Disproportionate Impact Of COVID-19 Research Articles

Risk Factors for Re-admission in Covid-19 Patients from a Tertiary Care Health System: Quality Control (QC) and Quality Improvement (QI) Project

The COVID-19 pandemic has made a significant impact on public health globally and has unleashed an array of deficiencies that have already crippled our health care system. It also brought out the health care disparities among minorities and thrust health inequity to the limelight. Hospital readmission is one descriptive marker for overall patient clinical prognosis. Prior to SARS-CoV-2 Pandemic (COVID-19), 30-day-all cause readmission rates was highest in patients with heart failure, psychoses, chronic lung disease, and peripheral vascular disease status post-surgical procedure. However, pneumonia is the most common reason for unplanned patient readmission. COVID-19 continues to evolve, from the rising versality in variants to the clinical concerns of longer haulers. This study followed by a review will illustrate COVID-19 post-acute disease role on readmission diagnosis and rates. The aim is to identify most common reason for readmission and overall patient clinical prognosis. Readmitted patients in this study were older.
 In this QC/QI project the frequent symptom on readmission was respiratory illness and the primary diagnostic codes on readmission were noted to be respiratory failure and “COVID-19 sequelae.” Readmitted patients in this study were older (>61yrs of age), with an equal sex distribution, more likely to have multiple comorbidities, majority were of African American ethnicity, reflecting the disproportionate impact ofCOVID-19 on this group. About 70% of readmissions had a Charlson Comorbidity index of 3 and above reflecting the chronic conditions present in this cohort. Less than 40% of patients were up to date with their COVID 19 immunization and overall mortality rate was close to 12%. Based on our QC/QI analysis, a comprehensive and coordinated approach that addresses important metrics comprising optimal medical management of comorbidities, COVID 19/Pneumococcal immunizations, focus on mental health treatment and homelessness is essential to decrease the risk for readmissions in this population.

United States Healthcare System

United States Healthcare System

"Black Is Not Monolithic": Complexities in COVID-19 Vaccine Decision-Making.

Longstanding inequities in the USA have resulted in the disproportionate impact of COVID-19 on Black Americans. Coupled with medical mistrust, COVID-19 vaccine uptake is lower in Black populations. We sought to understand the perspectives of Black parents on the COVID-19 pandemic, COVID-19 vaccination for themselves and their children, and trust with the medical community. Using qualitative methodology, we conducted in-depth semi-structured in-person interviews of Black parents of children admitted to the inpatient pediatric units in our tertiary academic medical center in Connecticut from July to November 2021. We used the grounded theory approach, and the constant comparative method until saturation was reached. We interviewed 20 parents who identified as Black; 50% were vaccinated against COVID-19. The following 5 themes and sub-themes emerged: (1) mixed feelings influenced COVID-19 vaccine decision-making ranging from much needed relief and feelings of uncertainty, distrust, and fear; (2) COVID-19 vaccine uptake was influenced by individual and family's health concerns and job or school mandates; (3) deferring the COVID-19 vaccine was influenced by the perception of risk and concerns about vaccine integrity; (4) institutional mistrust within the Black community bred by systemic racism influenced vaccine decision-making; and (5) conflicted feelings about the COVID-19 vaccine for their child. Our findings reiterate the complexities around vaccine decision-making and underscore the importance of recognizing the pervasive influence of institutional mistrust when counseling Black families about the COVID-19 vaccine.

S16: Post-Acute Covid-19 Cognitive Sequelae in an Aging Population

S16: Post-Acute Covid-19 Cognitive Sequelae in an Aging Population

National and regional trends in the prevalence of type 2 diabetes and associated risk factors among Korean adults, 2009–2021

Disproportionate impact of COVID-19 on socioeconomic and behavioral variables may have impacted the prevalence of diabetes. We utilized nationwide long-term serial study from the 2009 to 2021 Korea Community Health Survey (KCHS). We explored national and regional prevalence and trends of diabetes according to the socioeconomic and behavioral factors before and during the pandemic. Also, we interpreted which groups became more vulnerable to the prevalence of diagnosed diabetes during the pandemic. A total of 2,971,349 adults aged (19 to 39, 40 to 59, and ≥ 60 years) were included in the analysis. The prevalence of diagnosed diabetes increased slowly during the pandemic (11.6% [95% CI 11.5–11.7] in 2020 and 12.4% [95% CI 12.3–12.6] in 2021), compared to the pre-pandemic era (7.9% [95% CI 7.8–7.9] in 2009–2011 and 11.3% [95% CI 11.3–11.4] in 2018–2019). Also, women, low-income group, low-educational group, and infrequent walking group showed less prevalence of diagnosed diabetes than the others. The diabetic population increased slowly than expected during the pandemic. The pandemic seems to contribute to an unanticipated increase in under-diagnosis of diabetes among the already minority. This study may suggest reinforcing access to healthcare services among the minority during the pandemic.

Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States.

Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.

Which Curve Are We Flattening? The Disproportionate Impact of COVID-19 Among Economically Marginalized Communities in Ontario, Canada, Was Unchanged From Wild-Type to Omicron.

Person-level surveillance (N = 14 million) and neighborhood-level income data were used to explore magnitude of inequalities in COVID-19 hospitalizations and deaths over 5 waves in Ontario, Canada. Despite attempts at equity-informed policies alongside fluctuating levels of public health measures, the magnitude of inequalities in hospitalizations and deaths remained unchanged across waves.

Coalition of Faith Leaders, Community Organizations, and Governmental Organizations to Implement a COVID-19 Campaign in a Latino Neighborhood, Baltimore, Maryland, 2020-2021.

The disproportionate impact of COVID-19 on low-income Latinos with limited access to health care services prompted the expansion of community-based COVID-19 services. From June 25, 2020, to May 20, 2021, we established a coalition of faith leaders, community organizations, and governmental organizations to implement a Spanish-language hotline and social media campaign that linked people to a COVID-19 testing site at a local church in a high-density Latino neighborhood in Baltimore, Maryland. This retrospective analysis compared the characteristics of Latinos accessing testing in community versus health care facility-based settings. (Am J Public Health. 2022;112(S9):S913-S917. https://doi.org/10.2105/AJPH.2022.307074).

Same storm, different boats: the impact of COVID-19 on Black students and academic staff in UK and US higher education.

The permanence of systemic racism in the UK and USA means that Black people are disadvantaged in myriad ways, including within the Academy. While the disproportionate impact of COVID-19, alongside the Black Lives Matter movement, has increased awareness of the challenges faced by Black communities, these issues remain, both in and beyond higher education. Furthermore, there is still a paucity of research individualising the experiences of Black people, who are often homogenised with other ethnic minority groups. This paper explores the impact of COVID-19 on UK and US Black students and academic staff, utilising a critical race theory (CRT) framework. Analysis revealed that Black students and staff experienced COVID-19 against the backdrop of racism as a “pandemic within a pandemic” (Laurencin and Walker, Cell Systems 11:9–10, 2020), including racial (re)traumatisation, loneliness and isolation. Other themes included precarious employment and exploitation. Recommendations are offered for penetrative interventions that can support Black students and staff in the wake of strained race relations neglecting their adverse experiences and a global pandemic.

High Uptake and Series Completion of COVID-19 Vaccine at Community-Based Vaccination for Latinos With Limited English Proficiency.

Background:Despite the disproportionate impact of COVID-19 on Latinos, there were disparities in vaccination, especially during the early phase of COVID-19 immunization rollout.Methods:Leveraging a community-academic partnership established to expand access to SARS-CoV2 testing, we implemented community vaccination clinics with multifaceted outreach strategies and flexible appointments for limited English proficiency Latinos.Results:Between February 26 and May 7 2021, 2250 individuals received the first dose of COVID-19 vaccination during 18 free community events. Among them, 92.4% (95% confidence interval [CI], 91.2%-93.4%) self-identified as Hispanic, 88.7% (95% CI, 87.2%-89.9%) were limited English proficiency Spanish speakers, 23.1% (95% CI, 20.9%-25.2%) reported prior COVID-19 infection, 19.4% (95% CI, 16.9%-22.25%) had a body mass index of more than 35, 35.0% (95% CI, 32.2%-37.8%) had cardiovascular disease, and 21.6% (95% CI, 19.2%-24.0%) had diabetes. The timely second-dose completion rate was high (98.7%; 95% CI, 97.6%-99.2%) and did not vary by outreach method.Conclusion:A free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the US.

