Food Insecurity During the First Year of COVID-19: An Analysis of Employment and Sociodemographic Factors Among a Longitudinal Cohort (CHASING COVID)

ObjectivesWhile much has been reported about the impact of COVID-19 on U.S. food insecurity, longitudinal data and the variability experienced by people working in different industries are limited. This study aims to further characterize individuals experiencing food insecurity during the pandemic in terms of employment and sociodemographic characteristics and degree of food insecurity. MethodsThe study sample consisted of people enrolled in a U.S. prospective cohort study (CHASING COVID) who completed all food insecurity questionnaires from Visit 1 (April-July 2020) through Visit 7 (May-June 2021). Descriptive statistics and logistic regression models were used to determine employment and sociodemographic correlates of food insecurity (using a screening question from the USDA HFSS). Patterns of food insecurity and utilization of food benefit programs were also examined. ResultsThirty-one percent (1251/4019) of the sample were food insecure. Black and Hispanic respondents, households with children, and those with lower income and education levels had a higher odds of food insecurity. People employed in construction, leisure/hospitality and trade/transportation industries had the highest burden of both food insecurity and income loss. Among those reporting food insecurity, 40% were persistently food insecure ([≥]4 consecutive visits), and 46% did not utilize any food benefit programs. ConclusionsThe pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in vulnerable industries and ensure those experiencing food insecurity can easily participate in food benefit programs for which they are eligible.

Plans to vaccinate children for COVID-19: a survey of US parents

In a national online survey of 2,074 US parents conducted in March 2021, 49.4% reported plans to vaccinate their child for COVID-19 when available. Lower income and less education were associated with greater parental vaccine hesitancy/resistance, while safety, effectiveness and lack of need were the primary reasons for vaccine hesitancy/resistance.

The emergence, surge and subsequent wave of the SARS-CoV-2 pandemic in New York metropolitan area: The view from a major region-wide urgent care provider.

BackgroundDescribing SARS-CoV-2 testing and positivity trends among urgent care users is crucial for understanding the trajectory of the pandemic. ObjectiveTo describe demographic and clinical characteristics, positivity rates, and repeat testing patterns among patients tested for SARS-CoV-2 at CityMD, an urgent care provider in the New York City metropolitan area. DesignRetrospective study of all persons testing for SARS-CoV-2 between March 1, 2020 and January 8, 2021 at 115 CityMD locations in the New York metropolitan area. PatientsIndividuals receiving a SARS-CoV-2 diagnostic or serologic test. MeasurementsTest and individual level SARS-CoV-2 positivity by PCR, rapid antigen, or serologic tests. ResultsDuring the study period, 3.4 million COVID tests were performed on 1.8 million individuals. In New York City, CityMD diagnosed 268,298 individuals, including 17% of all reported cases. Testing levels were higher among 20-29 year olds, non-Hispanic Whites, and females compared with other groups. About 24.8% (n=464,902) were repeat testers. Test positivity was higher in non-Hispanic Black (6.4%), Hispanic (8.0%), and Native American (8.0%) patients compared to non-Hispanic White (5.4%) patients. Overall seropositivity was estimated to be 21.7% (95% Confidence Interval [CI]: 21.6-21.8) and was highest among 10-14 year olds (27.3%). Seropositivity was also high among non-Hispanic Black (24.5%) and Hispanic (30.6%) testers, and residents of the Bronx (31.3%) and Queens (30.5%). Using PCR as the gold standard, SARS-CoV-2 rapid tests had a false positive rate of 5.4% (95%CI 5.3-5.5). ConclusionUrgent care centers can provide broad access to critical evaluation, diagnostic testing and treatment of a substantial number of ambulatory patients during pandemics, especially in population-dense, urban epicenters.

