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Venous Thromboembolism Management in Patients With COVID-19

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The severe systemic inflammatory processes and hypercoagulability occurring with COVID-19 illness increase the risk for atherosclerotic plaque disruption and acute myocardial infarction (AMI). Patients with a previous history of coronary disease and/or other significant comorbidities are particularly predisposed to cardiovascular complications with COVID-19 infection.1 In this installment, we will discuss a patient with COVID-19 and venous thromboembolism.

Case Presentation

A 61-year-old woman presents to a rural emergency department with complaints of progressively worsening dyspnea over the past 24 hours and pleuritic chest pain. On initial presentation, the patient is hypoxic with an oxygen saturation of 92% on 5 L/min supplemental oxygen via nasal cannula and exhibits sinus tachycardia (130-140 beats per minute).

The patient’s COVID-19 polymerase chain reaction (PCR) test is positive. Blood work reveals D-dimer is 3 times higher than normal (<0.4 mcg/mL), initial troponin within normal limits (0-0.1 ng/mL), hemoglobin 10.7 g/dL, hematocrit 33.1%, and platelet count 172 ×10/µL.


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A massive saddle pulmonary emboli (PE) is present on spiral computed tomography (CT) arteriography with intravenous contrast of the pulmonary arteries. Echocardiogram demonstrates acute cor pulmonale with a right ventricular (RV) to left ventricular (LV) diameter ratio of 1.4. Venous ultrasound reveals a nonocclusive popliteal venous thromboembolism.

The patient is given full-dose enoxaparin and is transferred to an acute care cardiac specialty hospital for further treatment. Upon arrival at the specialty hospital, she is taken to the catheterization laboratory where a right and left pulmonary angiogram is performed with thrombectomy of the right and left pulmonary arteries.

Significant Medical History

The patient’s medical history includes type 2 diabetes mellitus, hypertension, dyslipidemia, hypothyroidism, and a 60-pack/year history of smoking.

Physical Examination

The patient is a middle-aged woman with obesity who is in acute respiratory distress. She has labored breathing and is tachypneic, with a respiratory rate in the mid-30s. Lung examination reveals mild expiratory wheezing bilaterally; a cardiac summation gallop is noted.

Electrocardiography (ECG) monitoring may indicate findings of cor pulmonale (right-sided heart failure) identified by a new incomplete or complete right bundle branch block, right axis deviation, or right ventricular ischemia with ST-segment depression in right pericardial leads. Monitoring with ECG also helps with evaluating for atrial arrhythmias such as atrial fibrillation commonly seen with PE.1

Spiral CT arteriography of the chest with contrast is ordered to rule out pulmonary embolus, which can be a contributing factor to respiratory symptoms, elevation in biomarkers, and a sequela of COVID-19 infection.3

Ultrasound of the lower extremities (bilaterally) is used to rule out deep vein thrombosis (DVT) in the lower extremities.

Diagnosis

The gold standard for confirmation of a PE is a spiral CT with arteriography. In this case, the test confirmed the presence of a massive saddle pulmonary embolus. Minimally invasive intervention is indicated if the patient is found to have right ventricular strain on echocardiogram (Table 1).

Coagulation: elevation in PT/INR, D-dimer, platelet count, fibrinogen
Cardiac biomarkers: troponin
Factor V Leiden mutation
Prothrombin gene mutation
Anticardiolipin antibodies (including lupus anticoagulant)
Hyperhomocysteinemia (usually due to folate deficiency)1,2
PT/INR, prothrombin time/international normalized radio

Radionuclide lung scan, commonly known as ventilation-perfusion (VQ) scan, may serve as a diagnostic tool for inpatients who have elevation in renal indices and are not able to undergo contrast studies. A VQ scan with a high clinical suspicion confirms the diagnosis of PE in 40% of cases.1

Echocardiogram is a useful tool for performing risk stratification. The presence of right ventricular wall akinesis or hypokinesis with sparing of the apex has a high specificity for acute PE. Also, in cases of PE, the ratio of the right ventricular end-diastolic area (RVEDA) to left ventricular end-diastolic area (LVEDA) exceeds the upper limit of normal, which is 0.6 mm.1

This article originally appeared on Clinical Advisor

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Source: https://www.medicalbag.com/home/medicine/venous-thromboembolism-management-patients-with-covid19/

Covid19

Adolescents Can Get Routine Immunizations With Their COVID Shots, CDC Advisers Say

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A 16-year-old gets a Pfizer-BioNTech COVID-19 vaccine in Anaheim, Calif., on April 28. Advisers to the Centers for Disease Control and Prevention now say it’s not necessary for adolescents to wait two weeks after a COVID shot to receive routine immunizations. Paul Bersebach/MediaNews Group via Getty Images hide caption

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Paul Bersebach/MediaNews Group via Getty Images

Children’s immunizations dropped dramatically during the pandemic, and health officials are eager to get kids caught back up on their routine shots before they return to school.

On Wednesday, the Centers for Disease Control and Prevention recommended that the Pfizer COVID-19 vaccine be given to children ages 12 to 15, opening vaccination to approximately 17 million adolescents. And a CDC advisory committee said health workers can decide to give other needed vaccines, such as for measles and HPV, without waiting two weeks after the COVID shot has been administered.