Foreword

Foreword Tamara Sonn (bio) The articles in this issue of the Georgetown Journal of International Affairs focus on civil society discourse and its implications for international affairs. The academic field of International Relations, reflecting its modernist origins, is state-centered; it focuses primarily on relations between political and military entities, with economic interests always a central focus and non-governmental institutions at the margins. Civil society discourse—whether expressed through the arts, religious, or secular organizations—have yet to find a place in the standard IR curriculum, leaving students ill-equipped to recognize social discontent and its potential political impacts. Clear examples of the analytic weakness of the traditional approach can be seen in the failure of the foreign policy establishment to recognize the long-standing social grievances that resulted in the 1979 Iranian Revolution, the 1991 implosion of the Soviet Union, and the 2010–11 Arab Spring. These weaknesses have been noticed. CIA Director Stansfield Turner wrote in 1991 of the failure to foresee that the United States would have to intervene militarily in Iran, Libya, Grenada, Panama, Lebanon and Kuwait during the previous decade.1 Regarding the Arab democracy uprisings, Secretary of State Hillary Clinton said in 2011, "We're facing an Arab awakening that nobody could have imagined and few predicted just a few years ago."2 Michael Walzer reflects on the secular bias of IR and therefore incomprehension of the rise of political Islam in his 2015 The Paradox of Liberation: Secular Revolutions and Religious Counterrevolutions. Yet portents of these and many other developments over the past century were clearly evident in the discourse of religious and other civil society actors and in the works of poets, fiction writers, playwrights, and musicians. Students trained to analyze the popular sentiments expressed in these discourses could contribute to more comprehensive intelligence gathering. They might even recognize that traditional foreign policy strategies actually contribute to destabilizing social unrest. For example, according to emeritus Georgetown Professor of Government and International Affairs Robert Lieber, "maintaining a secure supply of oil from the Middle East and the Persian Gulf" is essential to our national interest—even if it means compromising our commitment to democracy.3 Georgetown Distinguished Professor of the Practice of Diplomacy Dennis Ross recently argued in support of strengthening U.S. relations with Saudi Arabia despite the state-sanctioned murder of journalist Jamal [End Page 145] Khashoggi "and other human rights violations." In order to secure the free flow of "Saudi oil," we need to "do what we have always done:… balance values and interests."4 This approach is what drove the United States to participate in the overthrow of Iran's developing democracy in 1953, contributing to the anti-Americanism that drove the 1979 revolution and remains a potent threat today. Given the vested interests, it is unlikely that U.S. foreign policy training will change significantly in the near term. But the articles in this volume provide good examples of the kinds of analyses that would help inform more comprehensive understandings of international affairs. They include studies of the manipulation of religious conservatism by rightwing politicians in Brazil, and the political exploitation of disaffected young males radicalized online in South Korea; and the weaknesses (and, by implication, inconsistencies) of economic sanctions as a foreign policy tool in China; and the potential strengths of civil society activism in Yemen. Other articles deal with national issues that have important transnational resonances, such as the disproportionate impact of COVID-19 on indigenous communities in Latin America. Tamara Sonn Tamara Sonn is Professor Emerita at the Edmund A. Walsh School of Foreign Service, Georgetown University. Her most recent books include Islam and Democracy After the Arab Spring (with John L. Esposito and John O. Voll; Oxford, 2016), Islam: History, Religion, and Politics (Wiley Blackwell, 2016), and Is Islam an Enemy of the West? (Polity, 2016). She has published over one hundred chapters and articles, and her works have been translated into Arabic, Bengali, German, Portuguese, Korean, and Russian. She has lectured in North America, Europe, the Middle East, South Asia, and Africa. Her research has been supported by the American Council of Learned Societies, Fulbright, and the U.S. Department of State...

Questions Answered: Raghib Ali

Abstract The epidemiologist has just been awarded an OBE in the Queen's Platinum Jubilee Birthday Honours for his work on the disproportionate impact of Covid-19 on ethnic minorities, and increasing vaccine uptake in those groups.

