Background

Following the development, approval, and production of COVID-19 vaccines, a need arose for qualified personnel to administer vaccines. In 2020-21, licensed healthcare professionals were under strain due to clinical caseloads, hospitalization, and burnout. University of Massachusetts TH Chan School of Medicine students in their preclinical years were not previously trained to administer intramuscular injections, but were identified to fill the immediate vaccination delivery gap.

Methods

Medical and nursing students, in collaboration with medical and nursing faculty, developed a program training students on intramuscular injection. 163 incoming medical students were trained through online materials covering best practices for intramuscular injection, followed by in-person simulation-based skills sessions where students practiced injection under direct supervision. Upon completion of this training, all students became eligible to volunteer as vaccinators at local clinics under appropriate supervision.

Results

Following online training, objective student comprehension scores increased from 74.4% to 91.5%, and confidence scores rose from 1.74 to 2.94. Both increases in scores were statistically significant. After training, 61% of students enrolled to serve as volunteer vaccinators. This cohort of students volunteered 135 shifts (462 hours) at vaccine clinics from August 2021-March 2022.

Conclusions

This model illustrates how simulation-based training of a clinical skill can be integrated into the preclinical curriculum. It demonstrates the possibility of training medical students to respond to public need and could be implemented for introducing other appropriate procedural skills in the preclinical curriculum. Further, this model demonstrates the strength of interprofessional collaboration in the medical education setting.

Background/purpose: It is well established that olfactory dysfunction (dysosmia/anosmia/parosmia) is associated with COVID-19. It is not clear how much this association changed over the course of the pandemic as new variants emerged. We examined trends in anosmia (and related diagnoses) alongside incidence of confirmed SARS-CoV-2 infections before and during the pandemic to determine temporal associations.

Methods: In a retrospective cohort study of patients 18 years or older within a large integrated delivery system with SARS-CoV-2 infection between January 1, 2019, and October 31, 2022, we assigned five distinct periods of variant dominance. We also identified patients with at least one olfactory disturbance diagnosis and calculated the monthly rate of these encounters per COVID-19 diagnoses (per 100,000 health plan members) for each variant, comparing rates using a one-way ANOVA.

Results/outcomes: 23,570 adult eligible patients had 65,996 encounters with an anosmia-related diagnosis (median=2 encounters per patient, IQR 1-4). The median age was 46.1 (IQR 32.1-61.4) years and 61% were female. The ratio of mean anosmia encounters to SARS-CoV-2 infections varied with statistical significance across periods of variant dominance: initial variant, 3.13; epsilon, 1.41; alpha, 2.58; delta, 1.46; and omicron, 0.48 (p=0.005).

Conclusions: Anosmia and related diagnoses were differentially associated with COVID-19 variants and waves. These differences may be due to several factors, including differing variant symptomology, mitigation of the disease by vaccines and treatments, and changes to COVID-19 care-seeking behavior over time. As new variants emerge, it is important to recognize that SARS-CoV-2 infection may or may not present with sensory symptoms.

Background/Purpose: Queens County, NY was identified as the epicenter of the COVID-19 pandemic in the United States, representing a significant proportion of racial and ethnic minorities. As the pandemic surged and new variants emerged, one factor that has not been explored is the level of pandemic readiness one year into the pandemic.

Methods: This study conducted 651 online survey questionnaires of residents in three communities in Queens, NYC. Participants were recruited from community leaders and local elected officials. Survey questionnaire included basic demographic information, readiness assessment, and assessment of participants’ knowledge gain on COVID-19 preparedness. Chi-square and odds ratio analyses were employed using SAS.

Results: Study results revealed that urban communities continue to be inadequately prepared for the second and third waves of the pandemic. Latinx exhibited lower levels of preparedness compared to other populations. Additionally, poor preparedness was found to be associated with affordability challenges stemming from poverty. A mere 7% of the surveyed communities achieved an advanced level of pandemic readiness, indicating the majority still lacked basic preparedness measures. Lastly, employed individuals were found to be less prepared compared to the unemployed.

Conclusion: Profound disparities in pandemic preparedness were observed in vulnerable communities, specifically among racial/ethnic groups. The results of this study revealed that varying social determinants influenced different levels of readiness. These findings contribute to the existing scientific literature on the odds of COVID-19 infection as it correlates to social and economic inequities among racial/ethnic communities.

Background

The Washington State Department of Health (DOH) stood up the COVID-19 Vaccine Program to support the management of COVID-19 vaccines as part of state-wide response efforts. This expanded infrastructure enabled DOH to mobilize vaccine quickly and address access gaps. As response efforts and associated funding wind down, and COVID-19 vaccines become commercialized, DOH initiated an intentional “Forward Planning” process to leverage lessons learned to revise needed long-term immunization infrastructure that is highly responsive to future public health emergencies.

Methods

The Office of Immunization and COVID-19 Vaccine Program developed a project charter and workgroups were tasked with assessing response efforts and developing recommendations for long-term capacity. The process has included intentional engagement of external partners (including local health jurisdictions, Tribal Nations, and providers) and internal staff. Assessment criteria was prioritized and included safety, agency priority, quality improvement, community requests, and impact.