The American Academy of Pediatrics made a similar recommendation. “Given the importance of routine vaccination and the need for rapid uptake of COVID-19 vaccines, the AAP supports coadministration of routine childhood and adolescent immunizations with COVID-19 vaccines,” the academy said.

Dr. José Romero, a pediatrician who chairs the CDC immunization advisory committee and is the Arkansas secretary of health, said, “A lot of our not just adolescents, but children in particular, are behind on their immunizations because of the COVID pandemic.”

“They weren’t going to regular checkups and regular visits with their doctors,” he said in an interview Thursday with NPR’s Morning Edition. “So to take advantage of a visit with a physician to administer all vaccines that are necessary at that time is highly advantageous.”

A Kaiser Permanente study published in the journal Pediatrics found that “the number of recommended vaccine doses and measles-containing vaccine doses administered to children decreased dramatically” shortly after the national coronavirus state of emergency was declared in March 2020. “While this decrease was modest and recovered rapidly in children [less than 2 years old], it was more severe and persistent in older children.”

The researchers found that the decline in vaccinations resulted from the “markedly decreased number of visits” to doctors’ offices during the pandemic. Comparing January-August 2020 to the same period in 2019, the researchers found that “well visits” dropped more than 35% and other in-person visits fell nearly 72%.

In the NPR interview, Romero called the move to vaccinate adolescents for COVID-19 “a big, big step forward in achieving large-scale immunity here in this country.”

Below are highlights of the interview, edited for length and clarity.

I heard you hesitate to use the word herd immunity.

Right. As you know, it appears that that goal has been modified. And what we’re looking for now is achieving a certain amount of individuals that have received at least one dose. I think that that’s reasonable at this point and that we need to move forward with reasonable expectations.

On whether state health departments should require kids to get the COVID vaccine as a condition of going to school

The requirement for a vaccine depends on the prevalence of the disease and the severity of disease. Now, if we can bring this under control with routine parental consent to give this vaccine and not mandate it, I think it’s possible to do it that way. But we’ll have to see how it goes forward.

On how to overcome hesitancy about the COVID vaccine and convince parents that it’s safe for their kids

It will take education. And we have programs getting ready and gearing up to do this, to have public messaging of this. Really, the most important people here are the pediatricians, the family practitioners. Those individuals that have a relationship with the parent, the parents trust them. And a recommendation for the use of the vaccine goes a long way.

On concerns over long-term side effects of the COVID vaccine for adolescents

I am not that concerned. Certainly we know that the bridging studies indicate that these vaccines act very similarly or better than adults. I don’t think that there’s going to be a sudden untoward effect that’s discovered. We’re going to watch this very closely. As you know, this country has very, very good vaccine safety measures in place. The measures that have caught the allergic reactions and the clotting reactions in adults worked very, very well.

Taylor Haney and Fernando Pizarro produced and edited the audio version of this story. Avie Schneider produced for the web.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/05/13/996528695/adolescents-can-get-routine-immunizations-with-their-covid-shots-cdc-advisers-sa

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KFF COVID-19 Vaccine Monitor: COVID-19 Vaccine Access, Information, and Experiences Among Hispanic Adults in the U.S.

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The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.

Key Findings

  • The latest KFF COVID-19 Vaccine Monitor report highlights the disproportionate toll the pandemic has taken on Hispanic adults in the United States. Hispanic adults, particularly those who mainly speak Spanish, were born outside the U.S., or who have lower incomes, are more likely than White adults to say someone close to them has gotten sick from COVID-19 or that they worry about someone in their family getting sick and more likely to say the pandemic has negatively affected their financial situation. At a time when many are facing growing financial needs, one in ten (11%) Hispanic adults, rising to one-quarter (26%) of those who are potentially undocumented, say there was a time in the past 3 years when they or a family member decided not to apply for or stopped participating in a government assistance program that helps with food, housing, or health care because they were afraid it might negatively affect their or a family member’s immigration status.
  • Among those who have not yet been vaccinated, Hispanic adults are about twice as likely as White adults to say they want to get a COVID-19 vaccine as soon as possible, indicating an opportunity for more focused outreach and information efforts. While nearly half (47%) of Hispanic adults report having received at least one dose of a COVID-19 vaccine, one-third of unvaccinated Hispanic adults say they want a vaccine as soon as possible, about twice the share as among unvaccinated Black and White adults. By contrast, unvaccinated Hispanic adults are half as likely as unvaccinated White adults to say they will “definitely not” get the vaccine (17% vs. 34%).
  • Large shares of Hispanic adults – particularly those with lower incomes, the uninsured, and those who are potentially undocumented – express concerns that reflect access-related barriers to vaccination. Compared to White adults, larger shares of unvaccinated Hispanic adults say they are concerned about missing work due to vaccine side effects, that they might have to pay out of pocket for the vaccine (despite it being free), not being able to get the vaccine from a trusted place, or having difficulty traveling to a vaccination site. Among Hispanic adults, the shares expressing many of these concerns are even greater among those with lower incomes, the uninsured, and those who are potentially undocumented.
  • Requests for documentation may pose a barrier to vaccination for some Hispanic adults, particularly those who live in immigrant families. Over half of Hispanic adults (56%) who have been vaccinated say they were asked to provide a government-issued identification when they received their vaccine and 15% say they were asked to provide a Social Security number. While eligibility to receive a COVID-19 vaccine in the U.S. is not linked to immigration status, requests for these types of information or documents may be a deterrent for some Hispanic adults, particularly those in immigrant families. In fact, about four in ten unvaccinated Hispanic adults (rising to 58% of those who are potentially undocumented) say they are concerned that they may be required to provide a government-issued identification or Social Security number to get vaccinated, and about one third (rising to 63% of the potentially undocumented) are concerned that getting the vaccine may negatively affect their own or a family member’s immigration status.
  • There are gaps in information about who is eligible for the vaccine and how to get it among the Hispanic population. Large shares of unvaccinated Hispanic adults, particularly those who are potentially undocumented, are unsure if they are eligible to get a vaccine or say they don’t have enough information about when or where to get one. At least half are unaware that the vaccines are free for all U.S. residents and that all adults are eligible regardless of immigration status.
  • Making COVID-19 vaccines available in more convenient locations, providing paid time off to recover from side efforts, or requiring vaccination for travel may be more effective at encouraging vaccine uptake among Hispanic adults compared to others. Almost half of unvaccinated Hispanic adults who are not yet ready to get the vaccine right away say they’d be more likely to get vaccinated if the vaccine was offered at a place they normally go for care, and four in ten of those with jobs say they’d be more likely to get it if their employer arranged for it to be delivered at their workplace, both higher than the shares of White adults who say the same. Over half of employed, unvaccinated Hispanic adults who are not yet ready to get the vaccine say they’d be more inclined to get it if their employer gave them paid time off to get vaccinated and recover from side effects. Requiring the vaccine for airline or international travel may be particularly effective at encouraging foreign-born Hispanics the vaccine, with about six in ten saying such requirements would make them more likely to get vaccinated.

