Real-world utilization of SARS-CoV-2 serological testing in RNA positive patients across the United States.

BACKGROUND: As diagnostic tests for COVID-19 were broadly deployed under Emergency Use Authorization, there emerged a need to understand the real-world utilization and performance of serological testing across the United States. METHODS: Six health systems contributed electronic health records and/or claims data, jointly developed a master protocol, and used it to execute the analysis in parallel. We used descriptive statistics to examine demographic, clinical, and geographic characteristics of serology testing among patients with RNA positive for SARS-CoV-2. RESULTS: Across datasets, we observed 930,669 individuals with positive RNA for SARS-CoV-2. Of these, 35,806 (4%) were serotested within 90 days; 15% of which occurred <14 days from the RNA positive test. The proportion of people with a history of cardiovascular disease, obesity, chronic lung, or kidney disease; or presenting with shortness of breath or pneumonia appeared higher among those serotested compared to those who were not. Even in a population of people with active infection, race/ethnicity data were largely missing (>30%) in some datasets-limiting our ability to examine differences in serological testing by race. In datasets where race/ethnicity information was available, we observed a greater distribution of White individuals among those serotested; however, the time between RNA and serology tests appeared shorter in Black compared to White individuals. Test manufacturer data was available in half of the datasets contributing to the analysis. CONCLUSION: Our results inform the underlying context of serotesting during the first year of the COVID-19 pandemic and differences observed between claims and EHR data sources-a critical first step to understanding the real-world accuracy of serological tests. Incomplete reporting of race/ethnicity data and a limited ability to link test manufacturer data, lab results, and clinical data challenge the ability to assess the real-world performance of SARS-CoV-2 tests in different contexts and the overall U.S. response to current and future disease pandemics.

Real-world performance of SARS-Cov-2 serology tests in the United States, 2020.

BACKGROUND: Real-world performance of COVID-19 diagnostic tests under Emergency Use Authorization (EUA) must be assessed. We describe overall trends in the performance of serology tests in the context of real-world implementation. METHODS: Six health systems estimated the odds of seropositivity and positive percent agreement (PPA) of serology test among people with confirmed SARS-CoV-2 infection by molecular test. In each dataset, we present the odds ratio and PPA, overall and by key clinical, demographic, and practice parameters. RESULTS: A total of 15,615 people were observed to have at least one serology test 14-90 days after a positive molecular test for SARS-CoV-2. We observed higher PPA in Hispanic (PPA range: 79-96%) compared to non-Hispanic (60-89%) patients; in those presenting with at least one COVID-19 related symptom (69-93%) as compared to no such symptoms (63-91%); and in inpatient (70-97%) and emergency department (93-99%) compared to outpatient (63-92%) settings across datasets. PPA was highest in those with diabetes (75-94%) and kidney disease (83-95%); and lowest in those with auto-immune conditions or who are immunocompromised (56-93%). The odds ratios (OR) for seropositivity were higher in Hispanics compared to non-Hispanics (OR range: 2.59-3.86), patients with diabetes (1.49-1.56), and obesity (1.63-2.23); and lower in those with immunocompromised or autoimmune conditions (0.25-0.70), as compared to those without those comorbidities. In a subset of three datasets with robust information on serology test name, seven tests were used, two of which were used in multiple settings and met the EUA requirement of PPA ≥87%. Tests performed similarly across datasets. CONCLUSION: Although the EUA requirement was not consistently met, more investigation is needed to understand how serology and molecular tests are used, including indication and protocol fidelity. Improved data interoperability of test and clinical/demographic data are needed to enable rapid assessment of the real-world performance of in vitro diagnostic tests.

Facing the future of transit ridership: shifting attitudes towards public transit and auto ownership among transit riders during COVID-19

Public transit agencies face a transformed landscape of rider demand and political support as the COVID-19 pandemic recedes. We explore people’s motivations for returning to or avoiding public transit a year into the pandemic. We draw on a March 2021 follow-up survey of over 1,900 people who rode transit regularly prior to the COVID-19 pandemic in Toronto and Vancouver, Canada, and who took part in a prior survey on the topic in May 2020. We investigate how transit demand changes associated with the pandemic relate to changes in automobile ownership and its desirability. We find that pre-COVID frequent transit users between the ages of 18–29, a part of the so-called “Gen Z,” and recent immigrants are more attracted to driving due to the pandemic, with the latter group more likely to have actually purchased a vehicle. Getting COVID-19 or living with someone who did is also a strong and positive predictor of buying a car and anticipating less transit use after the pandemic. Our results suggest that COVID-19  may have increased the attractiveness of auto ownership among transit riders likely to eventually purchase cars anyway (immigrants, twentysomethings), at least in the North American context. We also conclude that getting COVID-19 or living with someone who did is a positive predictor of having bought a car. Future research should consider how having COVID-19 transformed some travelers’ views, values, and behaviour. Supplementary Information The online version contains supplementary material available at 10.1007/s11116-022-10344-2.

Inequalities of extreme commuting across Canada

There is growing body of research and practice assessing transportation equity and justice. Commuting is an especially important dimension to study since such frequent, non-discretionary travel, can come at the expense of time for other activities and therefore negatively impact mental health and well-being. An ”extreme commuter” is a worker who has a particularly burdensome commute, and has previously been defined based on one-way commute times above 60 or 90 minutes. In this paper, we examine the social and geographic inequalities of extreme commuting in Canada. We use a 25% sample of all commuters in Canada in 2016 (n = 4,543,417) and our analysis consists of descriptive statistics and logistic regression models. The average one-way commute time in 2016 across Canada was 26 minutes, but over 9.7% of the workforce had commute times exceeding 60 minutes. However, this rate of extreme commuting was 11.5% for low-income households, 13.5% for immigrants, and 13.4% among non-white Canadians, reaching as high as 18.6% for Black Canadians and 14.7% for Latin American Canadians specifically. We find that these inequalities persist even after controlling for household factors, commute mode, occupation, and built environment characteristics. The persistently significant effects of race in our models point to factors like housing and employment discrimination as possible contributors to extreme commuting. These results highlight commuting disparities at a national scale prior to the COVID-19 pandemic, and represents clear evidence of structural marginalization contributing to racialized inequalities in the critical metric of daily commute times seldom recognized by Canadian scholars and planners.

