Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at https://www.acpjournals.org/topic/category/coronavirus.
1. Racial minorities more likely to become infected with COVID-19
An analysis of Kaiser Permanente members in Northern California early in the COVID-19 pandemic found that racial minorities were more likely than white patients to test positive for COVID-19. The findings are published in Annals of Internal Medicine.
Researchers from Kaiser Permanente, The Permanente Medical Group, and Stanford Cancer Institute studied health records for 3.5 million patients in the Kaiser Health system, more than 91,000 of whom received a COVID-19 test between Feb. 1 and May 31, 2020. That data showed that Latino patients were nearly 4 times as likely as white patients to become infected with the virus, while Asian and Black patients were 2 times as likely to test positive for COVID-19 compared to white patients. The odds of hospitalization were also higher for Latino, Asian, and Black patients with COVID-19 than for white patients. However, the study did not find racial disparities in mortality among patients hospitalized after infection.
The researchers concluded that while race was a major factor in likelihood of infection, it contributed in a minor way to hospitalization, admission, and death. For those adverse outcomes, age was the major predictor. According to the authors, these findings reinforce that health systems should aim to mitigate the spread of COVID-19 in their highest-risk communities by seeking to reduce transmission among the most vulnerable. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-6979.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The corresponding author, Gabriel J. Escobar, MD, can be reached through Jan Greene at janice.x.greene@kp.org.
2. Racial opinions of vaccine
Current recommendations for talking to patients about COVID-19 vaccines do not provide specific guidance on how to discuss mistrust. Authors from the University of Chicago, University of Washington School of Medicine, and the University of California, San Francisco suggest specific strategies and language that clinicians can use to address mistrust of COVID-19 vaccines among racial and ethnic minorities. Their advice is published in Annals of Internal Medicine. Read the full text: https://www.acpjournals.org/doi/10.7326/M21-0055.
Currently, only 18% of Black Americans and 40% of Latinx Americans trust that a COVID-19 vaccine will be effective. Even fewer trust that it will be safe. The impact of this mistrust is alarming: Fewer than half of Black Americans intend to get vaccinated against COVID-19. To reduce the disproportionate burden of COVID-19 morbidity and mortality among people of color, this mistrust must be addressed and health care providers are in a unique position to address patients' concerns.
The authors detail four specific strategies to help promote trust among patients of color about COVID-19 vaccines. The authors say health care providers should lead with listening, tailor responses to patient concerns, use accessible language, and acknowledge uncertainty. Prioritizing these discussions using these strategies may help increase the acceptance of COVID-19 vaccinations and improve health outcomes among persons of color.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The corresponding author, Monica Peek, MD, MPH, MS can be reached through Ashley Skorski at askorski@uchicago.edu.
3. Majority of Los Angeles health care workers surveyed hesitant about getting COVID-19 vaccine
In a recent survey, a majority of Los Angeles area health care workers expressed hesitancy about getting the COVID-19 vaccine. Respondents were most heavily influenced by the fast-tracked development of the vaccine (83.5%), the novel and unfolding science of SARS-CoV-2 (75.7%), and the political climate in which the research and regulatory process were playing out at the time of survey distribution (58.5%).
Researchers from the University of California surveyed a volunteer cohort of 1,069 asymptomatic health care workers employed by the University of California, Los Angeles to track incidence and risk factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. As an addendum, a cross-sectional survey designed to assess attitudes toward vaccines, including prospective acceptance of novel coronavirus vaccines, was distributed to participants in September 2020 and completed online through October 2020. The findings are published in Annals of Internal Medicine.
Among the participants, fewer than half (46.9%) felt that a novel coronavirus vaccine would protect them against COVID-19. Just over one third (34.8%) of participants expressed confidence in the scientific vetting process for SARS-CoV-2 vaccines, with almost half (47.8%) reporting they would not be willing to participate in vaccine trials. Most participants (65.5%) indicated they would delay vaccination once coronavirus vaccines became available for distribution (49.4% would prefer to wait and see how the vaccine affects others first, and 16.1% would not get it soon but indicated they might in the future), and 1.30% never intend to get vaccinated. Compared with prescribing clinicians, other health care workers were about 20% to 30% more likely to delay or decline a coronavirus vaccine when all other demographic factors were held equal. Participants identifying as Asian (23.9%) or Latino (26.2%) were less likely to accept vaccination immediately upon availability compared with those in other racial and ethnic groups. Health care workers aged 50 years or older were more likely than their younger coworkers to accept vaccination right away. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-7580.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The corresponding author, Anne W. Rimoin, MPH, PhD, can be reached through Brad Smith at bssmith@support.ucla.edu.
