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Johannesson JM, Glover WA, Petti CA, Veldman TH, Tsalik EL, Taylor DH, Hendren S, Neighbors CE, Tillekeratne LG, Kennedy SW, Harper B, Kibbe WA, Corbie G, Cohen-Wolkowiez M, Woods CW, Lee MJ. Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review. Front Public Health 2023; 11:1237066. [PMID: 37841714 PMCID: PMC10568314 DOI: 10.3389/fpubh.2023.1237066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers. Methods A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery. Results Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them. Conclusion A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery.
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Affiliation(s)
- Jon M. Johannesson
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - William A. Glover
- North Carolina State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, United States
| | - Cathy A. Petti
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Healthspring Global Inc., Bradenton, FL, United States
| | - Timothy H. Veldman
- Duke Global Health Institute, Durham, NC, United States
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, United States
| | - Ephraim L. Tsalik
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Donald H. Taylor
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Stephanie Hendren
- Duke University Medical Center Library, Duke University, Durham, NC, United States
| | - Coralei E. Neighbors
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, United States
| | | | - Scott W. Kennedy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Barrie Harper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Warren A. Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, United States
| | - Giselle Corbie
- Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Christopher W. Woods
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, United States
| | - Mark J. Lee
- Department of Pathology, Duke University School of Medicine, Durham, NC, United States
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Sachdev DD, Petersen M, Havlir DV, Schwab J, Enanoria WT, Nguyen TQ, Mercer MP, Scheer S, Bennett A, Tenner AG, Marks JD, Bobba N, Philip S, Colfax G. San Francisco's Citywide COVID-19 Response: Strategies to Reduce COVID-19 Severity and Health Disparities, March 2020 Through May 2022. Public Health Rep 2023; 138:747-755. [PMID: 37408322 PMCID: PMC10323495 DOI: 10.1177/00333549231181353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
San Francisco implemented one of the most intensive, comprehensive, multipronged COVID-19 pandemic responses in the United States using 4 core strategies: (1) aggressive mitigation measures to protect populations at risk for severe disease, (2) prioritization of resources in neighborhoods highly affected by COVID-19, (3) timely and adaptive data-driven policy making, and (4) leveraging of partnerships and public trust. We collected data to describe programmatic and population-level outcomes. The excess all-cause mortality rate in 2020 in San Francisco was half that seen in 2019 in California as a whole (8% vs 16%). In almost all age and race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, with markedly diminished excess mortality among people aged >65 years. The COVID-19 response in San Francisco highlights crucial lessons, particularly the importance of community responsiveness, joint planning, and collective action, to inform future pandemic response and advance health equity.
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Affiliation(s)
| | - Maya Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Diane V. Havlir
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joshua Schwab
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Trang Q. Nguyen
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Mary P. Mercer
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ayanna Bennett
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Andrea G. Tenner
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - James D. Marks
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
| | - Naveena Bobba
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Susan Philip
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Grant Colfax
- San Francisco Department of Public Health, San Francisco, CA, USA
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3
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Reproducibility and implementation of a rapid, community-based COVID-19 "test and respond" model in low-income, majority-Latino communities in Northern California. PLoS One 2022; 17:e0276257. [PMID: 36301834 PMCID: PMC9612491 DOI: 10.1371/journal.pone.0276257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate implementation of a community-engaged approach to scale up COVID-19 mass testing in low-income, majority-Latino communities. METHODS In January 2021, we formed a community-academic "Latino COVID-19 Collaborative" with residents, leaders, and community-based organizations (CBOs) from majority-Latinx, low-income communities in three California counties (Marin/Merced/San Francisco). The collaborative met monthly to discuss barriers/facilitators for COVID-19 testing, and plan mass testing events informed by San Francisco's Unidos en Salud "test and respond" model, offering community-based COVID-19 testing and post-test support in two US-census tracts: Canal (Marin) and Planada (Merced). We evaluated implementation using the RE-AIM framework. To further assess testing barriers, we surveyed a random sample of residents who did not attend the events. RESULTS Fifty-five residents and CBO staff participated in the Latino collaborative. Leading facilitators identified to increase testing were extended hours of community-based testing and financial support during isolation. In March-April 2021, 1,217 people attended mass-testing events over 13 days: COVID-19 positivity was 3% and 1% in Canal and Planada, respectively. The RE-AIM evaluation found: census tract testing coverage of 4.2% and 6.3%, respectively; 90% of event attendees were Latino, 89% had household income <$50,000/year, and 44% first-time testers (reach), effectiveness in diagnosing symptomatic cases early (median isolation time: 7 days) and asymptomatic COVID-19 (41% at diagnosis), high adoption by CBOs in both counties, implementation of rapid testing (median: 17.5 minutes) and disclosure, and post-event maintenance of community-based testing. Among 265 non-attendees surveyed, 114 (43%) reported they were aware of the event: reasons for non-attendance among the 114 were insufficient time (32%), inability to leave work (24%), and perceptions that testing was unnecessary post-vaccination (24%) or when asymptomatic (25%). CONCLUSION Community-engaged mass "test and respond" events offer a reproducible approach to rapidly increase COVID-19 testing access in low-income, Latinx communities.