COVID-19 Evidence Accelerator: A parallel analysis to describe the use of Hydroxychloroquine with or without Azithromycin among hospitalized COVID-19 patients.

BACKGROUND: The COVID-19 pandemic remains a significant global threat. However, despite urgent need, there remains uncertainty surrounding best practices for pharmaceutical interventions to treat COVID-19. In particular, conflicting evidence has emerged surrounding the use of hydroxychloroquine and azithromycin, alone or in combination, for COVID-19. The COVID-19 Evidence Accelerator convened by the Reagan-Udall Foundation for the FDA, in collaboration with Friends of Cancer Research, assembled experts from the health systems research, regulatory science, data science, and epidemiology to participate in a large parallel analysis of different data sets to further explore the effectiveness of these treatments. METHODS: Electronic health record (EHR) and claims data were extracted from seven separate databases. Parallel analyses were undertaken on data extracted from each source. Each analysis examined time to mortality in hospitalized patients treated with hydroxychloroquine, azithromycin, and the two in combination as compared to patients not treated with either drug. Cox proportional hazards models were used, and propensity score methods were undertaken to adjust for confounding. Frequencies of adverse events in each treatment group were also examined. RESULTS: Neither hydroxychloroquine nor azithromycin, alone or in combination, were significantly associated with time to mortality among hospitalized COVID-19 patients. No treatment groups appeared to have an elevated risk of adverse events. CONCLUSION: Administration of hydroxychloroquine, azithromycin, and their combination appeared to have no effect on time to mortality in hospitalized COVID-19 patients. Continued research is needed to clarify best practices surrounding treatment of COVID-19.

Accelerating Advances in Cancer Care Research: A Lookback at the 21st Century Cures Act in 2020.

The 21st Century Cures Act (Cures Act), signed into law in 2016, was designed to advance new therapies by modernizing clinical trials, funding research initiatives, and accelerating the development and use of health information technology. To analyze the current issues in cancer care related to the implementation and impact of the Cures Act, NCCN convened a multistakeholder working group. Participants discussed the legislation's impact on the oncology community since enactment and identified the remaining gaps and challenges as experienced by stakeholders. In June 2020, the policy recommendations of the working group were presented at the virtual NCCN Policy Summit: Accelerating Advances in Cancer Care Research: A Lookback at the 21st Century Cures Act in 2020. The summit consisted of informative discussions and a multistakeholder panel to explore the recommendations and the future of the Cures Act. This article explores identified policy recommendations from the NCCN Working Group and the NCCN Policy Summit, and analyzes opportunities to advance innovative cancer care and patient access to data.

Riders Who Avoided Public Transit During COVID-19

Millions of North Americans stopped riding public transit in response to COVID-19. We treat this crisis as a natural experiment to illustrate the importance of public transit in riders’ abilities to access essential destinations. We measured the impacts of riders forgoing transit through a survey of transportation barriers completed by more than 4,000 transit riders in Toronto and Vancouver (Canada). We used Heckman selection models to predict six dimensions of transport disadvantage and transport-related social exclusions captured in our survey. We then complemented model results with an analysis of survey comments describing barriers that individuals faced. Lack of access to alternative modes is the strongest predictor of a former rider experiencing transport disadvantage, particularly neighborhood walkability and vehicle ownership. Groups at risk of transport disadvantage before COVID-19, particularly women and people in poorer health, were also more likely to report difficulties while avoiding public transit. Barriers described by respondents included former supports no longer offering rides, gendered household car use dynamics, and lack of culturally specific or specialized amenities within walking distance.Policymakers should plan for a level of redundancy in transportation systems that enables residents to access essential destinations when unexpected service losses occur. Designing communities that enable residents to walk to those essential destinations will help reduce the burdens faced by transit riders during crises that render transit unfeasible. At the same time, planners championing active travel as an alternative to transit during such crises also need to devise solutions for former transit riders for whom active travel is ill suited, for example, due to physical challenges with carrying groceries or needing to chaperone children. [ABSTRACT FROM AUTHOR] Copyright of Journal of the American Planning Association is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Building the Critical Path for COVID-19 Therapeutics

From the Executive Summary: Hundreds of therapeutics are in preclinical or clinical development for treating COVID-19 [coronavirus disease 2019] patients. But as of May 2020, so far none have demonstrated effectiveness sufficient to warrant approval for general use, although one antiviral drug (remdesivir) has shown sufficient impact in ongoing clinical trials to support an authorization for emergency use. This is a reflection of the complexity, time, costs, and uncertainties associated with developing therapeutics - a process that not only encompasses preclinical evaluation and clinical trials to demonstrate safety and effectiveness, but also manufacturing at pandemic scale, and sufficient payment to enable appropriate and effective access. [...] Policy attention has understandably focused on the development of vaccines as the path to recovery. But even with these unprecedented actions, the widespread availability of effective vaccines remains many months away, if not longer. To reduce the impact of the pandemic in the meantime, intensive effort is also needed to accelerate therapeutics development to help prevent infections, reduce their severity, and mitigate or prevent further outbreak waves.COVID-19 (Disease);Therapeutics;Public health