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1.
BMJ Open ; 12(1): e052495, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1613003

ABSTRACT

OBJECTIVES: To examine the prevalence of mental health symptoms during the first surge of COVID-19 in the USA, and their associations with COVID-19-related emotional distress, health self-management and healthcare utilisation. DESIGN: Cross-sectional analysis of wave 3 (1-22 May 2020) survey data from the ongoing Chicago COVID-19 Comorbidities (C3) study. SETTING: Seven academic and community health centres in Chicago, Illinois. PARTICIPANTS: 565 adults aged 23-88 with one or more chronic conditions completing at least one prior C3 study wave. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinically relevant anxiety and depressive symptoms as measured using Patient-Reported Outcomes Measurement Information System short forms. Self-reported emotional and health-related responses to COVID-19 were measured through a combination of single-item questions and validated measures. RESULTS: Rates of anxiety and depressive symptoms were 14% (81/563) and 15% (84/563), respectively. Anxiety and depressive symptoms were then each separately associated with greater worry about contracting COVID-19 (relative risk (RR) 2.32, 95% CI 1.52 to 3.53; RR 1.67, 95% CI 1.10 to 2.54), greater stress (RR 4.93, 95% CI 3.20 to 7.59; RR 3.01, 95% CI 1.96 to 4.61) and loneliness (RR 3.82, 95% CI 2.21 to 6.60; RR 5.37, 95% CI 3.21 to 8.98), greater avoidance of the doctor (RR 1.62, 95% CI 1.06 to 2.49; RR 1.54, 95% CI 1.00 to 2.36) and difficulty managing health (least square means (LS Means) 6.09, 95% CI 5.25 to 6.92 vs 4.23, 95% CI 3.70 to 4.75; LS Means 5.85, 95% CI 5.04 to 6.65 vs 4.22, 95% CI 3.70 to 4.75) and medications (LS Means 3.71, 95% CI 2.98 to 4.43 vs 2.47, 95% CI 2.02 to 2.92) due to the pandemic. CONCLUSIONS: Identifying and addressing mental health concerns may be an important factor to consider in COVID-19 prevention and management among high-risk medical populations.


Subject(s)
COVID-19 , Self-Management , Adult , Anxiety/epidemiology , Chicago/epidemiology , Chronic Disease , Cross-Sectional Studies , Depression/epidemiology , Humans , Pandemics , Prevalence , SARS-CoV-2
2.
Health Aff (Millwood) ; 40(11): 1784-1791, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496547

ABSTRACT

Racial health inequities exemplified during the COVID-19 crisis have awakened a sense of urgency among public health and policy experts to examine contributing factors. One potential factor includes the socioeconomic disadvantage of racially segregated neighborhoods. This study quantified associations of neighborhood socioeconomic disadvantage in Chicago, Illinois, as measured by the Area Deprivation Index (ADI), with racial disparities in COVID-19 positivity. A retrospective cohort included 16,684 patients tested for COVID-19 at an academic medical center and five community-based testing sites during Chicago's "first wave" (March 12, 2020-June 25, 2020). Patients living in Black majority neighborhoods had two times higher odds of COVID-19 positivity relative to those in White majority neighborhoods. The ADI accounted for 20 percent of the racial disparity; however, COVID-19 positivity remained substantially higher at every decile of the ADI in Black relative to White neighborhoods. The remaining disparities (80 percent) suggest a large, cumulative effect of other structural disadvantages in urban communities of color.


Subject(s)
COVID-19 , Chicago/epidemiology , Humans , Residence Characteristics , Retrospective Studies , SARS-CoV-2 , Socioeconomic Factors
3.
J Acquir Immune Defic Syndr ; 88(3): 261-271, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1470214

ABSTRACT

BACKGROUND: COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW. METHODS: As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access. RESULTS: Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3). CONCLUSIONS: Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.