Recent SARS-CoV-2 seroconversion in a national, community-based prospective cohort of U.S. adults

BackgroundEpidemiologic risk factors for incident SARS-CoV-2 infection as determined via prospective cohort studies greatly augment and complement information from case-based surveillance and cross-sectional seroprevalence surveys. MethodsWe estimated the incidence of SARS-CoV-2 infection and risk factors in a well-characterized, national prospective cohort of 6,738 U.S. adults, enrolled March-August 2020, a subset of whom (n=4,510) underwent repeat serologic testing between May 2020 and January 2021. We examined the crude associations of sociodemographic factors, epidemiologic risk factors, and county-level community transmission with the incidence of seroconversion. In multivariable Poisson models we examined the association of social distancing and a composite score of several epidemiologic risk factors with the rate of seroconversion. FindingsAmong the 4,510 individuals with at least one serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by January 2021. Among 3,422 participants seronegative in May-September 2020 and tested during November 2020-January 2021, we observed 161 seroconversions over 1,646 person-years of follow-up (incidence rate of 9.8 per 100 person-years [95%CI 8.3-11.5]). In adjusted models, participants who reported always or sometimes social distancing with people they knew (IRRalways vs. never 0.43, 95%CI 0.21-1.0; IRRsometimes vs. never 0.47, 95%CI 0.22-1.2) and people they did not know (IRRalways vs. never 0.64, 95%CI 0.39-1.1; IRRsometimes vs. never 0.60, 95%CI 0.38-0.97) had lower rates of seroconversion. The rate of seroconversion increased across tertiles of the composite score of epidemiologic risk (IRRmedium vs. low 1.5, 95%CI 0.92-2.4; IRRhigh vs. low 3.0, 95%CI 2.0-4.6). Among the 161 observed seroconversions, 28% reported no symptoms of COVID-like illness (i.e., were asymptomatic), and 27% reported a positive SARS-CoV-2 diagnostic test. Ultimately, only 29% reported isolating and 19% were asked about contacts. InterpretationModifiable epidemiologic risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the U.S during May 2020-January 2021. FundingU.S. National Institutes of Allergy and Infectious Diseases (NIAID).

Patterns of SARS-CoV-2 testing preferences in a national cohort in the United States

In order to understand preferences about SARS-CoV-2 testing, we conducted a discrete choice experiment among 4793 participants in the Communities, Households, and SARS-CoV-2 Epidemiology (CHASING COVID) Cohort Study from July 30-September 8, 2020. We used latent class analysis to identify distinct patterns of preferences related to testing and conducted a simulation to predict testing uptake if additional testing scenarios were offered. Five distinct patterns of SARS-CoV-2 testing emerged. "Comprehensive testers" (18.9%) ranked specimen type as most important and favored less invasive specimen types, with saliva most preferred, and also ranked venue and result turnaround time as highly important, with preferences for home testing and fast result turnaround time. "Fast track testers" (26.0%) ranked result turnaround time as most important and favored immediate and same day turnaround time. "Dual testers" (18.5%) ranked test type as most important and preferred both antibody and viral tests. "Non-invasive dual testers" (33.0%) ranked specimen type and test type as similarly most important, preferring cheek swab specimen type and both antibody and viral tests. "Home testers" (3.6%) ranked venue as most important and favored home-based testing. By offering less invasive (saliva specimen type), dual testing (both viral and antibody tests), and at home testing scenarios in addition to standard testing scenarios, simulation models predicted that testing uptake would increase from 81.7% to 98.1%. We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options, which consider this heterogeneity, would likely increase testing uptake. SIGNIFICANCEDuring the COVID-19 pandemic, diagnostic testing has allowed for early detection of cases and implementation of measures to reduce community transmission of SARS-CoV-2 infection. Understanding individuals preferences about testing and the service models that deliver tests are relevant in efforts to increase and sustain uptake of SARS-CoV-2 testing, which, despite vaccine availability, will be required for the foreseeable future. We identified substantial differences in preferences for SARS-CoV-2 testing in a discrete choice experiment among a large national cohort of adults in the US. Offering additional testing options that account for or anticipate this heterogeneity in preferences (e.g., both viral and antibody tests, at home testing), would likely increase testing uptake. ClassificationBiological Sciences (major); Psychological and Cognitive Sciences (minor)

Household factors and the risk of severe COVID-like illness early in the US pandemic

ObjectiveTo investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. MethodsWe used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. ResultsIn logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings. ConclusionEarly in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease.

