Risk of coronavirus disease 2019 (COVID-19) acquisition among emergency department patients: A retrospective case control study

• Published in: Infection control and hospital epidemiology Vol. 42; no. 1; pp. 105 - 107
• Main Authors: Ridgway, Jessica P., Robicsek, Ari A.
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.01.2021
• Subjects: Case-Control Studies; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 - transmission; Disease transmission; Disease Transmission, Infectious - prevention & control; Disease Transmission, Infectious - statistics & numerical data; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Emergency Service, Hospital - trends; Ethnicity; Female; Hispanic people; Hospitals; Humans; Infection Control - organization & administration; Male; Middle Aged; Pandemics; Patients; Postal codes; Protective equipment; Research Brief; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Management - organization & administration; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - pathogenicity; Severe acute respiratory syndrome coronavirus 2; United States - epidemiology; United States; United States > US
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2020.1224

Comparison of Cases and Controls in Bivariate and Multivariate Analyses Characteristic Cases (N=102), Mean (SD) or No. (%) Controls (N=201), Mean (SD) or No. (%) P Value aOR in Multivariate Model (95% CI) Age, y (SD) 46.4 (22.7) 52.2 (21.1) .026 1.00 (0.99–1.02) Race/Ethnicity Black 4 (3.9) 10 (5.0) .0003 1.58 (0.40–6.28) Hispanic 40 (39.2) 37 (18.4) 7.04 (2.85–17.40) White 41 (40.2) 128 (63.7) Reference Other/Unknown 17 (16.7) 26 (12.9) 1.95 (0.82–4.63) Social Vulnerability Index, percentile (SD) 0.59 (0.25) 0.58 (0.27) .58 1.04 (0.31–3.50) Emergency Severity Index 2 8 (7.9) 33 (16.4) .006 Reference 3 62 (61.4) 130 (64.7) 2.25 (0.88–5.73) 4–5 32 (31.7) 38 (18.9) 3.36 (1.11–10.22) % COVID-19 test positivity in home ZIP code <2 24 (23.5) 46 (22.9) Reference 2–6 17 (16.7) 36 (17.9) 0.60 (0.20–1.79) 7–13 13 (12.7) 52 (25.9) 0.27 (0.08–0.86) 14–19 26 (25.5) 27 (13.4) 0.024 2.00 (0.60–6.69) >20 22 (21.6) 40 (19.9) 0.86 (0.23–3.05) No. patients with COVID-19 in ED in the 24 hours prior to arrival 0 19 (18.6) 47 (23.4) 0.41 Reference 1–5 50 (49.0) 83 (41.3) 2.49 (0.75–8.24) >5 33 (32.4) 71 (35.3) 0.83 (0.17–4.12) Minutes of ED colocation with COVID-19 patients 0.94 0 36 (35.3) 69 (34.3) Reference 1–500 46 (45.1) 89 (44.3) 1.08 (0.47–2.47) >500 20 (19.6) 43 (21.4) 1.32 (0.45–3.88) Note. SD, standard deviation; ED, emergency department; aOR, adjusted odds ratio; CI, confidence interval. Many EDs have implemented various strategies to limit SARS-CoV-2 transmission, including the use of personal protective equipment such as face masks and eye protection, cohorting patients with respiratory symptoms, social distancing, and limiting visitors.5–7 The EDs in this study may have implemented different infection control precautions at different times, and we did not seek to determine which strategies are most effective for reducing SARS-CoV-2 transmission. Since the start of the COVID-19 pandemic, ED patient volume has dropped 41.5%–63.5%.1 Although some of the reduction in ED volume may be explained by patients with nonemergency conditions avoiding EDs, evidence exists that patients with serious medical emergencies may also be foregoing ED care.2 Indeed, ED visits for serious, time-sensitive health conditions like cerebrovascular accidents and myocardial infarctions have significantly declined since the start of the COVID-19 pandemic.8,9 This decline in ED volume is likely in part due to fear of contracting COVID-19 in the ED.2 Our results suggest that this fear may be unfounded.