Subject(s)
African Americans , COVID-19/complications , HIV Infections/complications , HIV-1 , SARS-CoV-2 , Sexuality/classification , Adult , Anti-HIV Agents/therapeutic use , COVID-19/epidemiology , Chicago/epidemiology , Female , HIV Infections/epidemiology , Homosexuality, Male , Humans , Male , Pre-Exposure Prophylaxis , Stress, Psychological , Transgender Persons , Young Adult
4.
Vaccine ; 39(41): 6088-6094, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1442603

ABSTRACT

BACKGROUND: By the beginning of December 2020, some vaccines against COVID-19 already presented efficacy and security, which qualify them to be used in mass vaccination campaigns. Thus, setting up strategies of vaccination became crucial to control the COVID-19 pandemic. METHODS: We use daily COVID-19 reports from Chicago and New York City (NYC) from 01-Mar2020 to 28-Nov-2020 to estimate the parameters of an SEIR-like epidemiological model that accounts for different severity levels. To achieve data adherent predictions, we let the model parameters to be time-dependent. The model is used to forecast different vaccination scenarios, where the campaign starts at different dates, from 01-Oct-2020 to 01-Apr-2021. To generate realistic scenarios, disease control strategies are implemented whenever the number of predicted daily hospitalizations reaches a preset threshold. RESULTS: The model reproduces the empirical data with remarkable accuracy. Delaying the vaccination severely affects the mortality, hospitalization, and recovery projections. In Chicago, the disease spread was under control, reducing the mortality increment as the start of the vaccination was postponed. In NYC, the number of cases was increasing, thus, the estimated model predicted a much larger impact, despite the implementation of contention measures. The earlier the vaccination campaign begins, the larger is its potential impact in reducing the COVID-19 cases, as well as in the hospitalizations and deaths. Moreover, the rate at which cases, hospitalizations and deaths increase with the delay in the vaccination beginning strongly depends on the shape of the incidence of infection in each city.


Subject(s)
COVID-19 Vaccines , COVID-19 , Chicago/epidemiology , Humans , New York City/epidemiology , Pandemics , SARS-CoV-2 , Vaccination
5.
JAMA Netw Open ; 4(9): e2125187, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1439653

ABSTRACT

Importance: COVID-19, caused by SARS-CoV-2 virus, has disproportionately affected Black and Hispanic communities in the US, which can be attributed to social factors including inconsistent public health messaging and suboptimal adoption of prevention efforts. Objectives: To identify behaviors and evaluate trends in COVID-19-mitigating practices in a predominantly Black and Hispanic population, to identify differences in practices by self-reported ethnicity, and to evaluate whether federal emergency financial assistance was associated with SARS-CoV-2 acquisition. Design, Setting, and Participants: This survey study was conducted by telephone from July 1 through August 30, 2020, on a random sample of adults who underwent SARS-CoV-2 testing at a safety-net health care system in Chicago during the surge in COVID-19 cases in the spring of 2020. Behaviors and receipt of a stimulus check were compared between participants testing positive and negative for SARS-CoV-2. Differences in behaviors and temporal trends were assessed by race and ethnicity. Main Outcomes and Measures: SARS-CoV-2 infection was assessed using nasopharyngeal quantitative reverse transcriptase-polymerase chain reaction testing. Mitigating behaviors and federal emergency financial assistance were assessed by survey. Race and ethnicity data were collected from electronic health records. Results: Of 750 randomly sampled individuals, 314 (41.9%) consented to participate (169 [53.8%] women). Of those, 159 (51%) self-reported as Hispanic and 155 (49%) as non-Hispanic (120 [38.2%] Black), of whom 133 (84%) and 76 (49%) tested positive for SARS-CoV-2, respectively. For all participants, consistent mask use (public transport: adjusted odds ratio [aOR], 0.00; 95% CI, 0.00-0.34; social gatherings: aOR, 0.10; 95% CI, 0.00-0.50; running errands: aOR, 0.18; 95% CI, 0.07-0.42; at work: aOR, 0.23; 95% CI, 0.07-0.79) and hand sanitizer use (aOR, 0.26; 95% CI, 0.13-0.52) were associated with lower odds of infection. During 3 sampled weeks, mitigation practices were less frequent among Hispanic compared with non-Hispanic participants (eg, mask use while running errands: aOR, 0.26; 95% CI, 0.15-0.46). Hispanic participants were at high risk of infection (aOR, 5.52; 95% CI, 4.30-7.08) and more likely to work outside the home (aOR, 2.05; 95% CI, 1.27-3.30) compared with non-Hispanic participants, possibly because of limited receipt of stimulus checks (aOR, 0.03; 95% CI, 0.02-0.07) or unemployment benefits (aOR, 0.36; 95% CI, 0.16-0.74). Conclusions and Relevance: In this survey study of adults in a large US city, public health messaging improved preventive behaviors over time but lagged among Hispanic participants; messaging tailored to Hispanic communities, especially for mask use, should be prioritized. Hispanic individuals were at higher risk for infection, more often worked outside the home, and were less likely to have received a stimulus check; this suggests larger studies are needed to evaluate the provision of economic support on SARS-CoV-2 transmission dynamics in low-income populations.