Introduction

The COVID-19 pandemic has taken a stark disproportionate toll on people of color, including the Hispanic population. Hispanic people have faced increased risk of exposure to the virus as many are employed in essential jobs that cannot be done from home and live in larger, multigenerational households. Reflecting these increased risks, Hispanic people have suffered higher rates of COVID-19 infection, hospitalization, and death compared to their White counterparts. Despite being harder hit by the pandemic, Hispanic people have been less likely than White people to receive a COVID-19 vaccine so far. These disparate impacts of the COVID-19 pandemic have exposed and exacerbated longstanding underlying disparities in health and health care facing Hispanic people. Prior to the pandemic, these disparities had already been compounded by immigration policies implemented during the Trump administration that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and health care. Although the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families.

This report from the KFF COVID-19 Vaccine Monitor is based on interviews with 778 Hispanic adults in the U.S., including 334 conducted in Spanish and 408 with adults born outside the U.S., including 185 who indicated that they do not have lawful permanent resident status (referred to in this report as “potentially undocumented”). It provides insights into how Hispanic adults have been affected by the COVID-19 pandemic and their access, information, and experiences with COVID-19 vaccinations. Moreover, it illustrates the varied experiences within the Hispanic population, including describing the experiences of Hispanic immigrants, for whom data remain limited. Throughout this report, Hispanic adults include people of any race, other groups (i.e., White and Black adults) are non-Hispanic.

COVID-19 Impacts on Hispanic Adults in the U.S.

The survey findings reveal that Hispanic adults have substantial fears about getting sick from coronavirus, and that many have close connections to people who have gotten sick or died from COVID-19. They also highlight the widespread negative financial impacts of the pandemic for Hispanic adults. In addition, they provide insight into how immigration-related fears may be affecting Hispanic adults’ willingness to participate in assistance programs for food, housing, and health care, at a time when many have growing needs due to the financial impacts of the pandemic.

About two-thirds of Hispanic adults say they are worried that they or someone in their family will get sick from coronavirus, including 41% who say they are very worried. The share saying they are very worried is higher among Hispanic adults than among Black adults (30%) and is four times the rate among White adults (10%). Worries about getting sick from coronavirus are even more prevalent among Hispanic immigrants, particularly those without permanent resident status. Seven in ten (69%) of potentially undocumented Hispanic adults say they are very worried about themselves or a family member getting sick from COVID-19 as are over half (57%) of foreign-born Hispanic adults with permanent resident status. Among U.S.-born Hispanic adults (who are much younger on average than their foreign-born counterparts), one quarter (24%) express this level of worry. There also are stark differences in levels of concern among Hispanic adults by language spoken and household income, with nearly three in four (73%) of Hispanic adults who completed the survey in Spanish and over half (53%) of those in lower income households reporting being very worried about getting sick.

This higher level of worry is not unfounded, as Hispanic adults are more likely than White adults to report close connections to someone who has gotten sick or died from coronavirus. Nearly three in ten (28%) of Hispanic adults say they or someone in their household has tested positive for coronavirus, higher than the shares of Black (21%) and White adults (18%). This share rises among Hispanic adults born outside the United States, including 40% of the potentially undocumented. About four in ten (38%) Hispanic adults say a close friend or family member has died from coronavirus, similar to the 34% among Black adults and higher than the 18% among White adults. There were no major differences in the likelihood of having a close friend or family member die by immigration status.