‘The disparity is evident’: COVID-19, violence against women and support for Black and minoritised survivors

The disproportionate impact of COVID-19 on women and on Black and minoritised groups has highlighted the gendered and intersectional nature of the pandemic where structural inequality has reproduced disproportionately and exacerbated existing gendered and racialised inequalities. The pandemic and subsequent lockdowns led to an increase in domestic violence and abuse; noted to be disproportionately affected at multiple interlocking levels, home and the wider structural context constituted sites of violence for Black and minoritised survivors. Not only were women being subjected to heightened levels of violence and expanded coercive control but they faced greater constraints in seeking help. The decommissioning and closure of Black and minoritised organisations at a disproportionate level under austerity, inequitable funding structures and the simultaneous reinforcement of a hostile immigration environment have closed the door to safety for many survivors. Reporting on research conducted during 2020 with Black and minoritised organisations about the challenges encountered during the pandemic highlights how they rapidly adapted and reshaped survivor-centred support provision, the ways in which survivors experienced and responded to expanded forms of abuse, and the responses they and women received from mainstream service providers and the greater intersectional advocacy this required.

How can Gender Smart Mobility become a More Intersectional form of Mobility Justice

This paper discusses ethical issues relating to equity in smart mobility (SM) with a focus on the intersections of gender, race and class. The H2020 TInnGO (Transport and Innovation Gender Observatory) project, in which this work was undertaken, was built around the concept that Gender Smart Mobility (GSM) requires not just the development of smart mobility but the application of gender and diversity mainstreaming.
 The paper is set against a background of slow but steady progress towards gender equality in transport, where women in the EU now account for between 22-27% of the transport workforce, and their multimodal journeys are underserved by current transport provision. Gender and diversity mainstreaming recognises the importance of applying intersectionality in creating fair and equitable transport services which can reduce the vulnerability of certain groups to social-exclusion related transport poverty. Although championed by the EU as an objective of transport policy, Gender Mainstreaming (GM) has had limited uptake at national level and has been criticised for its oversimplification of gender, and prioritisation of gender over other factors.
 Incorporating intersectionality into transport policy can build on advances already made by GM However little work has been conducted in this area. Therefore, we have discussed how an intersectionality-based policy analysis framework used in health can be applied to this area.
 The paper argues for wider use of intersectionality (i.e., gender and diversity mainstreaming) in the SM sector and how it can be operationalised to create more equitable transport and societies. The discussion is timely given the disproportionate impact of COVID-19.

146 Health equity approach to statewide outreach to under-resourced communities during COVID

OBJECTIVES/GOALS: Despite a disproportionate impact of COVID-19 on minority and under-resourced communities, nearly all COVID-19 resources have only been online in English. A statewide coalition of community and academic partners used community-engaged strategies to provide tailored outreach to diverse populations. METHODS/STUDY POPULATION: The STOP COVID-19 CA statewide team had a workgroup focused on communications. Members of this group represented different sectors, racial/ethnic groups, disciplines, and regions across the state. They had regular meetings to discuss and strategize how to overcome the impact of historic and structural racism on access to COVID-19 resources, including testing, vaccines, and protective equipment. The team also shared regular updates about changes in community concerns and needs as well as new, tailored resources. RESULTS/ANTICIPATED RESULTS: Together, the team has been able to reach diverse populations across the state, including providing information about COVID-19 in multiple languages and formats, from radio to virtual town halls to local health fairs. The multiple sites also increased access to vaccines and testing through trusted community leaders and locations, including church-based locations to bringing vaccines and testing directly to workplaces. These community pop-up vaccination sites have helped to vaccinate large numbers of diverse populations, some of whom were initially unsure about getting the vaccine, which has helped to reduce the gaps in community vaccination rates by race/ethnicity. DISCUSSION/SIGNIFICANCE: This network of community-engaged strategies utilized for rapid COVID-19 response could also be used to for responses to future public health emergencies, addressing chronic diseases (e.g., diabetes, hypertension), or even other complex issues that affect society and health (e.g., climate change).

Guest Editors’ Introduction—Visionary Praxis: Paule Marshall’s, Ntozake Shange’s, and Toni Morrison’s Foresight concerning Sick Violence and Violent Sickness

This introduction provides an overview of the special issue that focuses on the interconnections of Black women’s literary studies with the crises of COVID-19 and ongoing anti-Black violence. More specifically, it considers how the work of three renowned writers, Paule Marshall, Ntozake Shange, and Toni Morrison—which collectively spans over fifty years—offers models for how to reimagine our current circumstances and create more just futures in our national and global communities. The essay identifies and expounds on the overarching question of the special issue: how does the work of Marshall, Shange, and Morrison speak to contemporary affairs and concerns? By engaging this question, this collection of essays offers new insights about these women’s writing in particular and expands the corpus of scholarship on Black women’s writing in general. In the aftermath of the passing of these writers, a collective reappraisal of their oeuvres is a timely and fitting tribute, as each of their bodies of work reveals that they long have engaged concerns about Black people’s encounters with systemic barriers that have laid the foundation for the current twinned crises of anti-Black violence and the disproportionate impact of COVID-19.