Subject(s)
African Americans , COVID-19/prevention & control , Health Behavior/ethnology , Pandemics , Urban Population , Adult , COVID-19/economics , COVID-19/ethnology , Chicago/epidemiology , Cross-Sectional Studies , Employment , Female , Gift Giving , Hand Sanitizers , Health Surveys , Humans , Male , Masks , Middle Aged , Odds Ratio , Physical Distancing , Prevalence , SARS-CoV-2
6.
J Pediatr ; 239: 74-80.e1, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1433570

ABSTRACT

OBJECTIVES: To assess rates of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in K-8 schools with risk mitigation procedures in place, and to evaluate SARS-CoV-2 transmission in school and household contacts of these positive individuals. STUDY DESIGN: In this prospective observational study, screening testing for SARS-CoV-2 was performed by oropharyngeal swabbing and polymerase chain reaction (PCR) analysis in students and staff at K-8 private schools in high-risk Chicago ZIP codes. New coronavirus disease 2019 (COVID-19) diagnoses or symptoms among participants, household contacts, and nonparticipants in each school were queried. RESULTS: Among 11 K-8 private schools across 8 Chicago ZIP codes, 468 participants (346 students, 122 staff members) underwent screening testing. At the first school, 17 participants (36%) tested positive, but epidemiologic investigation suggested against in-school transmission. Only 5 participants in the subsequent 10 schools tested positive for an overall 4.7% positivity rate (1.2% excluding school 1). All but 1 positive test among in-person students had high PCR cycle threshold values, suggesting very low SARS-CoV-2 viral loads. In all schools, no additional students, staff, or household contacts reported new diagnoses or symptoms of COVID-19 during the 2 weeks following screening testing. CONCLUSIONS: We identified infrequent asymptomatic COVID-19 in schools in high-risk Chicago communities and did not identify transmission among school staff, students, or their household contacts. These data suggest that COVID-19 mitigation procedures, including masking and physical distancing, are effective in preventing transmission of COVID-19 in schools. These results may inform future strategies for screening testing in K-8 schools.


Subject(s)
Asymptomatic Diseases/epidemiology , COVID-19/diagnosis , Mass Screening , Schools , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Chicago/epidemiology , Faculty , Humans , Prospective Studies , Students
7.
PLoS One ; 16(9): e0256682, 2021.
Article in English | MEDLINE | ID: covidwho-1416872

ABSTRACT

BACKGROUND: Glucocorticoid (GC)-exacerbated hyperglycemia is prevalent in hospitalized patients with diabetes mellitus (DM) but evidence-based insulin guidelines in inpatient settings are lacking. METHODS AND FINDINGS: Retrospective cohort study with capillary blood glucose (CBG) readings and insulin use, dosed with 50% basal (glargine)-50% bolus (lispro) insulin, analyzed in hospitalized patients with insulin-treated DM given GC and matched controls without GC (n = 131 pairs). GC group (median daily prednisone-equivalent dose: 53.36 mg (IQR 30.00, 80.04)) had greatest CBG differences compared to controls at dinner (254±69 vs. 184±63 mg/dL, P<0.001) and bedtime (260±72 vs. 182±55 mg/dL, P<0.001). In GC group, dinner CBG was 30% higher than lunch (254±69 vs. 199±77 mg/dL, P<0.001) when similar lispro to controls given at lunch. Bedtime CBG not different from dinner when 20% more lispro given at dinner (0.12 units/kg (IQR 0.08, 0.17) vs. 0.10 units/kg (0.06, 0.14), P<0.01). Despite receiving more lispro, bedtime hypoglycemic events were lower in GC group (0.0% vs. 5.9%, P = 0.03). CONCLUSIONS: Since equal bolus doses inadequately treat large dinner and bedtime GC-exacerbated glycemic excursions, initiating higher bolus insulin at lunch and dinner with additional enhanced GC-specific insulin supplemental scale may be needed as initial insulin doses in setting of high-dose GC.