The pandemic has also taken a disproportionate financial toll on Hispanic families in the United States. About half (48%) of Hispanic adults say the pandemic has had a negative effect on their personal financial situation, higher than the share of White adults who say the same (36%). Among those with lower household incomes (under $40,000 per year), 56% of Hispanic adults say their financial status has been negatively affected by the pandemic, higher than the shares among lower-income Black or White adults (42% each). There were no major differences in the likelihood of reporting negative financial effects by immigration status. However, a 55% majority of Hispanic adults who completed the survey in Spanish say their financial situation has been negatively impacted by the pandemic, higher than the four in ten (43%) of English-speaking Hispanic adults who report being negatively affected.

Some Hispanic adults, particularly those who are potentially undocumented, report that they have avoided seeking assistance for food, housing, and/or health care due to immigration-related fears. The Trump administration implemented a range of immigration policy changes, including changes to public charge policy, that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and care. While the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families at a time when many are facing growing needs due to the pandemic.

Overall, one in ten Hispanic adults (11%), say there was a time in the past 3 years when they or a family member decided not to apply for or stopped participating in a government assistance program because they were afraid it might negatively affect their or a family member’s immigration status. Across Hispanic adults overall, 6 percent say they did not apply for or stopped participating a program to help with food, 4 percent say assistance for housing, and 3 percent say a health care program.

The share saying they or a family member did not apply for or stopped participating in a program in the past 3 years due to immigration-related fears increased rises to 26% among potentially undocumented Hispanic adults. Among potentially undocumented Hispanic adults, 21% say they did not apply for or stopped participating a program to help their family with food, 12 percent say assistance for housing, and 11 percent say a health care program. While undocumented immigrants generally are not eligible for any federally-funded assistance, many live in mixed immigration status families, including other family members such as U.S.-born citizen children, who may qualify for assistance.

COVID-19 Vaccination Intentions Among Hispanic Adults

Nearly half (47%) of Hispanic adults say they have already received at least one dose of a COVID-19 vaccine and another 17% say they intend to get one as soon as they can. The share of Hispanic adults who say they’ve received at least one dose of the vaccine is lower than the share among White adults (60%), while a larger share of Hispanic adults compared to White adults say they will “wait and see” how the vaccine is working for other people before getting vaccinated themselves (18% vs. 13%). Nearly one in five (17%) Hispanic adults report that they have not yet been vaccinated but want to get one as soon as possible, higher than the shares among White adults (6%) and Black adults (9%).

Among those who have not yet been vaccinated, Hispanic adults are twice as likely as White adults to say they want to get a COVID-19 vaccine as soon as they can, making them a key target for outreach and information. Looking just at those adults who have not yet received a COVID-19 vaccine, one-third of Hispanic adults say they want to get one as soon as they can compared to 16% of White adults and 17% of Black adults. By contrast, larger shares of unvaccinated White and Black adults compared to Hispanic adults say they will definitely not get a COVID-19 vaccine (34%, 26%, and 17%, respectively).

Some groups of Hispanic adults are more likely to say they have not yet gotten the vaccine but want to get one as soon as possible, suggesting they are particularly likely to face access barriers to getting the vaccine. For example, three in ten (31%) of potentially undocumented Hispanic adults report having gotten a COVID-19 vaccine, and nearly four in ten (37%) want one as soon as possible but haven’t yet gotten one. This finding is similar for uninsured nonelderly Hispanic adults, with about three in ten (29%) of this group reporting receiving the vaccine and another 30% wanting one as soon as possible. Adults who completed the survey in Spanish are also more likely than English speaking adults to say they want a vaccine as soon as possible, but this largely reflects a higher share of English-speaking Hispanic adults saying that they do not plan to get the vaccine.

Among Hispanic adults, divides in COVID-19 vaccination intention by age, education, and partisanship mirror those seen in the general population. Large majorities of Hispanic adults ages 50 and over say they’ve already gotten at least one dose of the vaccine or will do so as soon as possible (85% of those ages 50-64 and 88% of those ages 65 and over). By contrast, larger shares of younger Hispanic adults say they want to wait and see how the vaccine is working (20% of those ages 30-49 and 31% of those ages 18-29). Similarly, Hispanic adults who identify as Democrats or lean that way are much more likely than those who identify or lean Republican to say they have either gotten a vaccine or will do so as soon as they can, while Republicans are more likely to say they will definitely not get vaccinated. Hispanic adults with a college degree are more likely than those with lower levels of education to say they’ve already gotten a COVID-19 vaccine (61% vs. 45%), while those who are not college graduates are more likely to say they have not been vaccinated but want to do so as soon as possible (18% vs. 10%), suggesting possible access barriers for this less-educated group, similar to the groups mentioned above.