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Marquez C, Kerkhoff AD, Schrom J, Rojas S, Black D, Mitchell A, Wang CY, Pilarowski G, Ribeiro S, Jones D, Payan J, Manganelli S, Rojas S, Lemus J, Jain V, Chamie G, Tulier-Laiwa V, Petersen M, DeRisi J, Havlir DV. COVID-19 Symptoms and Duration of Rapid Antigen Test Positivity at a Community Testing and Surveillance Site During Pre-Delta, Delta, and Omicron BA.1 Periods. JAMA Netw Open 2022; 5:e2235844. [PMID: 36215069 PMCID: PMC9552893 DOI: 10.1001/jamanetworkopen.2022.35844] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022] Open
Abstract
Importance Characterizing the clinical symptoms and evolution of community-based SARS-CoV-2 infections may inform health practitioners and public health officials in a rapidly changing landscape of population immunity and viral variants. Objectives To compare COVID-19 symptoms among people testing positive with a rapid antigen test (RAT) during the Omicron BA.1 variant period (December 1, 2021, to January 30, 2022) with the pre-Delta (January 10 to May 31, 2021) and Delta (June 1 to November 30, 2021) variant periods and to assess the duration of RAT positivity during the Omicron BA.1 surge. Design, Setting, and Participants This cross-sectional study was conducted from January 10, 2021, to January 31, 2022, at a walk-up community COVID-19 testing site in San Francisco, California. Participants included children and adults seeking COVID-19 testing with an RAT, regardless of age, vaccine status, or symptoms. Main Outcomes and Measures Fisher exact tests or χ2 tests were used to compare COVID-19 symptoms during the Omicron BA.1 period with the pre-Delta and Delta periods for vaccination status and age group. Among people returning for repeated testing during the Omicron period, the proportion with a positive RAT between 4 and 14 days from symptom onset or since first positive test if asymptomatic was estimated. Results Among 63 277 persons tested (median [IQR] age, 32 [21-44] years, with 12.0% younger than 12 years; 52.0% women; and 68.5% Latinx), a total of 18 301 people (28.9%) reported symptoms, of whom 4565 (24.9%) tested positive for COVID-19. During the Omicron BA.1 period, 3032 of 7283 symptomatic participants (41.6%) tested positive, and the numbers of these reporting cough and sore throat were higher than during pre-Delta and Delta periods (cough: 2044 [67.4%] vs 546 [51.3%] of 1065 participants, P < .001 for pre-Delta, and 281 [60.0%] of 468 participants, P = .002, for Delta; sore throat: 1316 [43.4%] vs 315 [29.6%] of 1065 participants, P < .001 for pre-Delta, and 136 [29.1%] of 468 participants, P < .001, for Delta). Compared with the 1065 patients with positive test results in the pre-Delta period, congestion among the 3032 with positive results during the Omicron BA.1 period was more common (1177 [38.8%] vs 294 [27.6%] participants, P < .001), and loss of taste or smell (160 [5.3%] vs 183 [17.2%] participants, P < .001) and fever (921 [30.4%] vs 369 [34.7%] participants, P = .01) were less common. In addition, during the Omicron BA.1 period, fever was less common among the people with positive test results who had received a vaccine booster compared with those with positive test results who were unvaccinated (97 [22.5%] of 432 vs 42 [36.2%] of 116 participants, P = .003), and fever and myalgia were less common among participants who had received a booster compared with those with positive results who had received only a primary series (fever: 97 [22.5%] of 432 vs 559 [32.8%] of 1705 participants, P < .001; myalgia: 115 [26.6%] of 432 vs 580 [34.0%] of 1705 participants, P = .003). During the Omicron BA.1 period, 5 days after symptom onset, 507 of 1613 people (31.1%) with COVID-19 stated that their symptoms were similar, and 95 people (5.9%) reported worsening symptoms. Among people testing positive, 80.2% of participants who were symptomatic and retested remained positive 5 days after symptom onset. Conclusions and Relevance In this cross-sectional study, COVID-19 upper respiratory tract symptoms were more commonly reported during the Omicron BA.1 period than during the pre-Delta and Delta periods, with differences by vaccination status. Rapid antigen test positivity remained high 5 days after symptom onset, supporting guidelines requiring a negative test to inform the length of the isolation period.