The relationship between anxiety, health, and potential stressors among adults in the United States during the COVID-19 pandemic

ObjectiveTo estimate the prevalence of anxiety symptoms and the association between moderate or severe anxiety symptoms and health and potential stressors among adults in the U.S. during the COVID-19 pandemic MethodsThis analysis includes data from 5,250 adults in the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study surveyed in April 2020. Poisson models were used to estimate the association between moderate or severe anxiety symptoms and health and potential stressors among U.S. adults during the COVID-19 pandemic. ResultsGreater than one-third (35%) of participants reported moderate or severe anxiety symptoms. Having lost income due to COVID-19 (adjusted prevalence ratio [aPR] 1.27 (95% CI 1.16, 1.30), having recent COVID-like symptoms (aPR 1.17 (95% CI 1.05, 1,31), and having been previously diagnosed with depression (aPR 1.49, (95% CI 1.35, 1.64) were positively associated with anxiety symptoms. ConclusionsAnxiety symptoms were common among adults in the U.S. during the COVID-19 pandemic. Strategies to screen and treat individuals at increased risk of anxiety, such as individuals experiencing financial hardship and individuals with prior diagnoses of depression, should be developed and implemented.

Testing, Testing: What SARS-CoV-2 testing services do adults in the United States actually want?

ImportanceAscertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. ObjectiveTo determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. DesignA discrete choice experiment (DCE) was used to assess the relative importance of type of SARS-CoV-2 test, specimen type, testing venue, and results turnaround time. Uptake of an optimized testing scenario was simulated relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal (NP) swab in a providers office or urgent care clinic with results in >5 days. SettingOnline survey, embedded in an existing cohort study, conducted during July 30 - September 8, 2020. ParticipantsParticipants (n=4,793) were enrolled in the CHASING COVID Cohort Study, a national longitudinal cohort of adults >18 years residing in the 50 US states, Washington, DC, Puerto Rico, or Guam. Main Outcome(s) and Measure(s)Relative importance of SARS-CoV-2 testing method attributes, utilities of specific attribute levels, and probability of choosing a testing scenario based on preferences estimated from the DCE, the current typical testing option, or choosing not to test. ResultsTurnaround time for test results had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). Participants preferred fast results on both past and current infection and using a noninvasive specimen, preferably collected at home. Simulations suggested that providing immediate or same day test results, providing both PCR and serology, or collecting oral specimens would substantially increase testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions and RelevanceTesting strategies that offer both PCR and serology with non-invasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.

A national prospective cohort study of SARS/COV2 pandemic outcomes in the U.S.: The CHASING COVID Cohort

PurposeThe CHASING COVID Cohort study is a U.S.-based prospective cohort study launched during the upswing of the U.S. COVID-19 epidemic. The objectives are to: 1) estimate and evaluate determinants of the cumulative incidence of SARS-CoV-2 infection, disease, and deaths; 2) assess the impact of the pandemic on psychosocial and economic outcomes; and 3) assess the uptake of pandemic mitigation strategies. ParticipantsWe began enrolling participants March 28, 2020 using internet-based strategies. Adults [≥]18 years residing anywhere in the U.S. or U.S. territories were eligible. 6,753 people are enrolled in the cohort, including participants from all 50 U.S. states, the District of Columbia, Puerto Rico, and Guam. Participants are contacted regularly to complete study assessments, including interviews and specimen collection. Findings to dateOf 4,247 participants who provided a specimen for baseline serologic testing, 135 were seropositive by screening antibody testing (3.2%, 95% CI 2.7%-3.5%) and 90 were seropositive by confirmatory antibody testing (2.1%, 95% CI 1.7%-2.6%). Cohort data have been used to assess the role of household crowding and the presence of children in the household as potential risk factors for severe COVID-19 early in the U.S. pandemic; to describe the prevalence of anxiety symptoms and its relationship to COVID-19 outcomes and other potential stressors; and to identify preferences for SARS-CoV-2 diagnostic testing when community transmission is on the rise via a discrete choice experiment. Future plansThe CHASING COVID Cohort Study has outlined a research agenda that involves ongoing monitoring of the cumulative incidence and determinants of SARS-CoV-2 outcomes, mental health outcomes and economic outcomes. Additional priorities include COVID-19 vaccine hesitancy, uptake and effectiveness; incidence, prevalence and correlates of long-haul COVID-19; and the extent and duration of the protective effect of SARS-CoV-2 antibodies.