Hispanic Adults’ Experiences Getting a COVID-19 Vaccine

Among those who report receiving a COVID-19 vaccine, Hispanic adults are more likely than White and Black adults to report getting their vaccine through a community health clinic. The most common place people report receiving a COVID-19 vaccine across race and ethnicity groups is a large vaccination site. At least one-third of those who have received at least one dose of a vaccine reporting receiving it there (35% of vaccinated Hispanic adults, 37% of Black adults, and 35% of White adults). Consistent with other analysis showing community health centers are vaccinating larger shares of people of color, particularly Hispanic people, over one in five (22%) vaccinated Hispanic adults reported getting their vaccine at a community health clinic, twice the share of White (11%) and Black (10%) vaccinated adults who report the same. Among Hispanic adults, 30% of those who completed the interview in Spanish say they got vaccinated at a community health clinic compared to 17% of those who completed the interview in English. There were no significant differences in the share of Hispanic adults getting vaccinated at a community health clinic by immigration status or income.

Hispanic adults are less likely than White adults to report signing up for a vaccine appointment online. Among those who have gotten a vaccine or have tried to get an appointment, about half of Hispanic adults (48%) either signed up or tried to do so online compared to nearly six in ten White adults (58%). A quarter (25%) of Hispanic adults say they signed up or tried to sign up by phone, and another 16% scheduled or sought to schedule an appointment in person.

Many Hispanic adults report being asked for certain types of information or documentation when they signed up for or received a vaccine that may pose barriers to getting the vaccine for some. The COVID-19 vaccines are available for free regardless of insurance status. Some vaccine providers request health insurance information from people receiving the vaccine in order to bill for the cost of administering the vaccine, which may lead some people to be confused about whether uninsured people can get the vaccine or if they have to pay to receive one. The federal government has also clarified that vaccines are available to individuals regardless of immigration status. Despite this, requests for information and/or documentation to provide proof of identity or residency may vary across states, localities, and vaccination providers. For example, in some cases, individuals are being requested to provide government-issued identification or a Social Security number, while others provide a range of options to prove identity or residency, including self-attestation, and specify that a Social Security number is not required.

Among all Hispanic adults who made or attempted to make an appointment to receive a vaccine, about a third (32%) report being asked to provide health insurance information when making an appointment. Four in ten (42%) say they were asked to provide a government-issued identification and 14% say they were asked to provide a Social Security number. Among those who have been vaccinated for COVID-19, over half (56%) say they were asked for their ID at the vaccination site, 23% were asked for insurance information and 15% report being asked to provide a Social Security number.

Potential Barriers To COVID-19 Vaccination Among Hispanic Adults

Hispanic adults who have not yet been vaccinated for COVID-19 are more likely than White adults to express concerns that reflect access-related barriers to vaccination. Although potential side effects and vaccine safety are the top-ranked concerns among Hispanic adults who have not yet been vaccinated for COVID-19, many also report concerns related to potential challenges getting the vaccine. Among unvaccinated Hispanic adults, nearly two-thirds (64%) are concerned about missing work due to side effects, over half (52%) are worried they might have to pay out of pocket for the vaccine, and nearly half are concerned they won’t be able to get the vaccine from a place they trust (49%), shares that are significantly larger than their White counterparts.

Notably, among Hispanic adults who say they have not yet been vaccinated but want to do so right away, six in ten are concerned that they won’t be able to get the vaccine from a place they trust (61%) or that they might have to pay an out-of-pocket cost to get the vaccine (59%) and half (52%) are concerned about missing work due to vaccine side effects, highlighting that access remains a barrier even for those in the most eager group.

Because the Hispanic population includes higher shares of noncitizens compared to other groups, immigration-related concerns may also particularly affect this population. Four in ten unvaccinated Hispanic adults (39%) are concerned they might be required to provide a Social Security number or government-issued identification in order to get vaccinated, and just over a third (35%) are concerned that by getting the COVID-19 vaccine they might negatively affect their own or a family member’s immigration status.

Among unvaccinated Hispanic adults, those who are potentially undocumented, those without health insurance, and those with lower household incomes are more likely to express potential access-related barriers or immigration-related concerns to vaccination. The top access-related concern across these groups is that they might have to miss work due to side effects. Not surprisingly, potentially undocumented Hispanic adults are particularly concerned they may need to provide a Social Security number or government issued ID to get the vaccine (58%), and nearly two thirds (63%) are concerned getting the vaccine might negatively affect their or a family member’s immigration status.

In addition, unvaccinated Hispanic adults who are uninsured are more likely than those who have health insurance to say they are concerned about not being able to get the vaccine from a place they trust, being required to provide a Social Security number or government-issued ID, or negatively impacting their own or a family member’s immigration status.

Compared to their higher-income counterparts, unvaccinated Hispanic adults with incomes under $40,000 a year are more likely to say they are concerned about missing work due to COVID-19 vaccine side effects, having to pay an out-of-pocket cost to get vaccinated, negatively affecting someone’s immigration status, and having difficulty traveling to a vaccination site.

Strategies that address access-related concerns may be particularly effective for increasing enthusiasm to get the COVID-19 vaccine among Hispanic adults. For example, nearly half of Hispanic adults who have not gotten the vaccine and are not ready to get it right away (46%, rising to 64% among those born outside the U.S.) say they’d be more likely to get a COVID-19 vaccine if it was offered to them at a place they normally go to health care, compared to 23% of White adults. Four in ten Hispanic adults in this group (39%, rising to 49% of foreign-born) would be more likely to get vaccinated if they only needed to get one dose compared to a quarter (25%) of White adults. Over half (54%) of employed Hispanic adults who are not yet ready to get the vaccine say they would be more likely to get it if their employer gave them paid time off to recover from side effects compared to 19% of employed White adults. In addition, four in ten (38%) employed Hispanic adults in this group say they would be more likely to get vaccinated if their employer arranged for a medical provider to administer the vaccine at their workplace, compared to 14% of their White counterparts.