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Affiliation(s)
- Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - John Schrom
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Susana Rojas
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | - Susy Rojas
- Unidos en Salud, San Francisco, California
| | | | - Vivek Jain
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
| | - Valerie Tulier-Laiwa
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California
| | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley
| | | | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
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Wang X, Du Z, James E, Fox SJ, Lachmann M, Meyers LA, Bhavnani D. The effectiveness of COVID-19 testing and contact tracing in a US city. Proc Natl Acad Sci U S A 2022; 119:e2200652119. [PMID: 35969766 PMCID: PMC9407477 DOI: 10.1073/pnas.2200652119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022] Open
Abstract
Although testing, contact tracing, and case isolation programs can mitigate COVID-19 transmission and allow the relaxation of social distancing measures, few countries worldwide have succeeded in scaling such efforts to levels that suppress spread. The efficacy of test-trace-isolate likely depends on the speed and extent of follow-up and the prevalence of SARS-CoV-2 in the community. Here, we use a granular model of COVID-19 transmission to estimate the public health impacts of test-trace-isolate programs across a range of programmatic and epidemiological scenarios, based on testing and contact tracing data collected on a university campus and surrounding community in Austin, TX, between October 1, 2020, and January 1, 2021. The median time between specimen collection from a symptomatic case and quarantine of a traced contact was 2 days (interquartile range [IQR]: 2 to 3) on campus and 5 days (IQR: 3 to 8) in the community. Assuming a reproduction number of 1.2, we found that detection of 40% of all symptomatic cases followed by isolation is expected to avert 39% (IQR: 30% to 45%) of COVID-19 cases. Contact tracing is expected to increase the cases averted to 53% (IQR: 42% to 58%) or 40% (32% to 47%), assuming the 2- and 5-day delays estimated on campus and in the community, respectively. In a tracing-accelerated scenario, in which 75% of contacts are notified the day after specimen collection, cases averted increase to 68% (IQR: 55% to 72%). An accelerated contact tracing program leveraging rapid testing and electronic reporting of test results can significantly curtail local COVID-19 transmission.
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Affiliation(s)
- Xutong Wang
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712
| | - Zhanwei Du
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Emily James
- Information Technology Project Management Office, Dell Medical School, The University of Texas at Austin, Austin, TX 78712
| | - Spencer J. Fox
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712
| | | | - Lauren Ancel Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX 78712
- Santa Fe Institute, Santa Fe, NM 87501
| | - Darlene Bhavnani
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX 78712
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Kerkhoff AD, Rojas S, Black D, Ribeiro S, Rojas S, Valencia R, Lemus J, Payan J, Schrom J, Jones D, Manganelli S, Bandi S, Chamie G, Tulier-Laiwa V, Petersen M, Havlir D, Marquez C. Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program. JAMA Netw Open 2022; 5:e2214163. [PMID: 35616939 PMCID: PMC9136625 DOI: 10.1001/jamanetworkopen.2022.14163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Community-based COVID-19 testing and vaccination programs play a crucial role in mitigating racial and ethnic disparities in COVID-19 service delivery. They also represent a platform that can be leveraged to expand access to testing for chronic diseases, including diabetes, that disproportionately affect the Latinx community and other marginalized communities. OBJECTIVE To evaluate outcomes associated with a diabetes testing strategy designed to reach low-income Latinx persons by leveraging COVID-19 testing infrastructure and community trust developed during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This health care improvement study was conducted from August 1 to October 5, 2021, at an outdoor, community-based COVID-19 testing site at a transport hub in the Mission Neighborhood in San Francisco, California. Because the program was designed to expand access to diabetes screening to the local community, all individuals presenting for on-site testing were eligible. Data were analyzed in November 2021. INTERVENTIONS Integration of rapid, point-of-care hemoglobin A1c screening as a testing option in an existing low-barrier COVID-19 testing program. MAIN OUTCOMES AND MEASURES Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and utilized programmatic data and structured surveys among clients and staff. RESULTS Of 6631 individuals tested (median [IQR] age 39.3 [29.7-51.3] years; 3417 [52.3%] female, 4348 [65.6%] Latinx), 923 (13.9%) underwent hemoglobin A1c testing with or without COVID-19 testing and 5708 (86.1%) underwent COVID-19 testing only. Individuals tested for diabetes were more likely to be Latinx (763 of 923 individuals [82.7%] who underwent testing were Latinx vs 3585 of 5708 [62.8%] not undergoing testing), have an annual household income of less than $50 000 (450 individuals [81.2%] vs 2409 individuals [66.0%]), and not have health insurance (381 individuals [47.2%] vs 1858 individuals [39.9%]), and 206 (48.0%) had never tested for diabetes before. Overall, 313 (33.9%) and 113 (12.2%) individuals had prediabetes and diabetes, respectively; only 141 of 354 of these individuals (39.8%) had a primary care clinician whom they had seen in the prior 12 months, which was lower among Latinx individuals (113 of 307 individuals [36.8%] vs 28 of 47 [59.6%]). Acceptability of the rapid testing program was high-98% were satisfied with their visit and 96% said they would return for future services; key factors underpinning acceptability included friendly staff, efficiency, and a convenient location. CONCLUSIONS AND RELEVANCE In this health care improvement study conducted within an existing community-based COVID-19 testing program, integrating rapid testing for diabetes was feasible, reached low-income Latinx individuals, and identified many persons with prediabetes and diabetes, most of whom lacked access to services in formal health care settings. Leveraging pandemic-related public health responses represents an important opportunity for engaging socioeconomically disadvantaged populations into care for diabetes.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Susana Rojas