Subject(s)
Blood Glucose/analysis , Diabetes Mellitus , Glucocorticoids/adverse effects , Hyperglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Insulin , Aged , Chicago/epidemiology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiology , Drug Administration Schedule , Female , Humans , Insulin/administration & dosage , Insulin/blood , Male , Middle Aged , Retrospective Studies
8.
MMWR Morb Mortal Wkly Rep ; 70(35): 1195-1200, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1412223

ABSTRACT

To prevent transmission of SARS-CoV-2, the virus that causes COVID-19, colleges and universities have implemented multiple strategies including testing, isolation, quarantine, contact tracing, masking, and vaccination. In April 2021, the Chicago Department of Public Health (CDPH) was notified of a large cluster of students with COVID-19 at an urban university after spring break. A total of 158 cases of COVID-19 were diagnosed among undergraduate students during March 15-May 3, 2021; the majority (114; 72.2%) lived in on-campus dormitories. CDPH evaluated the role of travel and social connections, as well as the potential impact of SARS-CoV-2 variants, on transmission. Among 140 infected students who were interviewed, 89 (63.6%) reported recent travel outside Chicago during spring break, and 57 (40.7%) reported indoor social exposures. At the time of the outbreak, undergraduate-aged persons were largely ineligible for vaccination in Chicago; only three of the students with COVID-19 (1.9%) were fully vaccinated. Whole genome sequencing (WGS) of 104 specimens revealed multiple distinct SARS-CoV-2 lineages, suggesting several nearly simultaneous introductions. Most specimens (66; 63.5%) were B.1.1.222, a lineage not widely detected in Chicago before or after this outbreak. These results demonstrate the potential for COVID-19 outbreaks on university campuses after widespread student travel during breaks, at the beginning of new school terms, and when students participate in indoor social gatherings. To prevent SARS-CoV-2 transmission, colleges and universities should encourage COVID-19 vaccination; discourage unvaccinated students from travel, including during university breaks; implement serial COVID-19 screening among unvaccinated persons after university breaks; encourage masking; and implement universal serial testing for students based on community transmission levels.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Disease Outbreaks , SARS-CoV-2/isolation & purification , Students/statistics & numerical data , Universities , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Testing , COVID-19 Vaccines/administration & dosage , Chicago/epidemiology , Female , Humans , Male , Social Interaction , Travel-Related Illness , Young Adult
10.
JAMA Netw Open ; 4(9): e2122260, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1391521

ABSTRACT

Importance: Domestic violence (DV) has become a growing public health concern during the COVID-19 pandemic because individuals may be sheltering in place with abusers and facing mounting economic and health-related stresses. Objective: To analyze associations of the 2020 COVID-19 stay-at-home (SH) order with DV police reporting and resource availability, including differences by community area racial/ethnic composition. Design, Setting, and Participants: This longitudinal cohort study assessed DV police reports (January-June 2020) obtained from the Chicago, Illinois, Police Department and DV resource availability (March and August 2020) obtained from the NowPow community resource database, both for 77 community areas in Chicago. Data were analyzed July through December 2020. Exposures: The COVID-19 SH order effective March 21, 2020. Main Outcomes and Measures: Monthly rates of DV police reports and DV resource availability per 100 000 persons. Results: Of 77 community areas in Chicago, 28 (36.4%) were majority Black, 19 (24.7%) majority Hispanic/Latinx, 18 (23.4%) majority White, and 12 (15.6%) a different or no majority race/ethnicity, representing an estimated population of 2 718 555 individuals. For each community area, the SH order was associated with a decrease in the rate of DV police reports by 21.8 (95% CI, -30.48 to -13.07) crimes per 100 000 persons per month relative to the same months in 2019. Compared with White majority community areas, Black majority areas had a decrease in the rate of DV police reports by 40.8 (95% CI, -62.93 to -18.75) crimes per 100 000 persons per month relative to the same months in 2019. The SH order was also associated with a decrease in DV resource availability at a rate of 5.1 (95% CI, -7.55 to -2.67) resources per 100 000 persons, with the largest decreases for mental health (-4.3 [95% CI, -5.97 to -2.66] resources per 100 000 persons) and personal safety (-2.4 [95% CI, -4.40 to -0.41] resources per 100 000 persons). The Black majority south side of Chicago had a larger decrease in resource availability (-6.7 [95% CI, -12.92 to -0.46] resources per 100 000 persons) than the White majority north side. Conclusions and Relevance: In this longitudinal cohort study, the rate of DV police reports decreased after the SH order was implemented in Chicago. This decrease was largely observed in Black majority communities, whereas there was no significant change in White majority communities. These findings may reflect decreased DV incidence but may also reflect an exacerbation of underreporting. In addition, DV resource availability decreased disproportionately on the predominantly Black south side of Chicago.