Certain financial and travel-related incentives may also be particularly effective in increasing vaccine enthusiasm among Hispanic adults, especially those born outside the United States. Over four in ten (41%) of Hispanic adults (including 63% of those born outside the US) who are not yet ready to get the vaccine say they’d be more likely to get vaccinated if it was required for international travel compared to 17% of White adults. There are also differences in responses to employer incentives to get vaccinated. Nearly four in ten (38%) of employed Hispanic adults who are not yet ready to get the vaccine said they would be more likely to get it if their employer offered them a $200 incentive to get vaccinated, versus 22% of their White counterparts.

COVID-19 Vaccine Information Gaps and Needs

Increased outreach and education about how, where, and when to the vaccine may also facilitate increased vaccinations among the Hispanic population. Increasing awareness that the vaccine is free regardless of insurance status and available to all individuals regardless of immigration status may also encourage vaccination among those concerned about costs or potential negative immigration-related consequences.

Larger shares of Hispanic adults compared to White adults report lacking information about when and how to the get the vaccine, with particularly large information gaps among those who are foreign-born, who are Spanish-speakers, and who have lower incomes. Despite broadened eligibility for vaccines across states, 42% of unvaccinated Hispanic adults (compared to 26% of unvaccinated White adults) say they are unsure if they are eligible to receive the vaccine in their state, with this share rising to 57% among the potentially undocumented, 49% among Spanish speakers, and 47% with household incomes below $40,000. Similarly, 29% of Hispanic adults overall say they don’t have enough information about where to get a vaccine, including higher shares of potentially undocumented (43%) and Spanish-speaking (38%) Hispanic adults. Nearly half of all unvaccinated Hispanic adults (45%) say they lack information about when they can get a vaccine, and this share rises to more than half among those who are potentially undocumented (58%), those who completed the interview in Spanish (56%), and those with household incomes under $40,000 a year (54%).

Most Hispanic adults who completed the survey interview in Spanish (68%) say it is either “very easy” or “somewhat easy” to find COVID-19 vaccine information in Spanish, but 27% say it is at least “somewhat difficult.” Similarly, most Spanish speakers say they were able to access information or communicate in their preferred language when making their vaccine appointment (68%) and when getting their vaccine (77%), but some say they were not able to communicate in their preferred language when making an appointment (26%) or getting the vaccine (22%).

There are gaps in knowledge that the vaccine is available for free among unvaccinated Hispanic adults. Roughly half (46%) of unvaccinated Hispanic adults know that the vaccine is available for free even for those without health insurance while 9% believe this is not the case and four in ten (43%) are not sure. More than half (54%) of unvaccinated Hispanic women know that vaccines are available for free while four in ten (39%) of Hispanic men are also aware of this. Knowledge that the vaccine is available for free is higher among unvaccinated Hispanics who completed the survey in Spanish (60%) versus those who completed it in English (37%). Among Hispanic adults ages 18-64 who have not yet gotten vaccinated, similar shares of those with and without health insurance are aware that the vaccine is available regardless of health insurance status (47% and 44%, respectively).

There also are gaps in knowledge about the vaccine being available to all people regardless of immigration status among unvaccinated Hispanic adults. The federal government has clarified that all people are eligible to receive the COVID-19 vaccine regardless of immigration status. Four in ten unvaccinated Hispanic adults (42%) are aware that all adults living in the U.S. are eligible to receive a vaccine regardless of their immigration status, larger than the share of unvaccinated Black adults (15%) and White adults (27%) who know this is true. Yet, 9% of Hispanic adults believe it is not the case that all adults are eligible to get the vaccine regardless of immigration status and nearly half (48%) are not sure. Among unvaccinated Hispanic adults, a larger share of those who completed the survey in Spanish know that the vaccine is available regardless of immigration status compared to those who completed the survey in English (55% vs. 33%). Hispanic adults who are potentially undocumented are somewhat more likely than those born in the U.S. to incorrectly say it is not true that U.S. residents are eligible to get the vaccine regardless of immigration status (14% vs. 5%), while those born in the U.S. are more likely to say they’re not sure (56% vs. 35%).

Implications

Together these findings suggest that addressing access barriers and providing information through outreach and education efforts will be key for closing ongoing racial disparities in COVID-19 vaccinations for Hispanic adults. They indicate that increasing access to paid time off to get and recover from any side effects from the vaccine and making vaccines easily accessible through trusted sites of care and workplaces may facilitate uptake of vaccinations among Hispanic adults. Moreover, they highlight continued needs for outreach and education efforts within the Hispanic community to communicate how and where to get the vaccine and to clarify that the vaccines are free regardless of insurance status, that they are available to all people regardless of immigration status, and that receiving a vaccine will not negatively affect an individual’s current or future immigration status. The findings also reinforce why prioritizing equity in COVID-19 vaccinations is key, given the disproportionate health and economic impacts of the pandemic for Hispanic families and other people of color.

