Telemedicine Use Among Older Adults During the COVID-19 Pandemic

Objective Although technology adoption among older adults is improving, ethnic minorities and those with socioeconomic disadvantages may have lower utilization of telemedicine. Here, we evaluate telemedicine uptake amongst community-based older adults. Materials and Methods Using a retrospective cohort design, we examined electronic medical records (EMR) for documentation of telemedicine use among patients > 65 years old at Geriatric practices in the New York metropolitan area from January-November 2020. Demographic details and insurance payer were captured for telemedicine visits and compared to in-person encounters. Multivariable regression was used to evaluate the association of demographic, socioeconomic factors and visit type. Results A total of 712 patients (32.3%) engaged in 1,085 telemedicine visits. Telemedicine represented 80% and 66% of all encounters during April and May, respectively and averaged 11.8% between June and November. Use was similar across age groups, gender, race and insurance payer status between telemedicine versus in-person encounters. Patients with greater number of comorbidities were more likely to use telemedicine-. Medicaid recipients had preference for video visits. 47.5% of patients who engaged in video visits had another person/family member present during an encounter. Conclusions Telemedicine augmented access to health care for older individuals during the peak of the COVID pandemic and continues to be utilized to improve access to care for older Americans. Given the distinct preference for video visits among patients with multiple medical conditions and those who have Medicaid, telemedicine has potential to serve as a tool to reduce enduring health care disparities beyond the pandemic.

A Study of Short Term Outcomes among Covid-19 Patients Discharged without Follow up In the New York Metropolitan Area

Background: A shortage of beds, high case volume, decreased availability of outpatient medical doctors, and limited disease knowledge resulted in the premature discharge and poor follow up of COVID-19 patients in the New York Metropolitan Area. Objective: The primary objective of this retrospective study and phone survey was to characterize the demographics and clinical outcomes (e.g., readmission rates, comorbidities, mortality, and functional status) of COVID-19 patients discharged without follow-up. The secondary objective was to assess the impact of race and comorbidities on readmission rates and the extent to which patients were escalated to another care provider. Methods: Electronic medical records were reviewed for COVID-19 patients discharged from 3 NYMA hospitals in March 2020. Follow up data regarding medical status, ability to perform activities of daily living and functional status was also obtained from patients via phone call. The Chi-square, Fishers exact test and t-tests were used to analyze the data. Results: 349 patients were included in the analysis. The hospital readmission rate was 10.6% (58.8% for pulmonary reasons) and did not differ by race. 74.3% of readmissions were <14 days after release. The post-discharge mortality rate was 2.6%. Hypertension was the most common comorbidity (43%). There was a statistically significant association between mortality and number of comorbidities (p=<0.0001). 82% of patients were contacted by phone. 66.6% of patients returned to pre-COVID baseline function in ≥1 month. As a result of information obtained on the follow up phone call, 4.2% of patients required “escalation” to another provider. Conclusion: Discharging COVID-19 patients without prearranged follow up was associated with high readmission and mortality rates. While the majority of patients recovered, prolonged weakness, lengthy recovery, and the need for additional medical intervention was noted. Further work to assess the effectiveness COVID-19 post-discharge programs is warranted.

Declines and peaks in NO₂ pollution during the multiple waves of the COVID-19 pandemic in the New York metropolitan area

