High Seroprevalence of Anti-SARS-CoV-2 Antibodies in Chelsea, Massachusetts.

SARS-CoV-2 antibody testing allows quantitative determination of disease prevalence, which is especially important in high-risk communities. We performed anonymized convenience sampling of 200 currently asymptomatic residents of Chelsea, the epicenter of COVID-19 illness in Massachusetts, by BioMedomics SARS-CoV-2 combined IgM-IgG point-of-care lateral flow immunoassay. The seroprevalence was 31.5% (17.5% IgM+IgG+, 9.0% IgM+IgG-, and 5.0% IgM-IgG+). Of the 200 participants, 50.5% reported no symptoms in the preceding 4 weeks, of which 24.8% (25/101) were seropositive, and 60% of these were IgM+IgG-. These data are the highest seroprevalence rates observed to date and highlight the significant burden of asymptomatic infection.

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program.

BACKGROUND: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. INTRODUCTION: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program. METHODS: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (Ppos) or negative agreement (Pneg) were used to assess variability. RESULTS: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% ± 4.6%, Pneg = 0.91-0.95), presence of moderate nonproliferative or worse retinopathy (87% ± 3.9%, Ppos = 0.67-1.00), and presence of macular edema (99% ± 0.9%, Ppos = 0.67-1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% ± 11%, Ppos = 0.21-0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% ± 8.1%, Ppos = 0.19-0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% ± 5.0%, Ppos = 0.50-0.90). DISCUSSION: Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times. CONCLUSIONS: Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.

The impact of broadening COVID-19 testing eligibility on communities of color - A lesson for overcoming structural barriers to health care.

CDC guidelines for COVID-19 testing in March 2020 did not prioritize underserved communities. We present the effect that expanding COVID-19 testing had for residents of the predominantly Hispanic city of Chelsea, MA, which had the highest case rate in the state. Results were compared to another city with similar demographics, Lynn, MA, where testing eligibility remained unchanged. Institutional data were used to identify outpatient visits for influenza-like illness or COVID-19 exposure, COVID-19 tests, and hospitalizations for confirmed COVID-19 between 3/30/2020-4/28/2020. Multivariable logistic regressions were used to compare outcomes before and after the change in testing eligibility occurred on 4/13/2020. A total of 3,060 patients were included, 1,374 Chelsea residents and 1,686 Lynn residents. After guidelines changed, Chelsea residents were more likely to present as outpatients (adjusted odds ratio [AOR] 4.2, p < 0.001) and less likely to be hospitalized (AOR 0.2, p < 0.001). They were more likely to be tested (AOR 8.8, p < 0.001), but less likely to test positive (AOR 0.6, p = 0.05). Lynn residents were also more likely to be tested after 4/13/2020 (AOR 1.9, p < 0.001), but no significant differences in visit acuity or test positivity were observed. This study demonstrates how broadening testing eligibility for one highly affected, predominantly Hispanic community was associated with an increase in outpatient presentations and a concomitant decrease in test positivity and hospitalizations. These results highlight the impact of improved access to care on utilization of services among underserved communities, a lesson that is especially crucial as we continue to grapple with the COVID pandemic.

Have rates of behavioral health assessment and treatment increased for Massachusetts children since the Rosie D. decision? A report from two primary care practices.

Following a court decision (Rosie D. v. Romney), the Medicaid program in Massachusetts launched the statewide Children's Behavioral Health Initiative in 2008 to increase the recognition and treatment of behavioral health problems in pediatrics. We reviewed billing data (n = 64,194) and electronic medical records (n = 600) for well child visits in pediatrics in 2 practices to examine rates of behavioral health screening, problem identification, and treatment among children seen during the year before and 2 years after the program's implementation. According to electronic medical records, the percentage of well child visits that included any form of behavioral health assessment increased significantly during the first 2 years of the program, and pediatricians significantly increased their use of standardized screens. According to billing data, behavioral health treatment increased significantly. These findings suggest that behavioral health screening and treatment have increased following the Rosie D. decision.