457. Low Rates of COVID-19 in a Vulnerable Population: Learning from Early and Decisive Public Health Policies

Abstract

BackgroundDisasters, including pandemics, disproportionately affect vulnerable populations. The Downtown Eastside (DTES) neighborhood of Vancouver has high prevalence of mental illness, substance use, infectious disease and homelessness. While studies have described clinical characteristics of COVID-19 patients in other centres worldwide, data is lacking on marginalized groups. We describe the clinical characteristics and outcomes of COVID-19 patients seen at two urban hospitals who care for the vulnerable population in the DTES of Vancouver, British Columbia (BC), Canada.MethodsA retrospective chart review was conducted on all COVID-19 patients ≥19 years seen at either centre from January 1 to June 10, 2020. Descriptive statistics assessed demographics, comorbidities, presenting symptoms, laboratory values and outcomes, and were compared between subjects managed as inpatients (died vs. discharged) and outpatients.ResultsOf 71 COVID-19 subjects, mean age was 57y (SD 20); 36 (51%) were male. Time to presentation, symptoms and laboratory values were similar to other reports. 58 (82%) presented from the community, 3 (4%) from long-term care/rehabilitation centres, and 8 (11%) had no fixed address (NFA) or lived in the DTES. 45 (64%) had a known exposure, 20 (28%) were healthcare workers, 85% involved in direct patient care; 0/20 were admitted to hospital. Of the 8 NFA/DTES subjects, mean age was 46y (SD 13), 50% were male, 5 (63%) were admitted to hospital and all survived.Admitted subjects (n=34) were older (mean age 69 vs 46y, p< 0.001), 62% were male, and had more comorbidities (mean [SD] 3 [3] vs. 1 [2], p< 0.001). Eight (24%) died, 26 (76%) were discharged, 29% developed acute respiratory distress syndrome, 21% secondary infection, 18% renal failure, and 15% cardiac dysfunction. Of patients admitted to intensive care, 5/10 died.ConclusionOur results concur with other studies showing older age and comorbidities contribute to more severe COVID-19 disease. 64% of subjects had a known exposure, and only 11% had NFA/DTES residence. Given that there is no financial barrier to access healthcare in Canada and these hospitals serve our most vulnerable populations, our results may indicate that BC Public Health has done an effective job of tracking and limiting community spread of COVID-19.Disclosures All Authors: No reported disclosures