4. SARS-CoV-2 clusters can occur in hospitals despite robust control policies
A missed case of SARS-CoV-2 infection may have led to a cluster of cases among patients and health care workers in an acute care hospital, despite robust control policies in the facility. In the paper published in Annals of Internal Medicine, researchers from Harvard Medical School, Harvard Pilgrim Health Care Institute, Brigham and Women's Hospital, and the Massachusetts Department of Public Health discuss the cases and insights that may inform future measures to protect patients and staff.
While the patient had tested negative twice on admission, the investigators surmised that he was contagious from at least hospital day 3 and infected staff and patients for at least a week before detection. During this time, the patient had multiple transfers between units and services and also shared rooms with uninfected patients, which contributed to the spread. In addition, failure to wear eye protection and limitations of personal protective equipment (PPE) among those with near-range exposure to the patient may have contributed to some spread.
According to the authors, this case highlights important lessons about the limitations of admission testing. They stress the importance of obtaining more than one sample in high-risk patients, among other improved testing strategies. The authors also note that there is high risk for roommate-to-roommate transmissions in the setting of occult acute infection. They also note the potential value of serial testing to identify infections incubating on admission. They say opportunities to improve adherence to eye protection and masking of patients, surgical masks and face shields for providers with near-range exposure to symptomatic patients, and the value of whole-genome sequencing could also help define and contain hospital clusters. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-7567.
In an accompanying editorial from University of Texas Southwestern Medical Center, authors say that this case is just one example that exposes the many weaknesses in our health care systems, including insufficient training in infection prevention. While no single practice was identified as the culprit, there are hints, as there have been with past outbreaks, that small lapses in infection prevention may add up to transmission because of the high-risk activities that occur in health care settings. Read the full text: https://www.acpjournals.org/doi/10.7326/M21-0526.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The corresponding author, Michael Klompas, MD, MPH, can be reached through Elaine St. Peter at estpeter@bwh.harvard.edu. Editorialist Trish M. Perl, MD, MSc, can be reached through Remecka Owens at Remekca.Owens@UTSouthwestern.edu.
5. Lessons from 1918 Influenza Pandemic demonstrate the importance of restrictions on public gatherings
Lessons from the 1918 Influenza Pandemic demonstrate why school closures and other restrictions on mass gatherings may be necessary today to control the spread of SARS-CoV-2 infection. The historical analysis is published in Annals of Internal Medicine.
Authors from the University of Zurich reviewed detailed public health records from a region in Switzerland to study the effect of school closures, restrictions on mass gatherings, and other measures on the size and duration of the 1918 Spanish Influenza epidemic. Similar data collected in Switzerland during the present COVID-19 epidemic were analyzed, as well, and the two public health responses were compared.
The researchers found that during the first wave of the influenza pandemic in summer 1918 in the canton of Bern, there were salient associations between the centrally enacted, canton-wide public health interventions and the early and rapid containment of epidemic growth. During the second wave in autumn, cantonal authorities reacted hesitantly largely due to concerns about the economic effect of public health interventions experienced during the first wave and the associated political pressure. Mass gatherings and premature relaxation of restrictions of mass gatherings only 1 week later because of public pressure may have contributed to the length and intensity of the second wave, which was 2.6 times longer than the first wave and responsible for approximately 80% of all cases and deaths. The researchers noted strikingly similar patterns in the management of the COVID-19 outbreak in Switzerland in 2020: The second wave had a considerably higher amplitude, prolonged duration, and much higher associated rates of hospitalization and mortality. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-6231.
The author of an accompanying editorial from Johns Hopkins University says these lessons are important for informing responses to future pandemics. The author highlights the dangers of eschewing those lessons that history provides Read the editorial: https://www.acpjournals.org/doi/10.7326/M21-0449.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead corresponding authors can be contacted directly. Kaspar Staub, PhD can be reached at kaspar.staub@iem.uzh.ch, and Peter Jüni, MD can be reached at peter.juni@utoronto.ca. The corresponding author of the accompanying editorial, Graham Mooney, PhD, can be reached at 443-208-5505.
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