Response to Continuing 4-H Youth Development in SC During a Pandemic: The SC 4-H@Home Program

State mandates imposed by governors during COVID-19 affected extracurricular activities for children and youth. To continue providing 4-H programming during quarantine, Clemson Extension 4-H Youth Development Agents created the SC 4-H@Home program. Daily activities were developed that could be completed at-home using common household items and were delivered via email to registered participants. A survey was conducted at the conclusion of the program that included open and closed-ended questions to gauge the effectiveness of the program. Results indicate that, overall, the SC 4-H@Home program was beneficial to youth and contributed to their education during the COVID-19 crisis © This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License

Changes in sleep-wake patterns, circadian timing, and mood in Australian teens during the COVID-19 pandemic

During the COVID-19 pandemic, schools rapidly transitioned from in-person to remote learning. We examined sleep- and mood-related changes in early adolescents, before and after this transition to assess the impact of in-person vs. remote learning. Sleep-wake timing was measured using wrist-actigraphy and sleep diaries over 1–2 weeks in Year 7 students (age M±SD =12.79±0.42 years) during in-person learning (n=28) and remote learning (n=58;n=27 were studied in both conditions). Circadian timing was measured under a single condition in each individual using salivary melatonin (Dim Light Melatonin Onset;DLMO). Online surveys assessed mood (PROMIS Pediatric Anxiety and Depressive Symptoms) and sleepiness (Epworth Sleepiness Scale – Child and Adolescent) in each condition. During remote vs. in-person learning: (i) on school days, students went to sleep 26 min later and woke 49 min later, resulting in 22 min longer sleep duration (all p<0.0001);(ii) DLMO time did not differ significantly between conditions, although participants woke at a later relative circadian phase (43 minutes, p=0.03) during remote learning;(iii) participants reported significantly lower sleepiness (p=0.048) and lower anxiety symptoms (p=0.006). Depressive symptoms did not differ between conditions. Changes in mood symptoms were not mediated by changes in sleep timing. Although remote learning had the same school start times as in-person learning, removing morning commutes likely enabled adolescents to sleep longer, wake later, and to wake at a later circadian phase. These results indicate that remote learning, or later school start times, may extend sleep duration and improve some subjective symptoms in adolescents.

Slack as a virtual undergraduate dermatology community: a pilot

Dermatology has long been recognized as under-represented in UK's undergraduate curricula. With a diagnostic and educational toolkit that is heavily centred around face-to-face clinical examination, dermatology education has been disproportionately affected by the COVID-19 pandemic. Innovative approaches to distance teaching and learning within dermatology are essential, but historically have been unidirectional with a lack of community and patient-centred resources readily available. Online channel-based messaging apps such as Slack offer an opportunity to engage students in remote, multimodal collaborative learning by reproducing a classroom environment in the virtual space, while simultaneously maintaining a strong focus on patient care. The aim of this study was to determine the feasibility, acceptability and proof of concept for an online Slack community as an undergraduate dermatology learning platform. Undergraduate medical students participated in an online classroom for 6 weeks with a structured teaching programme encompassing online casebased discussions, seminars and journal clubs. The platform was facilitated by junior doctors (n = 10) and featured patient educators (n = 6). Students, faculty and patient educators completed a postcourse evaluation. In addition, students completed a pre-and postintervention dermatology quiz to determine knowledge acquisition. Mixed-methods analyses were applied including quantitative analyses to explore data trends and qualitative phenomenographic analyses to assimilate key underlying themes. Students (n = 65) were enrolled to join the platform for a 6-week period. The evaluation was completed by students (n = 52) from UK universities (n = 27). The majority of students (n = 27) interacted with the platform as passive observers (<= 5 active interactions). A small group of 'super users' (n = 4) actively engaged with the platform over 100 times during the study period. Ninety-six per cent of participants and 100% of faculty agreed that the overall quality of the course was excellent. No statistically significant difference in the pre-and postcourse dermatology quiz scores was noted, possibly owing to suboptimal levels of active engagement with the platform from many users. Barriers to engagement cited by the students included high university workload and the lack of a timetable for live sessions. A community-based online classroom can act as an enjoyable, acceptable and collaborative means of supplementing traditional educational methodologies for teaching dermatology to undergraduate medical students. Its ease of use and supportive nature can facilitate patient involvement, as well as other innovative approaches to teaching and learning dermatology, such as interuniversity collaboration and gamification of learning. Such advances may provide vital safeguards against the reduction in face-to-face learning that has accompanied the pandemic.