- San Francisco Latino Task Force–Response to COVID-19, San Francisco, California
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | - Susy Rojas
- Unidos en Salud, San Francisco, California
| | | | | | | | - John Schrom
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | | | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | - Maya Petersen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
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Schrom J, Marquez C, Pilarowski G, Wang CY, Mitchell A, Puccinelli R, Black D, Rojas S, Ribeiro S, Tulier-Laiwa V, Martinez J, Payan J, Rojas S, Jones D, Martinez D, Nakamura R, Chamie G, Jain V, Petersen M, DeRisi J, Havlir D. Comparison of SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction and BinaxNOW Rapid Antigen Tests at a Community Site During an Omicron Surge : A Cross-Sectional Study. Ann Intern Med 2022; 175:682-690. [PMID: 35286144 PMCID: PMC8943844 DOI: 10.7326/m22-0202] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND SARS-CoV-2 rapid antigen tests are an important public health tool. OBJECTIVE To evaluate field performance of the BinaxNOW rapid antigen test (Abbott) compared with reverse transcriptase polymerase chain reaction (RT-PCR) for detecting infection with the Omicron variant of SARS-CoV-2. DESIGN Cross-sectional surveillance study. SETTING Free, walk-up, outdoor, urban community testing and vaccine site led by Unidos en Salud, serving a predominantly Latinx community highly impacted by COVID-19. PARTICIPANTS Persons seeking COVID-19 testing in January 2022. MEASUREMENTS Simultaneous BinaxNOW and RT-PCR from nasal, cheek, and throat swabs, including cycle threshold (Ct) measures; a lower Ct value is a surrogate for higher amounts of virus. RESULTS Among 731 persons tested with nasal swabs, there were 296 (40.5%) positive results on RT-PCR; 98.9% were the Omicron variant. BinaxNOW detected 95.2% (95% CI, 91% to 98%) of persons who tested positive on RT-PCR with a Ct value below 30, 82.1% (CI, 77% to 87%) of those who tested positive on RT-PCR with a Ct value below 35, and 65.2% (CI, 60% to 71%) of all who were positive on RT-PCR. Among 75 persons with simultaneous nasal and cheek swabs, BinaxNOW using a cheek swab failed to detect 91% (20 of 22) of specimens that were positive on BinaxNOW with a nasal swab. Among persons with simultaneous nasal and throat swabs who were positive on RT-PCR with a Ct value below 30, 42 of 49 (85.7%) were detected by nasal BinaxNOW, 23 of 49 (46.9%) by throat BinaxNOW, and 44 of 49 (89.8%) by either. LIMITATION Participants were a cross-sectional sample from a community-based sentinel surveillance site, precluding study of viral or symptom dynamics. CONCLUSION BinaxNOW detected persons with high SARS-CoV-2 levels during the Omicron surge, enabling rapid responses to positive test results. Cheek or throat swabs should not replace nasal swabs. As currently recommended, high-risk persons with an initial negative BinaxNOW result should have repeated testing. PRIMARY FUNDING SOURCE University of California, San Francisco.
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Affiliation(s)
- John Schrom
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Carina Marquez
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Genay Pilarowski
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Chung-Yu Wang
- Chan Zuckerberg Biohub, San Francisco, California (C.W., A.M., J.D.)
| | - Anthea Mitchell
- Chan Zuckerberg Biohub, San Francisco, California (C.W., A.M., J.D.)
| | - Robert Puccinelli
- University of California, Berkeley, Berkeley, California (R.P., M.P.)
| | - Doug Black
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Susana Rojas
- Unidos en Salud and San Francisco Latino Task Force for COVID-19, San Francisco, California (Susana Rojas, V.T., Susy Rojas)
| | - Salustiano Ribeiro
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Valerie Tulier-Laiwa
- Unidos en Salud and San Francisco Latino Task Force for COVID-19, San Francisco, California (Susana Rojas, V.T., Susy Rojas)
| | - Jacqueline Martinez
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Joselin Payan
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Susy Rojas
- Unidos en Salud and San Francisco Latino Task Force for COVID-19, San Francisco, California (Susana Rojas, V.T., Susy Rojas)
| | - Diane Jones
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Daniel Martinez
- Unidos en Salud, San Francisco, California (G.P., S.Ribeiro, J.M., J.P., D.J., D.M.)
| | - Robert Nakamura
- California Department of Public Health, Richmond, California (R.N.)
| | - Gabriel Chamie
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Vivek Jain
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
| | - Maya Petersen
- University of California, Berkeley, Berkeley, California (R.P., M.P.)
| | - Joe DeRisi
- Chan Zuckerberg Biohub, San Francisco, California (C.W., A.M., J.D.)
| | - Diane Havlir
- University of California, San Francisco, San Francisco, California (J.S., C.M., D.B., G.C., V.J., D.H.)
