Disparities in SARS-CoV-2 Infection by Race, Ethnicity, Language, and Social Vulnerability: Evidence from a Citywide Seroprevalence Study in Massachusetts, USA

OBJECTIVES

Uncovering and addressing disparities in infectious disease outbreaks require a rapid, methodical understanding of local epidemiology. We conducted a seroprevalence study of SARS-CoV-2 infection in Holyoke, Massachusetts, a majority Hispanic city with high levels of socio-economic disadvantage to estimate seroprevalence and identify disparities in SARS-CoV-2 infection.

METHODS

We invited 2000 randomly sampled households between 11/5/2020 and 12/31/2020 to complete questionnaires and provide dried blood spots for SARS-CoV-2 antibody testing. We calculated seroprevalence based on the presence of IgG antibodies using a weighted Bayesian procedure that incorporated uncertainty in antibody test sensitivity and specificity and accounted for household clustering.

RESULTS

Two hundred eighty households including 472 individuals were enrolled. Three hundred twenty-eight individuals underwent antibody testing. Citywide seroprevalence of SARS-CoV-2 IgG was 13.1% (95% CI 6.9-22.3) compared to 9.8% of the population infected based on publicly reported cases. Seroprevalence was 16.1% (95% CI 6.2-31.8) among Hispanic individuals compared to 9.4% (95% CI 4.6-16.4) among non-Hispanic white individuals. Seroprevalence was higher among Spanish-speaking households (21.9%; 95% CI 8.3-43.9) compared to English-speaking households (10.2%; 95% CI 5.2-18.0) and among individuals in high social vulnerability index (SVI) areas based on the CDC SVI (14.4%; 95% CI 7.1-25.5) compared to low SVI areas (8.2%; 95% CI 3.1-16.9).

CONCLUSIONS

The SARS-CoV-2 IgG seroprevalence in a city with high levels of social vulnerability was 13.1% during the pre-vaccination period of the COVID-19 pandemic. Hispanic individuals and individuals in communities characterized by high SVI were at the highest risk of infection. Public health interventions should be designed to ensure that individuals in high social vulnerability communities have access to the tools to combat COVID-19.

Case studies in adaptation: centring equity in global health education during the COVID-19 pandemic and beyond

The COVID-19 pandemic disrupted all aspects of life globally and laid bare the pervasive inequities in access to education, employment, healthcare and economic security in both high-resource and low-resource settings. The global health field's brittle attempts of addressing global health inequities, through efforts that in some cases have evoked the colonialist forces implicated in shaping these disparities, have been further challenged by the pandemic. COVID-19 has forced global health leaders to reimagine their field through innovation such as shifting the application of global health to a local focus, collaborating with community organisations and exploring virtual education technologies. We present four case studies illustrating this promising movement towards a more sustainable, ethical and equitable model of global health education practice.Case 1: trainees from the Massachusetts General Hospital Center for Global Health partnered with the Board of Health of Holyoke, a majority Latinx city with high poverty levels, to respond to the COVID-19 pandemic through research and intervention. Case 2: Prevencasa, a community health organisation in Tijuana, Mexico, providing healthcare to local underserved communities, shifted its focus from hosting international trainees to developing a multidisciplinary training programme for Mexican healthcare professionals. Case 3: the Johns Hopkins Global Health Leadership Program adapted its curriculum into a hybrid online and in-person migrant health and human rights elective, collaborating with local organisations. Case 4: a US-based and a Latin American-based organisation collaborated to create a longitudinal, virtual urogynaecology training programme with hybrid simulation practice to increase accessibility of procedural-based training.

Computed tomography of the brain in acute carbon monoxide poisoning

Of 107 patients admitted to the South Western Hyperbaric Medical Centre with acute carbon monoxide poisoning for hyperbaric oxygen therapy 19 had cerebral imaging performed: 17 patients had CT, one patient had MRI and CT and one patient MRI alone. The role of brain CT is established in determining the prognosis from acute carbon monoxide poisoning. Brain imaging was indicated because of unconsciousness on admission and failure or delayed improvement in neurological status after initiation of hyperbaric oxygen therapy. Of the 18 patients who underwent brain CT, seven were found to have the characteristic changes of bilateral low attenuation areas within the globus pallidus and six had low attenuation changes within cerebral white matter. In two patients there were both globus pallidus and cerebral white matter changes. Out of the total of the 19 patients who were studied, four patients died, 10 recovered fully and five had variable disabilities ranging from short term memory loss to more severe cognitive impairment and physical disability. The role of CT and the practicalities of hyperbaric oxygen therapy for acute carbon monoxide poisoning are discussed in the light of the experience from a regional dedicated medical diving centre.