The Future of the Monograph in the Arts, Humanities and Social Sciences: Publisher Perspectives on a Transitioning Format

A web-based survey of academic publishers was undertaken in 2021 by a team at Oxford International Centre for Publishing into the state of monograph publication in the arts, humanities, and social sciences. 25 publishing organisations responded, including many of the larger presses, representing approximately 75% of monograph output. Responses to the survey showed that the Covid 19 pandemic has accelerated the existing trend from print to digital dissemination and that Open Access (OA) titles receive substantially greater levels of usage than those published traditionally. Responses also showed that for most publishers OA publication stands at under 25% of output and that fewer than 10% of authors enquire about OA publication options. Continuing problem areas highlighted by respondents were the clearing of rights for OA publication and the standardisation of title and usage metadata. All responding organisations confirmed that they expect to be publishing monographs in ten years' time, but that they anticipate the format and/or the model will be different, with open access expected to play a key part in the future, perhaps in the context of a mixed economy of OA and ‘toll access' publication. © 2023, The Author(s).

Incidence of atrial and ventricular arrhythmias in patients with CIEDs and COVID-19

Background: It remains unclear whether COVID-19 infection is associated with increased arrhythmia burden in patients with cardiac implantable electronic devices (CIEDs). Methods: We identified 46 patients tested positive for COVID-19 between 01/03/2020 and 31/05/2021 in our cohort of 1209 patients with CIED (3.8%). Data on arrhythmia burden during a 9 week period (a 4 week “pre-infection” period: P1, the week before the positive Covid-19 test: P2, and the 4 weeks afterwards: P3) was accessible in 35 patients. Results: 83% of patients were not hospitalised. Five patients (14.3%) (all non-hospitalised) had high rate atrial (HRA) events, 4 of which exclusively during P1 and/or P2. Thirty-two non-sustained VT (NSVT) episodes were recorded in 8 patients, one degenerating in VF requiring ICD shock (occurring in P2). One patient had frequent NSVT each week. After exclusion of this outlier, a numerical 4-fold increase in weekly NSVT episodes was observed between P1 and P3 (Patients with NSVT: 0.07±0.12 vs. 0.29±0.17 episodes/week, p=0.057;entire cohort: 0.015±0.060 vs. 0.059±0.138 episodes/week, p=0.16) (Figure 1). In P3, hospitalised patients had a trend towards higher NSVT burden vs. non-hospitalised patients (2/6 (33.3%) vs. 4/29 (13.8%), p=0.27) which was not apparent before the positive Covid-19 test. Conclusion: Our single-centre experience suggests that COVID-19 infection may result in an increase in VA but not atrial arrhythmia burden in patients with CIED. Funding Acknowledgement: Type of funding sources: None.Figure 1

So Unfair it’s Fair: Equipment handling in remote versus in-person introductory physics labs

While understanding laboratory equipment is an important learning goal of physics laboratory (lab) instruction, previous studies have found inequities as to who gets to use equipment in in-person lab classes. With the transition to remote learning during the COVID-19 pandemic, class dynamics changed and the effects on equipment usage remain unclear. As part of a larger effort to make intro physics labs more equitable, we investigated student equipment usage based on gender and race in two introductory physics lab courses, one taught in-person and one taught remotely. We found inequities between men and women for in-person instruction, replicating previous work with a new student population. In contrast, we found that remote instruction created a more gender equitable learning environment, albeit with one student typically in charge of the equipment per class session. When we looked at equipment handling based on student race, we found no inequities in either format. These results suggest that changes should be made in introductory labs to create a more gender equitable learning environment and that some aspects of remote labs could help make these labs more equitable. © 2022, American Association of Physics Teachers. All rights reserved.