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Naso J, Rojas S, Peng J, Marquez C, Contreras M, Castellanos E, Rojas S, Rubio L, Jones D, Jacobo J, Black D, Tulier-Laiwa V, Martinez J, Chamie G, Pilarowski G, DeRisi J, Havlir D, Petersen M. High Parental Vaccine Motivation at a Neighborhood-Based Vaccine and Testing Site Serving a Predominantly Latinx Community. Health Equity 2022; 5:840-846. [PMID: 35018317 PMCID: PMC8742294 DOI: 10.1089/heq.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To understand vaccine attitudes of Latinx parents highly impacted by COVID-19. Methods: In April 2021, we surveyed parents about their attitudes for COVID-19 vaccination of their children at a community-based outdoor testing/vaccination site serving predominantly low-income Latinx persons in San Francisco. Results: Among 1033 parents (75% Latinx), 92% would "definitely" or "probably" vaccinate their children. Vaccine concerns were higher for younger children and included side effects and impacts on fertility. Doctors and community organizations were noted as trusted sources of information, including among vaccine-concerned parents. Conclusion: Latinx parents accessing neighborhood-based COVID-19 testing/vaccination services are highly motivated to vaccinate their children for COVID-19.
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Affiliation(s)
- Jamie Naso
- Unidos en Salud, San Francisco, California, USA
| | - Susy Rojas
- The San Francisco Latino Task Force on COVID-19, San Francisco, California, USA
| | - James Peng
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | | | - Susana Rojas
- The San Francisco Latino Task Force on COVID-19, San Francisco, California, USA
| | - Luis Rubio
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Diane Jones
- Unidos en Salud, San Francisco, California, USA
| | - Jon Jacobo
- The San Francisco Latino Task Force on COVID-19, San Francisco, California, USA
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Joseph DeRisi
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Maya Petersen
- Division of Biostatistics, The School of Public Health, University of California, Berkeley, Berkeley, California, USA
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9
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Peng J, Liu J, Mann SA, Mitchell AM, Laurie MT, Sunshine S, Pilarowski G, Ayscue P, Kistler A, Vanaerschot M, Li LM, McGeever A, Chow ED, Marquez C, Nakamura R, Rubio L, Chamie G, Jones D, Jacobo J, Rojas S, Rojas S, Tulier-Laiwa V, Black D, Martinez J, Naso J, Schwab J, Petersen M, Havlir D, DeRisi J. Estimation of Secondary Household Attack Rates for Emergent Spike L452R Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants Detected by Genomic Surveillance at a Community-Based Testing Site in San Francisco. Clin Infect Dis 2022; 74:32-39. [PMID: 33788923 PMCID: PMC8083548 DOI: 10.1093/cid/ciab283] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sequencing of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral genome from patient samples is an important epidemiological tool for monitoring and responding to the pandemic, including the emergence of new mutations in specific communities. METHODS SARS-CoV-2 genomic sequences were generated from positive samples collected, along with epidemiological metadata, at a walk-up, rapid testing site in the Mission District of San Francisco, California during 22 November to 1 December, 2020, and 10-29 January 2021. Secondary household attack rates and mean sample viral load were estimated and compared across observed variants. RESULTS A total of 12 124 tests were performed yielding 1099 positives. From these, 928 high-quality genomes were generated. Certain viral lineages bearing spike mutations, defined in part by L452R, S13I, and W152C, comprised 54.4% of the total sequences from January, compared to 15.7% in November. Household contacts exposed to the "California" or "West Coast" variants (B.1.427 and B.1.429) were at higher risk of infection compared to household contacts exposed to lineages lacking these variants (0.36 vs 0.29, risk ratio [RR] = 1.28; 95% confidence interval [CI]: 1.00-1.64). The reproductive number was estimated to be modestly higher than other lineages spreading in California during the second half of 2020. Viral loads were similar among persons infected with West Coast versus non-West Coast strains, as was the proportion of individuals with symptoms (60.9% vs 64.3%). CONCLUSIONS The increase in prevalence, relative household attack rates, and reproductive number are consistent with a modest transmissibility increase of the West Coast variants. Summary: We observed a growing prevalence and modestly elevated attack rate for "West Coast" severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in a community testing setting in San Francisco during January 2021, suggesting its modestly higher transmissibility.