Subject(s)
Domestic Violence/statistics & numerical data , Police/statistics & numerical data , Adult , COVID-19/epidemiology , Chicago/epidemiology , Communicable Disease Control/legislation & jurisprudence , Domestic Violence/ethnology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics , Residence Characteristics/statistics & numerical data , SARS-CoV-2
11.
MMWR Morb Mortal Wkly Rep ; 69(15): 446-450, 2020 Apr 17.
Article in English | MEDLINE | ID: covidwho-1389842

ABSTRACT

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019. Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3). However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts. In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19. Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2. This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission. U.S residents should follow stay-at-home orders when required by state or local authorities.


Subject(s)
Betacoronavirus/isolation & purification , Community-Acquired Infections/transmission , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Chicago/epidemiology , Child , Child, Preschool , Cluster Analysis , Community-Acquired Infections/epidemiology , Community-Acquired Infections/mortality , Coronavirus Infections/epidemiology , Coronavirus Infections/mortality , Family , Humans , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , SARS-CoV-2 , Young Adult
12.
MMWR Morb Mortal Wkly Rep ; 69(43): 1591-1594, 2020 Oct 30.
Article in English | MEDLINE | ID: covidwho-1380140

ABSTRACT

Data on transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), among college athletes are limited. In August 2020, the Chicago Department of Public Health (CDPH) was notified of a cluster of COVID-19 cases among a university's men's and women's soccer teams. CDPH initiated an investigation, interviewed members of both teams, and collated laboratory data to understand transmission of SARS-CoV-2 within the teams. Numerous social gatherings with limited mask use or social distancing preceded the outbreak. Transmission resulted in 17 laboratory-confirmed COVID-19 cases across both teams (n = 45), likely from a single source introduction of SARS-CoV-2 (based on whole genome sequencing) and subsequent transmission during multiple gatherings. Colleges and universities are at risk for COVID-19 outbreaks because of shared housing and social gatherings where recommended prevention guidance is not followed. Improved strategies to promote mask use and social distancing among college-aged adults need to be implemented, as well as periodic repeat testing to identify asymptomatic infections and prevent outbreaks among groups at increased risk for infection because of frequent exposure to close contacts in congregate settings on and off campus.


Subject(s)
Athletes/statistics & numerical data , COVID-19/epidemiology , Disease Outbreaks , Soccer , Students/statistics & numerical data , Universities , Adolescent , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Testing , Chicago/epidemiology , Contact Tracing , Disease Outbreaks/prevention & control , Female , Humans , Male , Masks/statistics & numerical data , Physical Distancing , Quarantine , SARS-CoV-2/isolation & purification , Young Adult
13.
Cancer ; 127(21): 4072-4080, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1320064

ABSTRACT

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread, it remains unclear how vulnerable populations with preexisting health conditions like cancer have been affected. METHODS: Between July and September of 2020, the authors conducted a cross-sectional study that surveyed 2661 patients with breast cancer who were registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort and received 1300 responses (71.5% White patients and 22.4% Black patients). The survey measured the psychosocial well-being of participants before and during the COVID-19 pandemic and examined whether they experienced any type of financial challenges or treatment disruption. RESULTS: The results indicated that feelings of isolation increased significantly during the pandemic. Meanwhile, the overall median isolation/stress score was 1.2 on a scale from 0 (never) to 4 (always), which was not significantly different between White patients and Black patients. One-third of patients experienced some type of financial challenge during this time. Medicaid recipients, of whom almost 80% were Black, were more likely to experience financial challenges. In addition, approximately one-fourth of patients experienced difficulty getting treatment. CONCLUSIONS: This study indicates that the quality of life of patients with breast cancer and their scheduled treatments have been adversely affected during the COVID-19 pandemic. These findings suggest that more support should be provided by hospital centers and the medical research community to patients with cancer during this challenging pandemic. LAY SUMMARY: The authors surveyed patients with breast cancer in Chicago using a questionnaire to examine how their lives have been affected during the coronavirus disease 2019 (COVID-19) pandemic. The results indicate that the lives of patients with breast cancer and their scheduled treatments have been adversely affected during the pandemic. In addition, patients who were covered by Medicaid, most of whom were Black, were more likely to experience financial challenges. The findings suggest that hospital centers and the medical research community should reach out and provide more information to support patients with cancer during this challenging pandemic.