The negative impact of the pandemic on hospital admissions, morbidity and 30-day mortality for acute cirrhosis decompensation: a tertiary care perspective

Background and aims: The global pandemic has inevitably diverted resources away from management of chronic diseases, including cirrhosis, where up to 40% of patients are readmitted with new cirrhosis decompensation events. Whilst there is increasing knowledge on COVID-19 infection in liver cirrhosis, little is described on the impact of the pandemic on decompensated cirrhosis admissions and outcomes, which was the aim of this study. Method: A single-centre, retrospective study, evaluated decompensated cirrhosis admissions to a tertiary London hepatology and transplantation centre, from October 2018 to February 2021. Patients were included if they had an admission with cirrhosis decompensation defined as new onset jaundice or ascites, infection, encephalopathy, portal hypertensive bleeding or renal dysfunction. Admissions were excluded if they lasted <24 hours,were elective or occurred post liver-transplant. Results: Therewere 351 admissions in the pre-COVID period (October 2018 to February 2020) and 240 admissions during the COVID period (March 2020 to February 2021), with an average of 20.4 admissions per month throughout. Patients transferred in from secondary centres had consistently higher severity scores during the COVID period (UKELD 58 versus 54;p = 0.007, MELD Na 22 versus 18;p = 0.006, AD score 55.0 versus 51.0;p = 0.055). The proportion of ITU admissions pre versus during-COVID stayed constant (22.9% versus 19.2%), but there was a trend towards increased ICU admissions with acute-on-chronic liver failure (ACLF) (73.9% versus 63.8% prepandemic). Of those admitted to the intensive care without ACLF, there was a significant increase in EF-CLIF acute decompensation (AD) scores during the COVID period (58 versus 48, p = 0.009). In addition, there was a trend towards increased hospital re-admission rates during the COVID period (29.5% versus 21.5%, p = 0.067). When censored at 30 days, time to death post discharge was significantly reduced during the COVID period (p < 0.05) with a median time to death of 35 days compared to 62 days pre-COVID.(Figure Presented)Conclusion: This study provides a unique perspective on the impact that the global pandemic had on the clinical course and characteristics of decompensated cirrhosis admissions. The findings of increased early mortality and re-admissions, and higher AD scores, indicating increased disease morbidity, highlight the need to maintain resourcing on providing high-level hepatology care. Given that COVID-19 will likely be a chronic issue, alternative care pathways such as remote monitoring may need adoption to facilitate continuity of care post-discharge and to reduce readmission rates and morbidity in the future

Patient Practices and Experiences During COVID-19 Among Individuals Across the United States Enrolled in MS Life Lines Patient Support Program