Through Our Eyes, Hear Our Stories: A Virtual Photovoice Project to Document and Archive Asian American and Pacific Islander Community Experiences During COVID-19.

Through Our Eyes, Hear Our Voices is a virtual photovoice project that documents the impact of COVID-19 on Asian American and Pacific Islander (AAPI) communities. Quantitative studies on the disproportionate impact of COVID-19 are still emerging, but they do not reveal qualitative experiences of a racialized pandemic exacerbated by political leaders labeling it "China virus." As a qualitative participatory action research approach, photovoice is an ideal archival and pedagogical tool to capture the lived experience of AAPI communities. However, we had to adapt photovoice to a virtual research environment. We did so by adopting a variety of digital learning and information sharing platforms. In addition, we enlisted community-based organizations who are providing essential services for underrepresented communities to serve as research mentors for university student researchers. Finally, given the historic nature of the pandemic and the underrepresentation of AAPI experiences in mainstream archives, we emphasized the importance of students as co-producers of archival knowledge.

Adding a Correction Factor to the Allocation of Scarce Life-saving Resources in a Pandemic

Adding a Correction Factor to the Allocation of Scarce Life-saving Resources in a Pandemic

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant

BackgroundCOVID-19 has drastically affected transplant services, but there is limited understanding of the discrepancy of COVID-19 effects on various regions of the world.MethodsWe have explored the Global Observatory for Organ Donation and Transplantation data for assessing the transplant number changes between the calendar year 2019 (n = 157,301) and 2020 (129,681).ResultsThere was a disproportionate impact of COVID-19 on different areas of the world. Globally, there was a decline of 17.5%, in which deceased donation, kidney (20.9%), pancreas (16.2%), lung (12.7%), liver (11.3%), and heart (8%) transplant declined disproportionally in different regions of the world. The pandemic affected almost all geographic regions and nations, but China and the United States were mostly able to recover from the initial halt of the transplant practices by the pandemic so that there was a cumulative increase in transplant numbers.ConclusionsOur data show that developing nations lagged behind, whereas developed nations have been able to recover their transplantation programs during the pandemic. Further policy making and preparedness is required to safeguard the most vulnerable areas of the world to minimize the impact of any future pandemic on transplantation practices.

Predictors of Food Insecurity Before and During COVID-19 Among Middle-Aged and Older Adults

The indirect impact of COVID-19 on food security of middle aged and older adults is not well understood. This study examines changes in risk factors for food security from 2018-2020 in a population-based sample. Using data from the Health and Retirement Study (2018 and 2020 waves), we utilized generalized estimating equations (GEE) with repeated measures to examine factors associated with food insecurity among US adults aged 50 and older (n=3170) before COVID-19 and since COVID-19. The prevalence of food insecurity doubled from 2018 (4.83%) to 2020 (9.54%). In multivariate analyses, the population-averaged odds of experiencing food insecurity was 81% higher in 2020 compared to 2018. Other factors significantly associated with higher odds of food insecurity included being female (OR: 1.29), Black (OR: 1.46), lowest quintile for wealth (OR: 1.82), not working due to a disability (OR: 3.29), renting (OR: 2.04), greater IADL limitations (OR: 1.32), and greater number of chronic illness comorbidities (OR: 1.14). Factors significantly associated with lower odds of food insecurity included older age (65-74: OR: 0.73; 75+: OR: 0.56) and being above the median income level (OR: 0.47). Partnership status, education level, and ADL limitations were not significantly associated with the population-averaged odds of experiencing food insecurity. This study identified factors related to food insecurity among a community-dwelling sample of middle aged and older adults in the U.S. Future research should examine the impact of policies and intervention strategies to address the disproportionate impact of COVID-19 on populations at increased risk of experiencing food insecurity.