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Affiliation(s)
- James Peng
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jamin Liu
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- University of California, Berkeley—University of California, San Francisco Graduate Program in Bioengineering, Berkeley, California, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Anthea M Mitchell
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Matthew T Laurie
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sara Sunshine
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Genay Pilarowski
- Department of Pathology, Stanford University, Stanford, California, USA
| | | | - Amy Kistler
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Lucy M Li
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | | | - Eric D Chow
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Robert Nakamura
- California Department of Public Health, Richmond, California, USA
| | - Luis Rubio
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Diane Jones
- Unidos en Salud, San Francisco, California, USA
| | - Jon Jacobo
- Unidos en Salud, San Francisco, California, USA
| | | | - Susy Rojas
- Unidos en Salud, San Francisco, California, USA
| | | | - Douglas Black
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Jamie Naso
- Unidos en Salud, San Francisco, California, USA
| | - Joshua Schwab
- Division of Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Maya Petersen
- Division of Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joseph DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - IDseq Team
- Chan Zuckerberg Initiative, Redwood City, CaliforniaUSA
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10
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Johnson BD, Shui MW, Said K, Chavez A, Sachdev DD. Prioritizing COVID-19 Contact Tracing During a Surge Using Chatbot Technology. Am J Public Health 2022; 112:43-47. [PMID: 34936405 PMCID: PMC8713632 DOI: 10.2105/ajph.2021.306563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/04/2022]
Abstract
When COVID-19 cases surge, identifying ways to improve the efficiency of contact tracing and prioritize vulnerable communities for isolation and quarantine support services is critical. During a fall 2020 COVID-19 resurgence in San Francisco, California, prioritization of telephone-based case investigation by zip code and using a chatbot to screen for case participants who needed isolation support reduced the number of case participants who would have been assigned for a telephone interview by 31.5% and likely contributed to 87.5% of Latinx case participants being successfully interviewed. (Am J Public Health. 2022;112(1):43-47. https://doi.org/10.2105/AJPH.2021.306563).
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Affiliation(s)
- Brady D Johnson
- All authors are with the Population Health Division, San Francisco Department of Public Health, San Francisco, CA. Brady D. Johnson is also with the Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Meg Wall Shui
- All authors are with the Population Health Division, San Francisco Department of Public Health, San Francisco, CA. Brady D. Johnson is also with the Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Kiana Said
- All authors are with the Population Health Division, San Francisco Department of Public Health, San Francisco, CA. Brady D. Johnson is also with the Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Alejandro Chavez
- All authors are with the Population Health Division, San Francisco Department of Public Health, San Francisco, CA. Brady D. Johnson is also with the Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Darpun D Sachdev
- All authors are with the Population Health Division, San Francisco Department of Public Health, San Francisco, CA. Brady D. Johnson is also with the Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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11
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Marquez C, Kerkhoff AD, Naso J, Contreras MG, Castellanos Diaz E, Rojas S, Peng J, Rubio L, Jones D, Jacobo J, Rojas S, Gonzalez R, Fuchs JD, Black D, Ribeiro S, Nossokoff J, Tulier-Laiwa V, Martinez J, Chamie G, Pilarowski G, DeRisi J, Petersen M, Havlir DV. A multi-component, community-based strategy to facilitate COVID-19 vaccine uptake among Latinx populations: From theory to practice. PLoS One 2021; 16:e0257111. [PMID: 34543291 PMCID: PMC8452046 DOI: 10.1371/journal.pone.0257111] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND COVID-19 vaccine coverage in the Latinx community depends on delivery systems that overcome barriers such as institutional distrust, misinformation, and access to care. We hypothesized that a community-centered vaccination strategy that included mobilization, vaccination, and "activation" components could successfully reach an underserved Latinx population, utilizing its social networks to boost vaccination coverage. METHODS Our community-academic-public health partnership, "Unidos en Salud," utilized a theory-informed approach to design our "Motivate, Vaccinate, and Activate" COVID-19 vaccination strategy. Our strategy's design was guided by the PRECEDE Model and sought to address and overcome predisposing, enabling, and reinforcing barriers to COVID-19 vaccination faced by Latinx individuals in San Francisco. We evaluated our prototype outdoor, "neighborhood" vaccination program located in a central commercial and transport hub in the Mission District in San Francisco, using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework during a 16-week period from February 1, 2021 to May 19, 2021. Programmatic data, city-wide COVID-19 surveillance data, and a survey conducted between May 2, 2021 and May 19, 2021 among 997 vaccinated clients ≥16 years old were used in the evaluation. RESULTS There were 20,792 COVID-19 vaccinations administered at the neighborhood site during the 16-week evaluation period. Vaccine recipients had a median age of 43 (IQR 32-56) years, 53.9% were male and 70.5% were Latinx, 14.1% white, 7.7% Asian, 2.4% Black, and 5.3% other. Latinx vaccinated clients were substantially more likely than non-Latinx clients to have an annual household income of less than $50,000 a year (76.1% vs. 33.5%), be a first-generation immigrant (60.2% vs. 30.1%), not have health insurance (47.3% vs. 16.0%), and not have access to primary care provider (62.4% vs. 36.2%). The most frequently reported reasons for choosing vaccination at the site were its neighborhood location (28.6%), easy and convenient scheduling (26.9%) and recommendation by someone they trusted (18.1%); approximately 99% reported having an overall positive experience, regardless of ethnicity. Notably, 58.3% of clients reported that they were able to get vaccinated earlier because of the neighborhood vaccination site, 98.4% of clients completed both vaccine doses, and 90.7% said that they were more likely to recommend COVID-19 vaccination to family and friends after their experience; these findings did not substantially differ according to ethnicity. There were 40.3% of vaccinated clients who said they still knew at least one unvaccinated person (64.6% knew ≥3). Among clients who received both vaccine doses (n = 729), 91.0% said that after their vaccination experience, they had personally reached out to at least one unvaccinated person they knew (61.6% reached out to ≥3) to recommend getting vaccinated; 83.0% of clients reported that one or more friends, and/or family members got vaccinated as a result of their outreach, including 18.9% who reported 6 or more persons got vaccinated as a result of their influence. CONCLUSIONS A multi-component, "Motivate, Vaccinate, and Activate" community-based strategy addressing barriers to COVID-19 vaccination for the Latinx population reached the intended population, and vaccinated individuals served as ambassadors to recruit other friends and family members to get vaccinated.