Objective: To gain an understanding of COVID-19 practices and experiences among patients with multiple sclerosis (MS) enrolled in MS LifeLines, a disease-modifying therapy patientsupport program. Background: Research into the impact of COVID-19 on people with MS is ongoing. Design/Methods: Enrollees from MS LifeLines were invited to participate in an internet-based survey. Participants were included if they self-reported physician-diagnosed relapsing MS, initiated cladribine tablets or were currently being treated with interferon beta-1a (scIFNβ1a), and aged ≥18 years. Information collected included demographics, clinical characteristics, MS treatment/disease history, and COVID-19 understanding, preventive measures, exposure, and vaccination experiences. Findings were analyzed descriptively. Results: Among 1095 patients completing the survey from May 12-July 2, 2021 (616 cladribine tablets, 479 scIFNβ1a), mean (SD) age was 50 (11.9), 77.9% female, 76.9% non-Hispanic White/9.4% non-Hispanic Black/6.7% Hispanic;and mean (SD) Charlson Comorbidity Index 0.41 (0.89). Half (51.6%) had changed from in-person visits to telephone/video, 44.7% discussed COVID-19 concerns with their physician, and 26.4% discussed MS medication concerns. Patients described their understanding of the risk of developing complications with COVID-19 as 'very well'(48.5%) or 'fairly well'(26.6%). COVID-19 preventive measures were widely practiced (% responding 'always': mask wearing, 79.7%;monitoring symptoms, 68.0%;hand washing, 66.9%;6-foot social distancing, 56.5%;staying home, 51.5%;cleaning/disinfecting surfaces, 35.5%). For the total cohort, 7.8% received a positive COVID-19 test, 54.8% had a COVID-19 test, 16.3% had COVID-19 symptoms, and 30.9% had close contact with someone with COVID-19. Most (74.6%) were vaccinated, 8.3% were planning to get vaccinated, 12.1% were not planning to get vaccinated, and 5.0% were unsure. Similarly, 76.3% discussed COVID19 vaccination with their physician, 8.2% were planning to discuss vaccination with their physician, 11.1% were not planning to discuss vaccination with their physician, and 4.4% were unsure. Conclusions: The findings provide insight into COVID-19 understanding, preventive measures, exposure, and vaccination experiences of patients with MS.

THE EFFECT OF COVID -19 ON THE NEW DIAGNOSIS OF ESOPHAGOGASTRIC CANCER IN THE UK: A SINGLE-CENTRE EXPERIENCE

Background and aim: Covid-19 has had a devastating global impact and resulted in over 4.4 million directly attributed deaths. The UK entered lockdown in March 2020, redistributing its medical workforce and resources. Early estimations suggested at least 4700 extra cancer deaths at 5 years if there was a 3-month delay to surgery. Delays to diagnosis and treatment for esophagogastric (EG) cancers can be particularly detrimental to survival. The aim of this study is to assess the impact of Covid-19 on new cancer referrals to a centralised UK EG cancer centre, including presentation, decision making and treatment. Methods: Patients with EG cancer referred to a tertiary, high-volume centre between March 2019 and March 2021 were reviewed. Patients were stratified into Pre-covid (March 2019-March 2020) and Covid (March 2020- 2021) cohorts. Number of new referrals, clinical stage, treatment decision, and time to treatment were compared for gastric adenocarcinoma (GA), esophagogastric-junction adenocarcinoma (EGJA), esophageal adenocarcinoma (EA) and esophageal SCC (ESCC). Results: There was an 11% reduction in new cancer referrals (485 vs 431). GA, EGJA and EA did not have significant change in treatment intent, although there was a significant increase in the decision for definitive nonsurgical treatment of EA (P = 0.046). GA and EA patients had a small, but significant increase in average clinical stage at presentation (P < 0.05). There was no increase in time to treatment for GA, EGJA and EA. A significantly higher proportion of ESCC patients were given curative intent treatment in the Covid-19 cohort (P = 0.0006) however, this was accompanied with an increased time to treatment (35.8 days vs 27.9 days P = 0.0198). Conclusion: This high-volume centre has seen a reduction in new cancer referrals since the first UK lockdown. This was associated with a small, but significant, increase in clinical stage of GA and EA at presentation. This may represent an early indication of excess esophagogastric cancer deaths due to the impact of Covid-19. This data also confirms initial results showing that oncological decisions were not compromised, although Covid-19 remains a dynamic challenge.

