Early Data on Predictors of COVID-19 Treatment Frequency at Community Health Centers.

INTRODUCTION: Federally-funded community health centers (CHCs) serve on the front lines of the COVID-19 pandemic, providing essential COVID-19 testing and care for vulnerable patient populations. Overlooked in the scholarly literature is a description of how different characteristics and vulnerabilities shaped COVID-19 care delivery at CHCs in the first year of the pandemic. Our research objective was to identify organization- and state-level factors associated with more or fewer COVID-19 care and testing visits at CHCs in 2020. METHODS: Multilevel random intercept regression models examined associations among organization and state-level predictor variables and the frequency of COVID-19 care and testing visits at CHCs in 2020. The study sample included 1267 CHCs across the 50 states and the District of Columbia. RESULTS: The average CHC provided 932 patient visits for COVID-19-related care in 2020. Yet, the CHC's role in delivering COVID-19 services proved as diverse as the populations and localities CHCs serve. For example, after adjusting for other factors, each percentage-point increase in a CHC's Hispanic patient population size was associated with a 1.3% increase in the frequency of patient visits for COVID-19 care in 2020 (P < .001). Serving a predominantly rural patient population was associated with providing significantly fewer COVID-19-related care visits (P = .002). Operating in a state that enacted a mask-wearing policy in 2020 was associated with a 26.2% lower frequency of COVID-19 testing visits at CHCs in 2020, compared to CHCs operating in states without mask-wearing policies (P = .055). CONCLUSIONS: In response to the pandemic, the federal government legislated funding to help CHCs address challenges associated with COVID-19 and provide services to medically-underserved patient populations. Policymakers will likely need to provide additional support to help CHCs address population-specific vulnerabilities affecting COVID-19 care and testing delivery, especially as highly contagious COVID-19 variants proliferate (eg, Delta and Omicron).

Application of the "immunization islands" model to improve quality, efficiency and safety of a COVID-19 mass vaccination site.

Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.

Prevalence of Pre-existing Conditions Among Community Health Center Patients With COVID-19: Implications for the Patient Protection and Affordable Care Act.

BACKGROUND: Short- and long-term effects of COVID-19 will likely be designated pre-existing conditions. We describe the prevalence of pre-existing conditions among community health center patients overall and those with COVID-19 by race/ethnicity. MATERIALS AND METHODS: This cross-sectional study used electronic health record data from OCHIN, a network of 396 community health centers across 14 states. RESULTS: Among all patients with COVID-19, 33% did not have a pre-existing condition before the pandemic. Up to half of COVID-19-positive non-Hispanic Asians (51%), Hispanic (36%), and non-Hispanic black (28%) patients did not have a pre-existing condition before the pandemic. CONCLUSIONS: The future of the Patient Protection and Affordable Care Act is uncertain, and the long-term health effects of COVID-19 are largely unknown; therefore, ensuring people with pre-existing conditions can acquire health insurance is essential to achieving health equity.

The impact of the COVID-19 pandemic on harm reduction services in Spain.

BACKGROUND: Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. METHODS: This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March-June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. RESULTS: All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March-21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. CONCLUSION: Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.