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Affiliation(s)
- Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Jamie Naso
- Unidos en Salud, San Francisco, California, United States of America
| | - Maria G. Contreras
- Unidos en Salud, San Francisco, California, United States of America
- Department of Medicine, University of California, San Francisco, California, United States of America
- Clínica Martín Baró, San Francisco, California, United States of America
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - Edgar Castellanos Diaz
- Unidos en Salud, San Francisco, California, United States of America
- Clínica Martín Baró, San Francisco, California, United States of America
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Susana Rojas
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - James Peng
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Luis Rubio
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Diane Jones
- Unidos en Salud, San Francisco, California, United States of America
| | - Jon Jacobo
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - Susy Rojas
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | - Rafael Gonzalez
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Jonathan D. Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Salustiano Ribeiro
- Bay Area Phlebotomy and Laboratory Services (BayPLS), San Francisco, California, United States of America
| | - Jen Nossokoff
- Bay Area Phlebotomy and Laboratory Services (BayPLS), San Francisco, California, United States of America
| | - Valerie Tulier-Laiwa
- The San Francisco Latino Task Force-Response to COVID-19, San Francisco, California, United States of America
| | | | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Genay Pilarowski
- Department of Pathology, Stanford University, Stanford, California, United States of America
| | - Joseph DeRisi
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, United States of America
| | - Maya Petersen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
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12
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Otto WR, Grundmeier RW, Montoya-Williams D, Njoroge WFM, Wallis KE, Gerber JS, Yun K. Association between Preferred Language and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children in the United States. Am J Trop Med Hyg 2021; 105:1261-1264. [PMID: 34469330 PMCID: PMC8592181 DOI: 10.4269/ajtmh.21-0779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a disproportionate impact on Black, Hispanic, and other individuals of color, although data on the effect of a person’s language on SARS-CoV-2 infection are limited. Considering the barriers suffered by immigrants and non-English-speaking families, we tested whether children with a preferred language other than English was associated with SARS-CoV-2 infection. Children from families with a preferred language other than English had a higher predicted probability of SARS-CoV-2 test positivity (adjusted odds ratio, 3.76; 95% CI, 2.07–6.67) during the first wave of the pandemic. This discrepancy continued into the second wave (adjusted odds ratio, 1.64; 95% CI, 1.10–2.41), although the difference compared with families who prefer to speak English decreased over time. These findings suggest that children from non-English-speaking families are at increased risk of SARS-CoV-2 infection, and efforts to reverse systemic inequities causing this increased risk are needed.