Direct puncture venography in subcutaneous cavernous haemangiomas

The conventional assessment of subcutaneous cavernous haemangiomas by venography, arteriography, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) is often unsatisfactory and fails to show either the extent of the lesion or its feeding and draining vessels. We describe a direct puncture venography technique which successfully delineated the lesions in six patients. The technique was easy to perform and no complications occurred.

MRI diagnosis of vertebral arteriovenous malformations in neurofibromatosis

We describe two patients with neurofibromatosis, each of whom was found to have an arteriovenous malformation (AVM), an uncommon manifestation of the disease, presenting as an extradural space-occupying lesion in the cervical spine. In one patient the finding of an unsuspected AVM at operation led to massive blood loss; in the other magnetic resonance imaging (MRI) of the neck allowed the diagnosis to be made and the hazard of an operation to be avoided. Solid tumours that may occur in the disease of neurofibromatosis are known to cause neurological deficits as the result of space occupation. We wish to draw attention to another pathological entity which may cause neurological deficits: that of AVMs. We also propose that in the investigation of such a patient MRI be borne in mind as a non-invasive radiological tool, particularly as, hopefully, its cost reduces and its availability becomes more widespread.

Arachnoid cysts of the middle fossa predispose to subdural haematoma formation fact or fiction?

An association between arachnoid cysts of the middle fossa (ACMF) and complicating subdural haematoma (SDH) has been previously noted. More recently it has been hypothesized that ACMF may predispose to SDH formation. The Plymouth Neurosurgical Unit has treated twenty patients with ACMF between 1976-1985, seven of these being complicated by SDH. There was an age range of 11-56 years in those with SDH. Six of the seven patients with ACMF and SDH gave no significant trauma history. Four of these were males aged 11 to 20 years. The presenting histories, clinical findings and subsequent management of these patients were compared with the age-matched males with SDH alone (twelve patients). In the SDH alone group 100% suffered major skull trauma and 80% had demonstrable skull fractures. In addition the patients with ACMF were compared with patients presenting with other supratentorial arachnoid cysts in Plymouth. Only ACMF were associated with the development of SDH in our study. Three patients demonstrated total masking of the ACMF by isodense intracystic haematoma on computed tomography. In two of these patients the presence of an ACMF was suspected due to plain radiographic and CT enlargement of the middle fossa. It is advocated that with special reference to young males, in the absence of major skull trauma an ACMF should be suspected as a predisposing factor to SDH. Postoperative CT scans for at least one year are advisable in young patients with SDH as demonstration of the presence of an ACMF and SDH affects future management.

A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma

It has been increasingly recognised that patients with arachnoid cysts of the middle fossa appear more susceptible to the development of subdural haematomas. Seven patients with arachnoid cysts of the middle fossa and associated subdural haematomas are presented. Intra-cystic haemorrhage, masking the presence of an arachnoid cyst on computed tomography (CT) is highlighted. Repeat of CT scanning in young patients with subdural haematomas in the absence of severe trauma is recommended. Two theories are proposed to account for the observed susceptibility to the development of subdural haematomas in these patients.

Role of lymphography in carcinoma of the prostate

The results of bilateral pedal lymphography in 83 patients with adenocarcinoma of the prostate gland are presented. The patients were divided into two groups: 45 new cases and 38 late or old cases presenting several years after the onset of the disease. Altogether 25 of the new patients and 29 of the late patients had lymphographic evidence of lymph node metastases. The lymphogram results in relation to local tumour size, histological grade, the presence of skeletal metastases, and acid phosphatase levels are discussed. Of the new patients with T1 and T2 tumors--that is, those still localized within the prostatic capsule--41% had positive lymphograms. The inaccuracy of acid phosphatase estimations in detecting early extraprostatic spread is shown and compared with the greater accuracy of lymphography. Lymphography should be used as an initial investigation in all cases where aggressive therapy is being considered, and the importance of regular follow-up radiographs is emphasized.