Outcomes

Recommendations are being finalized and will prompt further intentional engagement of staff and union representation across the agency. Changes to bodies of work and corresponding staffing will be implemented over the next 24 months. Recommendations are also informing requests for federal and state funding. The Forward Planning process fostered cross-office collaboration and a culture of inclusion and innovation.

Conclusions

The Forward Planning process has facilitated buy-in from staff and partners due to its long runway and multiple mechanisms for sharing recommendations and feedback to plan a sustainable immunization infrastructure. Similar strategies may be useful to other jurisdictions as public health continues to experience significant funding and programmatic fluctuations.

Background/Purpose: American Indian/Alaska Native (AI/AN) populations were disproportionately affected by the COVID-19 pandemic, experiencing an excess hospitalization, mortality, and economic losses compared to the non-Hispanic White population. This study sought to understand and document the Indigenous determinants of health (IDOH) and role of leadership (Nation Building) in AI/AN communities that shaped mental wellbeing for four groups, educators, traditional knowledge holders, first responders, and recovery practitioners, during this crisis.

Methods: This work was accomplished in collaboration with and approval from three Native Nations in Arizona. The plan was to conduct 10 interviews with key participants from each of the four groups within each of the three Nations. A majority of the research team were American Indian and conducted and collected the qualitative data by Zoom^tm or telephone. All conversations were recorded for later transcription, translation and coding (NVIVO^tm).

Results/Outcomes: From May - November 2021, 92 participants were interviewed. The most prevalent IDOH and associated themes included physical and mental health (exhaustion, stress, fear), relationships, kinship, and collectivism (disruption, death, relying on others), cultural continuity (loss of ceremony and application of cultural knowledge), and self-determination (confusion/frustration and stress/safety). The groups also experienced differences in mental wellbeing aligned with their occupation. For example, first responders experienced disruption and social dissonance in the workplace due to varying political views and Traditional Knowledge Holders experienced a revitalization of cultural strategies to maintain health.

Conclusions: Although the differences between occupational groups are striking, the similarities that did exist drew on AI/AN identity and world view.

Background

At the onset of the COVID-19 epidemic in March 2020, the Desert Healthcare District (DHCD) and the County of Riverside Public Health Department established a collective impact fund and formed the Coachella Valley Equity Collaborative (CVEC) to mitigate the impact of COVID-19, while addressing the inequitable distribution and access of the COVID-19 vaccine, especially in the rural communities of the Coachella Valley, CA. At the time the CVEC was established, the COVID-19 vaccination rates in underserved low-income communities were significantly low.

Methods

By adopting an equity framework, the CVEC was able to quickly organize and work to reduce access barriers to health services for the hardest-hit farmworker communities. The Collaborative prioritized community-based efforts and leveraged trusted local messengers, such as Promotoras (Community Health Workers) to develop culturally and linguistically appropriate educational resources, reduce vaccine hesitancy by addressing misinformation, and ensuring equitable access by hosting enrollment and vaccination clinics at local churches, farms, and schools in underserved communities.

Results

The CVEC successfully increased the vaccination rate in 6-months from 43% to 62% amongst eligible underserved community members. To date, the CVEC has coordinated more than 400 mobile vaccination clinics resulting in the distribution of more than 48,000 doses of the COVID-19 vaccine.

Conclusion

The COVID-19 pandemic exposed the impact of an inadequate healthcare system and heightened the visibility of inequities, however, by adopting an equity framework, the CVEC and its partners were able to quickly organize and work to reduce access barriers to health services for the hardest-hit communities.

BACKGROUND

An estimated 20 million survivors of COVID-19 experience ongoing and sometimes debilitating symptoms (Long COVID). They often have difficulty accessing high-quality specialized care for particularly in populations that experience health disparities or in rural locations. The rapidly evolving science and care guidelines means that many healthcare providers do not have up-to-date information needed to care for these complex patients.

OBJECTIVES

We aim to expand access to comprehensive care for patients with long-COVID that is evidence-based, coordinated, equitable, and patient-centered in Arizona via provider education.

METHODS

Through collaborations with the NIH CEAL program, Centers for Disease Control, and other state and local funding, a monthly COVID Grand Rounds is offered leveraging local and national experts to share new discoveries and evidence-based practices to clinicians. The online format allows for participants from across the globe to attend. To supplement this for Arizona-based practitioners, a “warm-line” has been established for our multi-disciplinary Long COVID providers to share information directly with providers that need assistance.

RESULTS

Provider education, in the form of COVID Grand Rounds has educated primary care physicians (rural and urban) and subspecialists on issues related to the management of patients with Long COVID. More than 1,500 physicians have attended from 21 states in the US and 7 countries. This is supplemented by a provider-to-provider “warm-line”, allowing physicians from rural and less resourced communities access to our Long COVID physicians.

CONCLUSION

The COVID Grand Rounds and physician warm-line project are disseminating advance models of care for patients with Long COVID.