic are associated with their preferred media sources. The polarisation of US media has been reflected in politically motivated messaging around the coronavirus by some media outlets, such as Fox News. This resulted in different messaging around the risks of infection and behavioural changes necessary to mitigate that risk. This study determined if COVID-related behaviours differed according to trust in left-leaning or right-leaning media and how differences changed over the first several months of the pandemic. METHODS: Using the nationally representative Understanding America Study COVID-19 panel, we examine preventive and risky behaviours related to infection from COVID-19 over the period from 10 March to 9 June for people with trust in different media sources: one left-leaning, CNN and another right-leaning, Fox News. People's media preferences are categorised into three groups: (1) those who trust CNN more than Fox News; (2) those who have equal or no preferences and (3) those who trust Fox News more than CNN. RESULTS: Results showed that compared with those who trust CNN more than Fox news, people who trust Fox News more than CNN engaged in fewer preventive behaviours and more risky behaviours related to COVID-19. Out of five preventive and five risky behaviours examined, people who trust Fox News more than CNN practised an average of 3.41 preventive behaviours and 1.25 risky behaviours, while those who trust CNN more than Fox News engaged in an average of 3.85 preventive and 0.94 risky behaviours, from late March to June. The difference between these two groups widened in the month of May (p≤0.01), even after controlling for access to professional information and overall diversity of information sources. CONCLUSIONS: Our findings indicate that behavioural responses were divided along media bias lines. In such a highly partisan environment, false information can be easily disseminated, and health messaging, which is one of the few effective ways to slowdown the spread of the virus in the absence of a vaccine, is being damaged by politically biased and economically focused narratives. During a public health crisis, media should reduce their partisan stance on health information, and the health messaging from neutral and professional sources based on scientific findings should be better promoted.