ACT NOW a new diabetes foot educational and risk assessment tool for people with diabetes and health care professionals

Background: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and health care professionals (HCP) may be accused of medical negligence. Aim: Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Method: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a person with diabetes and recommendations were made. Results: An acronym ACT NOW has been devised to act as an educational tool ACT NOW stands for Accident (recent trauma to foot) Change in colour or shape, Temperature change -hot or cold, New pain, Oozing and Wound. The acronym was devised firstly, to help PwD and HCPs recognise the warning signs of foot complications, leading to potential amputation, and secondly, to trigger early and prompt referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the COVID 19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW tool was also created consisting of the acronym and a a checklist which prompts the PwD, their carers and HCPs to enquire and document the ACT NOW! symptoms or signs and to take possible further information such as a digital photo. The checklist can then be used as a document to facilitate referral to specialist care. Alternatively, the check list can be used when PwDs present for routine assessment with their HCPs. The ACT NOW tool has been disseminated through digital and traditional media and endorsement granted from many organisations, including the IDF. Discussion: Foot ulcers are highly susceptible to infection which can spread rapidly, causing overwhelming tissue destruction or gangrene, necessitating major amputation. The progression from an initial ‘scratch’ to gangrene can take as little as 48 hours. A lack of knowledge and education can lead to a lack of urgency among PwD, carers and HCPs, who may not recognise that they have a foot related problem requiring urgent referral or care interventions. If there are difficulties in accessing a HCP appointment, there is a risk of critical delay in PwD receiving appropriate assessment and treatment. ACT NOW is designed to promote timely referral and save limbs. iDEAL seeks to reduce amputations by 50% in 5 years by encouraging people to use ACT NOW. Prompt assessment and early referral can help reduce this unnecessary suffering. ACT NOW also seeks to reduce stigma often experienced by PwD regarding complications and remove any blame or shame associated with diabetes complications. These changes can be created through encouraging and enabling an environment of education, knowledge and trust using language that enables PwD.

COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis

Study Objectives: Social determinants of health (SDOH) influence the health outcomes of COVID-19 patients;yet, little is known about how patients at risk of significant disease burden view this relationship. Our study sought to explore patient perceptions of the influence of SDOH on their COVID-19 infection experience and COVID-19 transmission within their communities. Methods: We conducted a qualitative study of patients in a North Carolina health care system’s registry who tested positive for COVID-19 from March 2020 through February 2021. All patients’ addresses across six counties served were geo-referenced and analyzed by Kernel Density Estimation (KDE) to identify population-dense outbreaks of COVID-19 (hotspots). Spatial autocorrelation analysis was performed to identify census area clusters of white, Black and Hispanic populations, based on the 2019 American Community Survey dataset. Patients were identified by a randomized computer-generated sampling method. After informed consent, patients participated in semi-structured phone interviews in English or Spanish based on patient preference by trained bilingual researchers. Each interview was evaluated using a combination of deductive and inductive content analysis to determine prevalent themes related to COVID-19 knowledge and diagnosis, disease experience, and the impact of SDOH. Results: The 10 patients interviewed from our COVID-19 hotspots were of equal distribution by sex, and predominantly Black (70%), ages 22-70 years (IQR 45-62 years), and presented to the ED for evaluation (70%). The respondents were more frequently publicly insured (50% medicaid/medicare;vs 30% uninsured;vs 20% private). The interviews demonstrated themes surrounding the experience and impact of COVID-19. The perceived risk of contracting COVID-19 and knowledge of how to prevent infection varied greatly among our sample, and could be in part explained by SDOH such as their occupation, living conditions and mode of transportation. The experiences of COVID-19 testing, diagnosis, isolation and medical treatment were most influenced by the timing of infection in relation to the study period. For example, in the early months of the pandemic, the knowledge of isolation requirements and available support systems seemed to have negatively impacted the ability to isolate and follow public health guidance, as well as the support mechanisms provided by employers during this period. Communication of infection status once diagnosed varied greatly, with some voicing feelings of shame, and others advocating for sharing of infection experiences to change community behaviors. Suggestions for how to improve the COVID-19 response included improving communication and enforcing public health guidelines, including raising awareness for vulnerable populations on topics like expected symptoms, financial support, increasing testing, and vaccination delivery. Conclusion: Further exploration of important themes and related SDOH that influenced how the participants experienced the COVID-19 pandemic will be necessary to decrease the negative impacts of SDOH in communities that are high-risk for COVID-19 spread.

