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Holm RH, Pocock G, Severson MA, Huber VC, Smith T, McFadden LM. Using wastewater to overcome health disparities among rural residents. GEOFORUM; JOURNAL OF PHYSICAL, HUMAN, AND REGIONAL GEOSCIENCES 2023; 144:103816. [PMID: 37396346 PMCID: PMC10292026 DOI: 10.1016/j.geoforum.2023.103816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
The SARS-CoV-2 pandemic highlighted the need for novel tools to promote health equity. There has been a historical legacy around the location and allocation of public facilities (such as health care) focused on efficiency, which is not attainable in rural, low-density, United States areas. Differences in the spread of the disease and outcomes of infections have been observed between urban and rural populations throughout the COVID-19 pandemic. The purpose of this article was to review rural health disparities related to the SARS-CoV-2 pandemic while using evidence to support wastewater surveillance as a potentially innovative tool to address these disparities more widely. The successful implementation of wastewater surveillance in resource-limited settings in South Africa demonstrates the ability to monitor disease in underserved areas. A better surveillance model of disease detection among rural residents will overcome issues around the interactions of a disease and social determinants of health. Wastewater surveillance can be used to promote health equity, particularly in rural and resource-limited areas, and has the potential to identify future global outbreaks of endemic and pandemic viruses.
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Affiliation(s)
- Rochelle H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - Gina Pocock
- Waterlab, 23B De Havilland Crescent, 0020 Persequor Technopark, South Africa
| | - Marie A Severson
- Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clark St., Vermillion, SD 57069, United States
| | - Victor C Huber
- Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clark St., Vermillion, SD 57069, United States
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - Lisa M McFadden
- Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clark St., Vermillion, SD 57069, United States
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Dineen KK, Lowe A, Kass NE, Lee LM, Wynia MK, Voo TC, Mohapatra S, Lookadoo R, Ramos AK, Herstein JJ, Donovan S, Lawler JV, Lowe JJ, Schwedhelm S, Sederstrom NO. Treating Workers as Essential Too: An Ethical Framework for Public Health Interventions to Prevent and Control COVID-19 Infections among Meat-processing Facility Workers and Their Communities in the United States. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:301-314. [PMID: 35522376 PMCID: PMC9073494 DOI: 10.1007/s11673-022-10170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep this "essential industry" producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry's implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities.
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Affiliation(s)
- Kelly K. Dineen
- School of Law, School of Medicine (secondary), Creighton University, 2500 California Plaza, Omaha, NE 68178 USA
| | - Abigail Lowe
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Nancy E. Kass
- Berman Institute of Bioethics & Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Lisa M. Lee
- Office of the Vice President for Research and Innovation & Department of Population Health Sciences, Virginia Tech, Blacksburg, VA USA
| | - Matthew K. Wynia
- Center for Bioethics and Humanities & Internal Medicine University of Colorado School of Medicine, Aurora, CO USA
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel Lookadoo
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Athena K. Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Jocelyn J. Herstein
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Sara Donovan
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE USA
| | - James V. Lawler
- Global Center for Health Security & Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE USA
| | - John J. Lowe
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center & Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE USA
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Plumb EV, Ham RE, Napolitano JM, King KL, Swann TJ, Kalbaugh CA, Rennert L, Dean D. Implementation of a Rural Community Diagnostic Testing Strategy for SARS-CoV-2 in Upstate South Carolina. Front Public Health 2022; 10:858421. [PMID: 35450120 PMCID: PMC9016164 DOI: 10.3389/fpubh.2022.858421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
By developing a partnership amongst a public university lab, local city government officials and community healthcare providers, we established a drive-through COVID-19 testing site aiming to improve access to SARS-CoV-2 testing in rural Upstate South Carolina. We collected information on symptoms and known exposures of individuals seeking testing to determine the number of pre- or asymptomatic individuals. We completed 71,102 SARS-CoV-2 tests in the community between December 2020-December 2021 and reported 91.49% of results within 24 h. We successfully identified 5,244 positive tests; 73.36% of these tests originated from individuals who did not report symptoms. Finally, we identified high transmission levels during two major surges and compared test positivity rates of the local and regional communities. Importantly, the local community had significantly lower test positivity rates than the regional community throughout 2021 (p < 0.001). While both communities reached peak case load and test positivity near the same time, the local community returned to moderate transmission as indicated by positivity 4 weeks before the regional community. Our university lab facilitated easy testing with fast turnaround times, which encouraged voluntary testing and helped identify a large number of non-symptomatic cases. Finding the balance of simplicity, accessibility, and community trust was vital to the success of our widespread community testing program for SARS-CoV-2.
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Affiliation(s)
- Emily V. Plumb
- Research and Education in Disease Diagnosis and Intervention (REDDI) Lab, Center for Innovative Medical Devices and Sensors, Clemson University, Clemson, SC, United States
| | - Rachel E. Ham
- Research and Education in Disease Diagnosis and Intervention (REDDI) Lab, Center for Innovative Medical Devices and Sensors, Clemson University, Clemson, SC, United States
| | - Justin M. Napolitano
- Research and Education in Disease Diagnosis and Intervention (REDDI) Lab, Center for Innovative Medical Devices and Sensors, Clemson University, Clemson, SC, United States
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Kylie L. King
- Research and Education in Disease Diagnosis and Intervention (REDDI) Lab, Center for Innovative Medical Devices and Sensors, Clemson University, Clemson, SC, United States
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | | | - Corey A. Kalbaugh
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Delphine Dean
- Research and Education in Disease Diagnosis and Intervention (REDDI) Lab, Center for Innovative Medical Devices and Sensors, Clemson University, Clemson, SC, United States
- Department of Bioengineering, Clemson University, Clemson, SC, United States
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Forrest IS, Jaladanki SK, Paranjpe I, Glicksberg BS, Nadkarni GN, Do R. Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19. Infection 2021; 49:989-997. [PMID: 34089483 PMCID: PMC8179090 DOI: 10.1007/s15010-021-01633-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023]
Abstract
Purpose Limited mechanical ventilators (MV) during the Coronavirus disease (COVID-19) pandemic have led to the use of non-invasive ventilation (NIV) in hypoxemic patients, which has not been studied well. We aimed to assess the association of NIV versus MV with mortality and morbidity during respiratory intervention among hypoxemic patients admitted with COVID-19. Methods We performed a retrospective multi-center cohort study across 5 hospitals during March–April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at the conclusion of the respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups, and propensity-matched analysis. Results Of 2381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR = 30, 95% CI 16–60) with a mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms [55/154 (36%) versus 66/534 (12%), OR = 4.3, 95% CI 2.7–6.8], longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92 versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with a greater OR of death than NIV. Conclusions NIV was associated with lower respiratory intervention mortality and morbidity than MV. However, findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed to definitively determine the role of NIV in hypoxemic patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01633-6.
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Affiliation(s)
- Iain S Forrest
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA
| | - Suraj K Jaladanki
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA
| | - Ishan Paranjpe
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA. .,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA. .,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.
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