Subject(s)
Breast Neoplasms/therapy , COVID-19/epidemiology , Pandemics , Quality of Life , Withholding Treatment , Aged , /statistics & numerical data , Breast Neoplasms/ethnology , Chicago/epidemiology , Chicago/ethnology , Cross-Sectional Studies , Female , Financial Stress/epidemiology , Financial Stress/ethnology , Health Services Accessibility/statistics & numerical data , Health Surveys/statistics & numerical data , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Humans , Medicare/statistics & numerical data , Middle Aged , Patient Reported Outcome Measures , Prevalence , Social Isolation/psychology , United States , /statistics & numerical data
14.
JAMA Netw Open ; 4(7): e2117049, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1316186

ABSTRACT

Importance: Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. Objective: To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. Design, Setting, and Participants: In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. Main Outcomes and Measures: Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. Results: A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). Conclusions and Relevance: In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.


Subject(s)
COVID-19/prevention & control , Emigration and Immigration/trends , /statistics & numerical data , Adult , Arizona/epidemiology , COVID-19/epidemiology , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Chicago/epidemiology , Cross-Sectional Studies , Emigration and Immigration/statistics & numerical data , Female , Humans , Los Angeles/epidemiology , Male , Mass Screening/methods , Middle Aged , Qualitative Research , Surveys and Questionnaires
16.
MMWR Morb Mortal Wkly Rep ; 70(19): 707-711, 2021 May 14.
Article in English | MEDLINE | ID: covidwho-1227230

ABSTRACT

On May 13, 2020, Chicago established a free community-based testing (CBT) initiative for SARS-CoV-2, the virus that causes COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR). The initiative focused on demographic groups and geographic areas that were underrepresented in testing by clinical providers and had experienced high COVID-19 incidence, including Hispanic persons and those who have been economically marginalized. To assess the CBT initiative, the Chicago Department of Public Health (CDPH) compared demographic characteristics, economic marginalization, and test positivity between persons tested at CBT sites and persons tested in all other testing settings in Chicago. During May 13-November 14, a total of 253,904 SARS-CoV-2 RT-PCR tests were conducted at CBT sites. Compared with those tested in all other testing settings in Chicago, persons tested at CBT sites were more likely to live in areas that are economically marginalized (38.6% versus 32.0%; p<0.001) and to be Hispanic (50.9% versus 20.7%; p<0.001). The cumulative percentage of positive test results at the CBT sites was higher than that at all other testing settings (11.1% versus 7.1%; p<0.001). These results demonstrate the ability of public health departments to establish community-based testing initiatives that reach communities with less access to testing in other settings and that experience disproportionately higher incidences of COVID-19.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Community Health Services/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/ethnology , COVID-19 Testing/economics , Chicago/epidemiology , Child , Child, Preschool , Community Health Services/organization & administration , Female , Health Services Accessibility , Health Status Disparities , Humans , Infant , Infant, Newborn , Male , Middle Aged , Poverty Areas , Young Adult
17.
Proc Natl Acad Sci U S A ; 118(21)2021 05 25.
Article in English | MEDLINE | ID: covidwho-1223142

ABSTRACT

Black and Hispanic communities are disproportionately affected by both incarceration and COVID-19. The epidemiological relationship between carceral facilities and community health during the COVID-19 pandemic, however, remains largely unexamined. Using data from Cook County Jail, we examine temporal patterns in the relationship between jail cycling (i.e., arrest and processing of individuals through jails before release) and community cases of COVID-19 in Chicago ZIP codes. We use multivariate regression analyses and a machine-learning tool, elastic regression, with 1,706 demographic control variables. We find that for each arrested individual cycled through Cook County Jail in March 2020, five additional cases of COVID-19 in their ZIP code of residence are independently attributable to the jail as of August. A total 86% of this additional disease burden is borne by majority-Black and/or -Hispanic ZIPs, accounting for 17% of cumulative COVID-19 cases in these ZIPs, 6% in majority-White ZIPs, and 13% across all ZIPs. Jail cycling in March alone can independently account for 21% of racial COVID-19 disparities in Chicago as of August 2020. Relative to all demographic variables in our analysis, jail cycling is the strongest predictor of COVID-19 rates, considerably exceeding poverty, race, and population density, for example. Arrest and incarceration policies appear to be increasing COVID-19 incidence in communities. Our data suggest that jails function as infectious disease multipliers and epidemiological pumps that are especially affecting marginalized communities. Given disproportionate policing and incarceration of racialized residents nationally, the criminal punishment system may explain a large proportion of racial COVID-19 disparities noted across the United States.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Jails/statistics & numerical data , Public Health/statistics & numerical data , Racism/statistics & numerical data , COVID-19/ethnology , COVID-19/prevention & control , COVID-19/transmission , Chicago/epidemiology , Humans , Incidence , Prisoners/statistics & numerical data , SARS-CoV-2 , Socioeconomic Factors
18.
MMWR Morb Mortal Wkly Rep ; 70(17): 632-638, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1207942