The COVID-19 pandemic created an extreme natural experiment in which sudden changes in human behavior and economic activity resulted in significant declines in nitrogen oxide (NOx) emissions, immediately after strict lockdowns were imposed. Here we examined the impact of multiple waves and response phases of the pandemic on nitrogen dioxide (NO2) dynamics and the role of meteorology in shaping relative contributions from different emission sectors to NO2 pollution in post-pandemic New York City. Long term (> 3.5 years), high frequency measurements from a network of ground-based Pandora spectrometers were combined with TROPOMI satellite retrievals, meteorological data, mobility trends, and atmospheric transport model simulations to quantify changes in NO2 across the New York metropolitan area. The stringent lockdown measures after the first pandemic wave resulted in a decline in top-down NOx emissions by approx. 30 % on top of long-term trends, in agreement with sector-specific changes in NOx emissions. Ground-based measurements showed a sudden drop in total column NO2 in spring 2020, by up to 36 % in Manhattan and 19–29 % in Queens, New Jersey and Connecticut, and a clear weakening (by 16 %) of the typical weekly NO2 cycle. Extending our analysis to more than a year after the initial lockdown captured a gradual recovery in NO2 across the NY/NJ/CT tri-state area in summer and fall 2020, as social restrictions eased, followed by a second decline in NO2 coincident with the second wave of the pandemic and resurgence of lockdown measures in winter 2021. Meteorology was not found to have a strong NO2 biasing effect in New York City after the first pandemic wave. Winds, however, were favorable for low NO2 conditions in Manhattan during the second wave of the pandemic, resulting in larger column NO2 declines than expected based on changes in transportation emissions alone. Meteorology played a key role in shaping the relative contributions from different emission sectors to NO2 pollution in the city, with low-speed (< 5 ms−1) SW-SE winds enhancing contributions from the high-emitting power-generation sector in NJ and Queens and driving particularly high NO2 pollution episodes in Manhattan, even during – and despite – the stringent early lockdowns. These results have important implications for air quality management in New York City, and highlight the value of high resolution NO2 measurements in assessing the effects of rapid meteorological changes on air quality conditions and the effectiveness of sector-specific NOx emission control strategies.

Respiratory Distress in Hospitalized Non-Mechanically Ventilated COVID-19 Adults: A Retrospective Multicenter Cohort Study

Background: COVID-19 typically presents with respiratory symptoms which may progress with severe disease. There are standard guidelines for managing respiratory distress (e.g. opioids, anxiolytics) and palliative care teams are well versed in managing these symptoms. Aim: Determine the extent to which hospitalized COVID-19 patients with moderate respiratory distress received medications or palliative consultation for symptom management and if these interventions had any association with outcomes. Design: Retrospective chart review for hospitalized COVID-19+ patients from March 2-April 30, 2020. Setting: Large integrated health system in the New York Metropolitan area. Patients: 312 adult patients hospitalized with COVID-19 with an order for a non-rebreather mask and meeting criteria for moderate respiratory distress on the Respiratory Distress Observation Scale: concurrent respiratory rate ≥30 and heart rate ≥110 at any point during hospitalization. Patients receiving mechanical ventilation or intensive care were excluded. Results: Most COVID-19 patients experiencing moderate respiratory distress did not receive medications or palliative consultation for symptom management. Patients who received medications were predominantly white, older, and had a Do-Not-Resuscitate order. Patients who received a palliative consultation were more likely to be older, female, and white, with a Do-Not-Resuscitate order. Mortality was similar between those receiving medication and those who did not. Conclusion: Medications and palliative expertise for symptom management were underused for patients with moderate respiratory distress due to COVID-19. Education and triggers may help providers to identify moderate respiratory distress and consider symptomatic treatment and palliative consultation when appropriate.

Utilizing Rapid Research Implementation and Collaborations to Assess the Mental Health Impact of the COVID-19 Pandemic among Community and Clinical Cohorts

A research initiative was launched during the initial COVID-19 outbreak by three New York metropolitan area institutions. Collaborators recruited community members and patients from previous research studies to examine COVID-19 experiences and mental health symptoms through self-report surveys. The current report descriptively presents findings from the initial survey characterized by both community and clinical cohorts, and discusses challenges encountered with rapid implementation. The clinical cohort exhibited higher rates of symptoms of mental health difficulties (depression, anxiety, and PTSD) as compared to the community cohort. COVID-19 positivity rates were similar among both groups and lower than the national average. While both groups reported low rates of job loss, community members reported higher rates of financial difficulty resulting from the pandemic. Findings indicate the need for further collaborative research on the mental health impact of COVID-19.