Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort

We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.

Understanding the Burden of Legal Financial Obligations on Indigent Washingtonians

In criminal courts across the country, judges assess a variety of fines, fees and other legal financial obligations (LFOs) that many defendants struggle to pay. This paper examines the disproportionate burden that fine and fee assessment and collection practices impose on low-income, system-involved individuals, using administrative court data for criminal cases filed in Washington’s courts of limited jurisdiction between 2015 and 2020. The authors find that the majority of defendants do not or only partially pay their LFOs, but that these observations are more pronounced for indigent defendants. The authors also find that, of defendants who fully pay off their fines and fees, individuals with a public defender satisfy their debt after a greater number of days, as compared to individuals with private counsel. This is all in spite of public defender defendants generally being assessed smaller amounts in fines and fees at the outset. Additionally, the authors uncover that when defendants do pay off all of their fines and fees, they tend to do so on the day of assessment, with the likelihood of satisfying full payment generally decreasing as time goes on. These findings suggest that many people struggle with criminal justice debt, but that this problem disproportionately impacts indigent Washingtonians, subjecting them to a greater possibility of harm through the various methods of collections enforcement.

Community Perspectives on Social Influences on Suicide Within a Native American Reservation

Relative to the general population, Native Americans (NA) bear a disproportionate burden of suicide-related mortality rates. NA males and females aged 15 to 24 years experience suicide rates nearly 3 times than the U.S. all races rates in this age group. Although efforts have been made to understand and reduce suicide in tribal communities, a large portion has focused on individual characteristics with less attention given to social factors that may also inform suicide. This article aims to build on a local conceptual model of NA youth suicide by examining additional potential social factors through qualitative interviews. Findings from the thematic analysis resulted in the identification of seven perceived social influences: contagion, violence and abuse, discrimination and bullying, negative expectations, spirituality, social support, and cultural strengths. Public health approaches to reduce suicide should consider local social factors that resonate with tribal communities to build resilience.

Politics, Power, and Money

This chapter investigates how politics and power shape health outcomes, with special emphasis on how these forces intersect with economic inequality and the disproportionate burden of sickness experienced by low-income populations. During the spread of COVID-19, American political leadership faced a test of its ability to respond to sudden crisis. Rising to such a difficult occasion requires detailed plans for what to do in such a scenario, robust public health infrastructure, and leadership which takes decisive, data-informed action, listening to experts and communicating clearly and consistently with the public. Tragically, COVID-19 found the United States lacking in all these areas. Political leaders are in a position to mold public opinion, nudging the public mind towards new ways of thinking. The precise term for this is “shifting the Overton window.” By helping to mainstream a cavalier attitude towards COVID-19, the Trump administration shifted the Overton window towards greater acceptance of behaviors which create poorer health. The chapter then looks at the failure to adequately address race in the US. Among the factors that shape health, the area of race is particularly sensitive to political dynamics.

EFFECT OF KIDNEY DISEASE ON THE MORTALITY OF COVID POSITIVE PATIENTS IN A TERTIARY CARE HOSPITAL, INDIA

INTRODUCTION: CKD and kidney failure are signicant comorbidities associated with unfavourable outcomes in patients with COVID-19. Patients with CKD/kidney failure also have a disproportionate burden of other comorbidities 1 (e.g., coronary artery disease, hypertension, and diabetes mellitus) associated with more severe presentations of COVID-19 . SARS-CoV-2 infection frequently triggers a massive release of proinammatory cytokines and may induce coagulation abnormalities that increase the risk of 2 cardiovascular events and multiorgan dysfunction. MATERIALS & METHODS: It is a retrospective study done in government general hospital Vijayawada from patients admitted with covid positive status having comorbidities, with the help of medical records department, done during 1st April 2020 to 31st March 2021. RESULTS : Out of 150 patients who had a renal abnormality, 40 (27%)had AKI, 110 ( 73%) had CKD, and of these patients, 96( 64%) patients underwent dialysis, 54( 36%) patients did not undergo dialysis, having high mortality mainly in patients having CKD than AKI. Compared to patients with comorbidity without renal abnormality and patients with renal abnormalities, the mortality was high in the later group of patients. CONCLUSION: There is a signicant effect of kidney disease on mortality in covid positive patients. Patients having CKD will have higher mortality compared with AKI. Even though the mortality was seen in patients having comorbidities without renal involvement, mortality was much higher in patients with renal involvement.

Continued need for non-pharmaceutical interventions after COVID-19 vaccination in long-term-care facilities

Long-term care facilities (LTCFs) bear disproportionate burden of COVID-19 and are prioritized for vaccine deployment. LTCF outbreaks could continue occurring during vaccine rollout due to incomplete population coverage, and the effect of vaccines on viral transmission are currently unknown. Declining adherence to non-pharmaceutical interventions (NPIs) against within-facility transmission could therefore limit the effectiveness of vaccination. We built a stochastic model to simulate outbreaks in LTCF populations with differing vaccination coverage and NPI adherence to evaluate their interacting effects. Vaccination combined with strong NPI adherence produced the least morbidity and mortality. Healthcare worker vaccination improved outcomes in unvaccinated LTCF residents but was less impactful with declining NPI adherence. To prevent further illness and deaths, there is a continued need for NPIs in LTCFs during vaccine rollout.

‘When the Waves Roll High’: Religious Coping among the Amish and Mennonites during the COVID-19 Pandemic

Religious beliefs, practices, and social support facilitate coping with psychologically distressful events and circumstances. However, COVID-19 and governmental mandates for social distancing and isolation make in-person communal forms of religious coping difficult. While some congregations began holding virtual rituals, this was not an option for Amish and conservative Mennonite groups that restrict communication and media technologies as a religious sacrament. Governmental mandates placed a disproportionate burden on these groups whose members could not conduct rituals or interact virtually with other members and family. What religious coping strategies did the Amish and Mennonites use to cope with the COVID-19 pandemic given their restricted ability to participate in in-person rituals? We collected data from The Budget and The Diary, two Amish and Mennonite correspondence newspapers, which provide information on the experiences of community members. We content analyzed all entries from March 2020 to April 2020 and identified several themes related to religious coping focused on the positive benefits of the pandemic, specifically how it helps and reminds the Amish and Mennonites to refocus on the simple and important things in life, including God, spirituality, family, tradition, gardening, and other at-home hobbies, all of which reflect their religious commitment to a slower pace of life.

Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment

Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin. The disproportionate burden of acute rheumatic fever in Indigenous populations in Canada and special considerations for testing and treatment are discussed.