ABSTRACT

Early studies suggest that COVID-19 vaccines protect against severe illness (1); however, postvaccination SARS-CoV-2 infections (i.e., breakthrough infections) can occur because COVID-19 vaccines do not offer 100% protection (2,3). Data evaluating the occurrence of breakthrough infections and impact of vaccination in decreasing transmission in congregate settings are limited. Skilled nursing facility (SNF) residents and staff members have been disproportionately affected by SARS-CoV-2, the virus that causes COVID-19 (4,5), and were prioritized for COVID-19 vaccination (6,7). Starting December 28, 2020, all 78 Chicago-based SNFs began COVID-19 vaccination clinics over several weeks through the federal Pharmacy Partnership for Long-Term Care Program (PPP).† In February 2021, through routine screening, the Chicago Department of Public Health (CDPH) identified a SARS-CoV-2 infection in a SNF resident >14 days after receipt of the second dose of a two-dose COVID-19 vaccination series. SARS-CoV-2 cases, vaccination status, and possible vaccine breakthrough infections were identified by matching facility reports with state case and vaccination registries. Among 627 persons with SARS-CoV-2 infection across 75 SNFs since vaccination clinics began, 22 SARS-CoV-2 infections were identified among 12 residents and 10 staff members across 15 facilities ≥14 days after receiving their second vaccine dose (i.e., breakthrough infections in fully vaccinated persons). Nearly two thirds (14 of 22; 64%) of persons with breakthrough infections were asymptomatic; two residents were hospitalized because of COVID-19, and one died. No facility-associated secondary transmission occurred. Although few SARS-CoV-2 infections in fully vaccinated persons were observed, these cases demonstrate the need for SNFs to follow recommended routine infection prevention and control practices and promote high vaccination coverage among SNF residents and staff members.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/epidemiology , Occupational Diseases/epidemiology , Skilled Nursing Facilities , Adult , Aged , Asymptomatic Diseases/epidemiology , COVID-19/prevention & control , Chicago/epidemiology , Female , Humans , Immunization Schedule , Infection Control/organization & administration , Male , Middle Aged , Occupational Diseases/prevention & control
19.
Am J Nephrol ; 52(3): 250-260, 2021.
Article in English | MEDLINE | ID: covidwho-1171574