Ethical Reasoning During a Pandemic: Results of a Five Country European Study.

Introduction: There has been no work that identifies the hidden or implicit normative assumptions on which participants base their views during the COVID-19 pandemic, and their reasoning and how they reach moral or ethical judgements. Our analysis focused on participants' moral values, ethical reasoning and normative positions around the transmission of SARS-CoV-2.Methods: We analyzed data from 177 semi-structured interviews across five European countries (Germany, Ireland, Italy, Switzerland and the United Kingdom) conducted in April 2020.Results: Findings are structured in four themes: ethical contention in the context of normative uncertainty; patterns of ethical deliberation when contemplating restrictions and measures to reduce viral transmission; moral judgements regarding "good" and "bad" people; using existing structures of meaning for moral reasoning and ethical judgement.Discussion: Moral tools are an integral part of people's reaction to and experience of a pandemic. 'Moral preparedness' for the next phases of this pandemic and for future pandemics will require an understanding of the moral values and normative concepts citizens use in their own decision-making. Three important elements of this preparedness are: conceptual clarity over what responsibility or respect mean in practice; better understanding of collective mindsets and how to encourage them; and a situated, rather than universalist, approach to the development of normative standards.

UTILIZATION OF POINT-OF-CARE ULTRASOUND AND ROTATIONAL THROMBOELASTOMETRY TO DIAGNOSE AND MANAGE AMNIOTIC FLUID EMBOLISM PRESENTING AS POST-PARTUM HEMORRHAGE AND CARDIAC ARREST

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Amniotic fluid embolism (AFE) is a life-threatening obstetrical emergency. Despite its clinical significance there is little guidance on diagnosis and management[1, 2, 3]. In the absence of more specific diagnostic guidelines, point-of-care ultrasound (POCUS) in combination with rotational thromboelastometry (ROTEM) can aid in the diagnosis and management of AFE and have a significant impact on clinical outcomes[4]. CASE PRESENTATION: A 29-year-old, previously healthy, gravida 1 female presented at 39 weeks' gestation for induction of labor due to gestational diabetes and concerns surrounding the COVID-19 pandemic. The patient was laboring for approximately 10 hours when she suddenly started to feel nauseous, lightheaded, and subsequently suffered a syncopal episode complicated by fetal bradycardia. She was tachycardic, poorly responsive and in respiratory distress. She was transferred to the operating room (OR) for emergency Cesarean section. After the uterine incision, the intubated patient developed circulatory collapse followed by a sinus tachycardia pulseless electrical activity (PEA) arrest. Chest compressions were initiated, and the hospital code/resuscitation team was called to the OR. The patient started bleeding from her incision leading to an initial diagnosis of hemorrhagic shock. The code team, equipped with point-of-care ultrasound skill obtained an apical 4-chamber view (Figure 1) that revealed a severely dilated and hypokinetic right ventricle, and a hyperdynamic, underfilled left ventricle. The ultrasound findings in combination with significant bleeding were felt to be consistent with AFE not hemorrhagic shock and the extracorporeal membrane oxygenation (ECMO) team was activated for bedside cannulation. ROTEM (Figure 2) demonstrated markedly prolonged clotting time, prolonged clotting formation time and very low clot amplitude consistent with DIC, further supporting the diagnosis of AFE and prompted the difficult decision to withhold heparin after VA-ECMO cannulation. Following stabilization, patient was transferred to the intensive care unit with a diagnosis of AFE complicated by DIC and post-partum hemorrhage. She left the hospital with no physical or neurologic deficits 31 days later with her healthy baby boy. DISCUSSION: The description of POCUS use during cardiovascular resuscitation in the setting of AFE and other obstetric emergencies is rare. Identifying a dilated right ventricle on ultrasound can narrow the diagnosis of circulatory collapse in the peripartum patient to pulmonary embolism (PE) and AFE. ROTEM can help differentiate AFE from PE by identifying DIC with one study estimating the occurrence of DIC in PE at 1 % compared to 30-77% in AFE[5]. CONCLUSIONS: The use of POCUS and ROTEM in the diagnosis and management of AFE can guide lifesaving clinical decision making in the peripartum patient who develops circulatory collapse followed by cardiac arrest. REFERENCE #1: Sitaula S, Das D, Sitaula S, Chhetry M. Amniotic fluid embolism: A rare cause of maternal collapse-A case report. Clin Case Rep. 2020;8(12):3359-3361. Published 2020 Oct 26. doi:10.1002/ccr3.3433 REFERENCE #2: Loughran JA, Kitchen TL, Sindhakar S, Ashraf M, Awad M, Kealaher EJ. Rotational thermoelectrometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism. Int J Obstet Anesth. 2019;38:127-130. doi:10.1016/j.ijoa.2018.09.001 REFERENCE #3: Rath WH, Hoferr S, Sinicina I. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment. Dtsch Arztebl Int. 2014;111(8):126-132. doi:10.3238/arztebl.2014.0126 DISCLOSURES: No relevant relationships by Angela Phillips, source=Web Response No relevant relationships by David Tierney, source=Web Response

COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis

Study Objectives: Social determinants of health (SDOH) influence the health outcomes of COVID-19 patients;yet, little is known about how patients at risk of significant disease burden view this relationship. Our study sought to explore patient perceptions of the influence of SDOH on their COVID-19 infection experience and COVID-19 transmission within their communities. Methods: We conducted a qualitative study of patients in a North Carolina health care system’s registry who tested positive for COVID-19 from March 2020 through February 2021. All patients’ addresses across six counties served were geo-referenced and analyzed by Kernel Density Estimation (KDE) to identify population-dense outbreaks of COVID-19 (hotspots). Spatial autocorrelation analysis was performed to identify census area clusters of white, Black and Hispanic populations, based on the 2019 American Community Survey dataset. Patients were identified by a randomized computer-generated sampling method. Patients participated in semi-structured phone interviews in English or Spanish based on patient preference by trained bilingual researchers. Each interview was evaluated using a combination of deductive and inductive content analysis to determine prevalent themes related to COVID-19 knowledge and diagnosis, disease experience, and the impact of SDOH. Results: The 10 patients interviewed from our COVID-19 hotspots were of equal distribution by sex, and predominantly Black (70%), ages 22-70 years (IQR 45-62 years), and presented to the ED for evaluation (70%). The respondents were more frequently publicly insured (50% medicaid/medicare;vs 30% uninsured;vs 20% private). The interviews demonstrated themes surrounding the experience and impact of COVID-19. The perceived risk of contracting COVID-19 and knowledge of how to prevent infection varied greatly and could be in part explained by SDOH such as their occupation and living conditions. The experiences of COVID-19 testing, diagnosis, isolation and treatment were most influenced by the timing of infection in relation to the study period. Earlier in the pandemic, the knowledge of isolation requirements and available support systems seemed to have negatively impacted the ability to isolate and follow public health guidance, as well as the support mechanisms provided by employers during this period. Communication of infection status once diagnosed varied greatly, with some voicing feelings of shame, and others advocating for sharing of infection experiences to change community behaviors. Suggestions for how to improve the COVID-19 response included improving communication and enforcing public health guidelines, including raising awareness for vulnerable populations. Conclusion: Further exploration of important themes and related SDOH that influenced how the participants experienced the COVID-19 pandemic will be necessary to decrease the negative impacts of SDOH in communities that are high-risk for COVID-19 spread.