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Affiliation(s)
- William R Otto
- 1Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert W Grundmeier
- 2Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,6Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana Montoya-Williams
- 3Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,5PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,6Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wanjikũ F M Njoroge
- 4Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,5PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kate E Wallis
- 5PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,6Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Gerber
- 1Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,6Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine Yun
- 2Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,5PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,6Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Pharmacist-provided SARS-CoV-2 testing targeting a majority-Hispanic community during the early COVID-19 pandemic: Results of a patient perception survey. J Am Pharm Assoc (2003) 2021; 62:187-193. [PMID: 34465524 PMCID: PMC8373847 DOI: 10.1016/j.japh.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
Background Racial and ethnic minority groups are disproportionally represented among U.S. coronavirus disease (COVID-19) cases, owing to long-standing systemic inequities in the social determinants of health. Among Hispanic populations, a lack of access to testing sites has resulted in delayed time to diagnosis, risking increased spread within high-risk communities. The accessibility and expertise of community pharmacists support expanded pharmacist roles in public health and pandemic response, including point-of-care (POC) diagnostic testing. Objective To determine the local impact of community pharmacist-provided COVID-19 testing among a majority-Hispanic, lower income population during the early COVID-19 pandemic, as assessed by a patient satisfaction survey. Methods A 10-question Likert-type questionnaire was administered in English and Spanish to patients who received a pharmacist-provided POC COVID-19 test at a large-chain community pharmacy in Arizona between May 1, 2020 and June 14, 2020. Questions surrounded patient perceptions of the testing process and subsequent pharmacist counseling on their test results. Results A total of 622 patients completed the survey (94.1% participation rate among successful contacts, representing 28.3% of all eligible patients). The mean age was 42 years, 51% were female, and 64% of patients identified as Hispanic. More than 97% of surveyed patients either agreed or strongly agreed that receiving a pharmacist-provided COVID-19 test at a community pharmacy was a comfortable experience, expanded their access to care, and allowed them to receive their test results in a timely manner. In addition, more than half of surveyed patients “did not know” where they would have alternatively sought testing if the community testing site was not available. Overall, the results of this study demonstrated highly favorable patient perceptions of pharmacist-provided POC testing for COVID-19, with more than 99% of surveyed patients satisfied with their testing experience. Conclusion Among patients in a lower income majority-Hispanic community, pharmacist-provided POC testing services for COVID-19 were well received and expanded patient access to testing during the early pandemic.
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14
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Peng J, Mann SA, Mitchell AM, Liu J, Laurie MT, Sunshine S, Pilarowski G, Ayscue P, Kistler A, Vanaerschot M, Li LM, McGeever A, Chow ED, Team ID, Marquez C, Nakamura R, Rubio L, Chamie G, Jones D, Jacobo J, Rojas S, Rojas S, Tulier-Laiwa V, Black D, Martinez J, Naso J, Schwab J, Petersen M, Havlir D, DeRisi J. Estimation of secondary household attack rates for emergent SARS-CoV-2 variants detected by genomic surveillance at a community-based testing site in San Francisco. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.01.21252705. [PMID: 33688689 PMCID: PMC7941666 DOI: 10.1101/2021.03.01.21252705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sequencing of the SARS-CoV-2 viral genome from patient samples is an important epidemiological tool for monitoring and responding to the pandemic, including the emergence of new mutations in specific communities. METHODS SARS-CoV-2 genomic sequences were generated from positive samples collected, along with epidemiological metadata, at a walk-up, rapid testing site in the Mission District of San Francisco, California during November 22-December 2, 2020 and January 10-29, 2021. Secondary household attack rates and mean sample viral load were estimated and compared across observed variants. RESULTS A total of 12,124 tests were performed yielding 1,099 positives. From these, 811 high quality genomes were generated. Certain viral lineages bearing spike mutations, defined in part by L452R, S13I, and W152C, comprised 54.9% of the total sequences from January, compared to 15.7% in November. Household contacts exposed to "West Coast" variants were at higher risk of infection compared to household contacts exposed to lineages lacking these variants (0.357 vs 0.294, RR=1.29; 95% CI:1.01-1.64). The reproductive number was estimated to be modestly higher than other lineages spreading in California during the second half of 2020. Viral loads were similar among persons infected with West Coast versus non-West Coast strains, as was the proportion of individuals with symptoms (60.9% vs 64.1%). CONCLUSIONS The increase in prevalence, relative household attack rates, and reproductive number are consistent with a modest transmissibility increase of the West Coast variants; however, additional laboratory and epidemiological studies are required to better understand differences between these variants. SUMMARY We observed a growing prevalence and elevated attack rate for "West Coast" SARS-CoV-2 variants in a community testing setting in San Francisco during January 2021, suggesting its modestly higher transmissibility.
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Affiliation(s)
- James Peng
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sabrina A Mann
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
| | - Anthea M Mitchell
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
| | - Jamin Liu
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
- University of California, Berkeley—University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA 94720, USA
| | - Matthew T. Laurie
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
| | - Sara Sunshine
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
| | - Genay Pilarowski
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | | | - Amy Kistler
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | | | - Lucy M. Li
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | | | - Eric D. Chow
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
| | - IDseq Team
- Chan Zuckerberg Initiative, Redwood City, CA 94063, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Robert Nakamura
- California Department of Public Health, Richmond, CA 94804, USA
| | - Luis Rubio
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Diane Jones
- Unidos en Salud, San Francisco, CA 94143, USA
| | - Jon Jacobo
- Unidos en Salud, San Francisco, CA 94143, USA
| | | | - Susy Rojas
- Unidos en Salud, San Francisco, CA 94143, USA
| | | | - Douglas Black
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | | | - Jamie Naso
- Unidos en Salud, San Francisco, CA 94143, USA
| | - Joshua Schwab
- Division of Biostatistics, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Maya Petersen
- Division of Biostatistics, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joseph DeRisi
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
- Department of Biochemistry and Biophysics, University of California San Francisco, CA 94143, USA
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