SARS-CoV-2: A Canary in the Coal Mine for Public Safety Net Hospitals

Johnson-Agbakwu, Crista E; Eakin, Cortney M; Bailey, Celeste V; Sood, Shelly; Ali, Nyima; Doehrman, Pooja; Bhattarai, Bikash; Chambliss, Linda; Coonrod, Dean V

Background The COVID-19 pandemic has exposed disproportionate health inequities among underserved populations, including refugees. Public safety net health care systems play a critical role in facilitating access to care for refugees, and informing coordinated public health prevention and mitigation efforts during a pandemic crisis. Objective To evaluate the prevalence of SARS-CoV-2 among refugee women admitted for delivery relative to non-refugee parturient patients. We suspect the burden of infection is disproportionately distributed across refugee communities which may act as sentinels for community outbreaks. Study Design A cross-sectional study was performed examining parturient women admitted to the maternity unit between May 6 and July 22, 2020, when universal testing for SARS-CoV-2 was first employed. Risk factors for SARS-CoV-2 positivity were ascertained, disaggregated by refugee status, and other clinical and socio-demographic variables examined. Prevalence ratios (PR) were calculated and comparisons made to county level community prevalence over the same time period. Results The percent positive at the County level during this study period was 21.6%. Of 350 women admitted for delivery, 33 (9.4%) screened positive for SARS-CoV-2. When disaggregated by refugee status, 45 (12.8%) were refugees, of whom 8 (17.8%) tested positive, compared to 25 (8.19%) non-refugee patients testing positive, PR 2.16 (95%CI 1.04-4.51). Seven of the SARS-CoV-2 positive tests were among refugees from Central Africa. Conclusion The SARS-CoV-2 outbreak has disproportionately affected refugee populations. This study highlights the utility of universal screening in mounting a rapid response to an evolving pandemic and how we can better serve the refugee community. Focused response may help achieve more equitable care related to SARS-CoV-2 among vulnerable communities. Identification of such populations may help mitigate spread and facilitate a timely, culturally and linguistically enhanced public health response.