ABSTRACT

INTRODUCTION: Use of certain antihypertensive medications has been an area of interest during the COVID-19 pandemic, and several hypotheses have been developed regarding the effects of renin-angiotensin system blockers as well as calcium channel blockers in those infected with COVID-19. We seek to determine the association between exposure to ACEI, ARB, and CCB and outcomes in those admitted to the hospital with COVID-19 infection. METHODS: This retrospective cohort study included 841 adult patients hospitalized with COVID-19 infection at the University of Chicago Medical Center between March 25 and June 22, 2020. Out of these 841, 453 patients had a personal history of hypertension. For the first part, we evaluated primary outcomes of in-hospital mortality and ICU admission in hospitalized COVID-19 patients based on their exposure to particular medications regardless of a personal history of hypertension and compared them with those who were not on these medications. For the second part, we evaluated the aforementioned outcomes in 453 patients with a personal history of hypertension based on their medication exposure. Secondary outcomes of length of stay, readmission rate, and new-onset dialysis requirement were also compared across the study groups. RESULTS: Out of 841 patients, 111 (13.19%) were on ACEI/ARB (median age: 66.1, SD 15.4; 52.25% females) and 730 (86.80%) were not on them (median age: 56.6, SD 20.3; 50.14% females), while 277 (32.93%) used CCB (median age: 64.6, SD 15.2; 57.04% females) and 564 (67.06%) did not use CCB (median age: 54.6, SD 21.2; 47.16% females). After adjusting for demographics and covariates, neither ACEI/ARB nor CCB exposure was associated with any effect on mortality, but ACEI/ARB exposure was associated with 42% reduction in risk of ICU admissions (OR 0.58, 95% CI [0.35, 0.95], p value 0.03). In addition, combined use of ACEI/ARB and CCB was associated with statistically significant (45%) reduction in ICU admission (OR 0.55, 95% CI [0.32, 0.94], p value 0.029). Out of 453 patients with a personal history of hypertension, 85 (18.76%) were taking ACEI/ARB (median age 65, SD 15.6; 56.47% females) and 368 (81.24%) were not on ACEI/ARB (median age 62.8, SD 16.4; 54.89% females), while 208 (45.92%) out of 453 were on CCB (median age 65; SD 14.8; 60.1% females) and 245 (54.08%) were not on CCB (median age 61.7, SD 17.3; 51.02% females). In the fully adjusted model in this group, ACEI use was associated with 71% reduction in in-house mortality (OR 0.29, 95% CI [0.09, 0.93], p value 0.03). DISCUSSION/CONCLUSION: Among all hospitalized patients with COVID-19 infection, exposure to ACEI/ARB, as well as combined exposure to ACEI/ARB and CCB, were associated with reduced incidence of ICU admissions. In those admitted patients who had a personal history of hypertension, there was a trend towards reduced in-hospital mortality in those exposed to ACEI.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/mortality , Calcium Channel Blockers/therapeutic use , Hypertension/drug therapy , Aged , COVID-19/complications , COVID-19/drug therapy , COVID-19/ethnology , Chicago/epidemiology , Female , Humans , Hypertension/complications , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Retrospective Studies
20.
JCI Insight ; 6(9)2021 05 10.
Article in English | MEDLINE | ID: covidwho-1147004

ABSTRACT

BACKGROUNDEstimates of seroprevalence to SARS-CoV-2 vary widely and may influence vaccination response. We ascertained IgG levels across a single US metropolitan site, Chicago, from June 2020 through December 2020.METHODSParticipants (n = 7935) were recruited through electronic advertising and received materials for a self-sampled dried-blood spot assay through the mail or a minimal contact in-person method. IgG against the receptor-binding domain of SARS-CoV-2 was measured using an established highly sensitive and highly specific assay.RESULTSOverall seroprevalence was 17.9%, with no significant difference between method of contact. Only 2.5% of participants reported having had a diagnosis of COVID-19 based on virus detection, consistent with a 7-fold greater exposure to SARS-CoV-2 measured by serology than that detected by viral testing. The range of IgG level observed in seropositive participants from this community survey overlapped with the range of IgG levels associated with COVID-19 cases having a documented positive PCR test. From a subset of those who participated in repeat testing, half of seropositive individuals retained detectable antibodies for 3 to 4 months.CONCLUSIONQuantitative IgG measurements with a highly specific and sensitive assay indicated more widespread exposure to SARS-CoV-2 than observed by viral testing. The range of IgG concentrations produced from these asymptomatic exposures was similar to IgG levels occurring after documented nonhospitalized COVID-19, which were considerably lower than those produced from hospitalized COVID-19 cases. The differing ranges of IgG response, coupled with the rate of decay of antibodies, may influence response to subsequent viral exposure and vaccine.FundingNational Science Foundation grant 2035114, NIH grant 3UL1TR001422-06S4, NIH National Center for Advancing Translational Sciences grants UL1 TR001422 and UL1 TR002389, Dixon Family Foundation, Northwestern University Cancer Center (NIH grant P30 CA060553), and Walder Foundation's Chicago Coronavirus Assessment Network.


Subject(s)
COVID-19 Serological Testing/methods , COVID-19/epidemiology , Pandemics , SARS-CoV-2/immunology , Adolescent , Adult , Antibodies, Viral/blood , COVID-19/immunology , COVID-19/virology , COVID-19 Serological Testing/statistics & numerical data , Chicago/epidemiology , Cohort Studies , Dried Blood Spot Testing/methods , Dried Blood Spot Testing/statistics & numerical data , Female , Humans , Immunoglobulin G/blood , Male , Middle Aged , Sensitivity and Specificity , Seroepidemiologic Studies , Young Adult
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