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Source: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-access-information-experiences-hispanic-adults/

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Covid19

Vaccination Rates Are Relatively High for Older Adults, But Lag in Counties in the South, in Counties with Higher Poverty Rates and in Counties that Voted for Trump

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Older adults in the US have been disproportionately affected by the coronavirus pandemic, comprising the majority of COVID-19 hospitalizations and deaths. Since the authorization of COVID-19 vaccines beginning in December 2020, there has been significant progress vaccinating older adults, who were among the first groups prioritized for vaccines after health care workers and residents and staff in long-term care facilities. As of May 12, the Centers for Disease Control and Prevention (CDC) reported 84.0% of adults 65 and older have gotten at least their first dose and 71.9% have been fully vaccinated.

While there is evidence that vaccinations are already having a major impact on death rates and hospitalization rates for older adults, particularly for the long-term care population, vaccination equity issues still remain a problem and there are challenges reaching certain populations for vaccinations. Rates of fully vaccinated older adults vary across states, from 57.6% in Utah to 87.0% in Vermont (as of May 12, based on national CDC data), but these state-level metrics may mask even greater variation at the county level. County level analysis provides a more granular look at characteristics associated with variations in vaccination rates among older adults across the country.

This analysis examines variations in vaccination rates for older adults by county characteristics, based on data from the CDC as of May 11, 2021 that includes 77% of all counties (2,415) in the US. (See Data and Methods for additional details).

Key Takeaways

The average county COVID-19 vaccination rate weighted by population is 68.9% for adults ages 65 and older, but varies widely and is lower than average in counties:

  • With a higher share of seniors living in poverty (58.8%)
  • Ranking higher on the Social Vulnerability Index (60.1%)
  • Located in the South (60.7%)
  • With a higher share of adults who voted for Trump (63.3%) (Figure 1)

Findings

The average vaccination rate for adults 65 and older is 68.9% among counties reporting data, weighted by the population ages 65 and older (Figure 2).

Vaccination rates vary considerably across the 2,415 counties reporting data. At the high end (the top 10% of counties reporting data), at least 79.4% of adults 65 and older are fully vaccinated, and at the low end (the bottom 10% of counties), no more than 48.6% of older adults are fully vaccinated. However, rates are likely higher across all counties, including those in the top and bottom deciles, since vaccination rates continue to change rapidly.

Counties in the South have lower vaccination rates among older adults than counties in other regions, similar to findings from other KFF analysis that show vaccination rates overall are lower in Southern states (Figure 1; Table 1) The average vaccination rate for older adults in counties located in the South is 60.7%, lower than the average vaccination rate among older adults in counties in the Northeast (70.1%), Midwest (66.6%), and West (64.4%). Counties in the South represent a disproportionate share of counties with below-average vaccination rates: Southern counties comprise 34.0% of counties reporting data, but 42.9% of all counties with a vaccination rate below the weighted average of 68.9%. In contrast, Northeastern counties represent 8.4% of the overall counties reporting data, while only 5.4% of counties in this region have vaccination rates below the weighted average for older adults.

Vaccination rates among adults ages 65 and older are lower in counties where a relatively high share of adults 65 and older live in poverty compared to counties where a lower share of older adults live in poverty. Vaccination rates among adults 65 and older are more than 10 percentage points lower in counties where a higher share of people 65 and older live in poverty (58.8%) than in counties where a lower share of older adults live in poverty (69.0%).

Counties that rank high on the Social Vulnerability Index (SVI) show similar trends to counties with high shares of older adults living in poverty. This finding is not surprising given poverty is one of the 15 demographic measures used to calculate SVI, with other measures including race/ethnicity, disability, and lack of vehicle access. (SVI metrics are for the overall population of a county and are not just limited to adults 65 and older). Counties that rank high on the index (i.e., those with higher vulnerability) have a lower average vaccination rate for adults 65 and older than counties that rank lower on this index (60.1% vs 67.7%).

Consistent with the “wait and see” approach to vaccinations more common among Republican than Democratic voters, without regard to age, vaccination rates for older adults are lower in counties where a majority of voters voted for Donald Trump than in counties where a majority voted for Joe Biden in the 2020 election. In counties where Trump won the majority of votes, the average vaccination rate for adults 65 and older is more than 7 percentage points lower than in counties that voted for Biden (63.3% vs. 70.8%).

Discussion

While significant progress has been made in the last four months vaccinating older adults in the US against COVID-19, drilling down to the county level shows wide variation in the vaccination rate. These findings suggest there is more work to be done to increase vaccination rates for certain segments of the population, including older adults in Southern counties, in higher poverty areas, and in counties that voted for Trump. The fact that Southern counties lag in vaccinating older adults is consistent with higher poverty rates for older adults in the South than in other regions in the country. These results may also indicate that some older adults may face barriers that make it more difficult to access vaccinations, such as lack of transportation, lack of internet access, and health conditions that make traveling to vaccination sites difficult, among others. With 71.9% of older adults across all states in the US now fully vaccinated, this analysis nonetheless suggests that the push to vaccinate older adults is not yet over. Boosting vaccination rates among older adults – particularly among those living in high poverty areas and the South – may require additional and more targeted efforts to further remove barriers.

This analysis draws on data from multiple sources. Our main outcome of interest, vaccination rates by county, was collected from the Centers for Disease Control and Prevention’s (CDC) COVID-19 Integrated County View. The CDC data reports completed vaccination rates for total population and population over age 65. Data are not reported for Hawaii, New Mexico, Texas, and the smallest counties in Alaska and California. In addition, we exclude data for counties where less than 80% of vaccination records include county of residence, which eliminated data for Colorado, Georgia, Vermont, Virginia, and West Virginia. The analysis includes data for 2,415 counties, 77% of total counties (3,142) in the US.

The average population-weighted county vaccination rate for the total population is slightly lower than national estimates due to missing data from several states and counties as noted above.

We categorized states by region using the 2010 U.S. Census Bureau Region and Divisions classifications.

Data to categorize counties by demographic characteristics of residents is pulled from the Census Bureau’s 2019 American Community Survey 5-Year Estimates by county. We use ACS data to categorize counties by residents’ poverty. Specifically, we calculate the share of the county population that is age 65 and over in a family with income below poverty.

County Social Vulnerability Index (SVI) is from the CDC’s Agency for Toxic Substances and Disease Registry. SVI indicates a community’s vulnerability based on certain social conditions (i.e. socioeconomic status, household composition, language, etc.) that may affect the community in the event of a disaster.

The 2020 Presidential Election results were pulled from a GitHub repository that compiled data from media sources including The Guardian, townhall.com, Fox News, Politico, and the New York Times. Alaska is excluded from this component of the analysis as the only data available is at the district-level and cannot be cross-walked onto counties.

To classify counties, we translate continuous measures into categorical outcomes, using the group definitions below:

  • For continuous measures of poverty rate, SVI, and high-risk medical conditions, we classified counties below the 25th percentile of overall distribution of counties for each measure as “low,” counties above the 75th percentile as “high,” and all other counties as “medium.” For specific breaks for each variable, see Table 1.

Given ongoing concerns related to equitable access to the COVID-19 vaccine, assessing differences in vaccination rates by race/ethnicity at the county level would add to existing national and state level data. However, the results of our analysis do not have face validity when compared to data analyzed at the individual level showing that people with Hispanic ethnicity are vaccinated at lower rates than White people, leading us to conclude that there are confounding factors driving the results based on county-level racial and ethnic composition. Therefore, we do not include comparisons of vaccination rates based on county racial and ethnic composition.

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Source: https://www.kff.org/coronavirus-covid-19/issue-brief/vaccination-rates-are-relatively-high-for-older-adults-but-lag-in-counties-in-the-south-in-counties-with-higher-poverty-rates-and-in-counties-that-voted-for-trump/

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Covid19

Ohio Wants To Make 5 People Millionaires — If They’re Vaccinated

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In a bid to get more Ohioans vaccinated, Gov. Mike DeWine announced a $1 million lottery offer to adults who get at least one COVID-19 dose. Kids under 18 who get the vaccine will be entered into a lottery to get a scholarship. Phil Long/AP hide caption

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Phil Long/AP

Amid dropping vaccine demand in Ohio, Governor Mike DeWine announced five, weekly drawings of $1 million open to residents who’ve received at least one dose of a COVID-19 vaccine. A similar lottery for teenagers will provide the lucky names with a full, four-year scholarship to a public university in Ohio – room and board included.

“The number of Ohioans who get the vaccine will determine what our future looks like, particularly this coming winter,” DeWine said in a statewide address Wednesday. “Everyone has a stake in more Ohioans getting vaccinated.”

The first of the weekly drawings will be May 26. The money will come from existing federal Coronavirus Relief Funds.

“I know that some may say, ‘DeWine, you’re crazy! This million-dollar drawing idea of yours is a waste of money,'” DeWine said. “But truly, the real waste at this point in the pandemic — when the vaccine is readily available to anyone who wants it — is a life lost to COVID-19.”

Nearly 42% of Ohioans have received at least one dose of a COVID-19 vaccine, according to state data.

DeWine’s push to boost participation in the state’s immunization program is part of a trend among other states. In an effort to reach those who have yet to receive a first dose, officials in other states are offering free tickets to sports games or a free beer and a shot to entice vaccination.

Elsewhere in Ohio, DeWine said other businesses are running their own incentive program. He said the Cleveland Indians are offering discounts on tickets to games, as are the state’s minor league teams. The fast food restaurant, White Castle, is offering free butter cakes on a stick and Kroger, the grocery store chain, is giving employees $100 in cash.

Lottery details

The pool of names for the lottery drawing will be pulled from the Ohio Secretary of State’s publicly available voter registration database. There will also be a webpage created for people to sign up for the drawings if they are not in a voter registration database.

The Ohio Department of Health will be the sponsoring agency for the drawings, and the Ohio Lottery will conduct them. To be eligible to win, participants must be at least 18 or older on the day of the drawing, an Ohio resident, and must be vaccinated before the drawing.

An online portal will be created starting Tuesday for young participants to enter their names to win the scholarship

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/05/13/996445109/ohio-raises-the-stakes-to-boost-vaccinations-offers-5-1-million-drawings

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