A Study of Short Term Outcomes among Covid-19 Patients Discharged without Follow up In the New York Metropolitan Area

Background: A shortage of beds, high case volume, decreased availability of outpatient medical doctors, and limited disease knowledge resulted in the premature discharge and poor follow up of COVID-19 patients in the New York Metropolitan Area. Objective: The primary objective of this retrospective study and phone survey was to characterize the demographics and clinical outcomes (e.g., readmission rates, comorbidities, mortality, and functional status) of COVID-19 patients discharged without follow-up. The secondary objective was to assess the impact of race and comorbidities on readmission rates and the extent to which patients were escalated to another care provider. Methods: Electronic medical records were reviewed for COVID-19 patients discharged from 3 NYMA hospitals in March 2020. Follow up data regarding medical status, ability to perform activities of daily living and functional status was also obtained from patients via phone call. The Chi-square, Fishers exact test and t-tests were used to analyze the data. Results: 349 patients were included in the analysis. The hospital readmission rate was 10.6% (58.8% for pulmonary reasons) and did not differ by race. 74.3% of readmissions were <14 days after release. The post-discharge mortality rate was 2.6%. Hypertension was the most common comorbidity (43%). There was a statistically significant association between mortality and number of comorbidities (p=<0.0001). 82% of patients were contacted by phone. 66.6% of patients returned to pre-COVID baseline function in ≥1 month. As a result of information obtained on the follow up phone call, 4.2% of patients required “escalation” to another provider. Conclusion: Discharging COVID-19 patients without prearranged follow up was associated with high readmission and mortality rates. While the majority of patients recovered, prolonged weakness, lengthy recovery, and the need for additional medical intervention was noted. Further work to assess the effectiveness COVID-19 post-discharge programs is warranted.

The emergence, surge and subsequent wave of the SARS-CoV-2 pandemic in New York metropolitan area: The view from a major region-wide urgent care provider.

Background: Describing SARS-CoV-2 testing and positivity trends among urgent care users is crucial for understanding the trajectory of the pandemic. Objective: To describe demographic and clinical characteristics, positivity rates, and repeat testing patterns among patients tested for SARS-CoV-2 at CityMD, an urgent care provider in the New York City metropolitan area. Design: Retrospective study of all persons testing for SARS-CoV-2 between March 1, 2020 and January 8, 2021 at 115 CityMD locations in the New York metropolitan area. Patients: Individuals receiving a SARS-CoV-2 diagnostic or serologic test. Measurements: Test and individual level SARS-CoV-2 positivity by PCR, rapid antigen, or serologic tests. Results: During the study period, 3.4 million COVID tests were performed on 1.8 million individuals. In New York City, CityMD diagnosed 268,298 individuals, including 17% of all reported cases. Testing levels were higher among 20-29 year olds, non-Hispanic Whites, and females compared with other groups. About 24.8% (n=464,902) were repeat testers. Test positivity was higher in non-Hispanic Black (6.4%), Hispanic (8.0%), and Native American (8.0%) patients compared to non-Hispanic White (5.4%) patients. Overall seropositivity was estimated to be 21.7% (95% Confidence Interval [CI]: 21.6-21.8) and was highest among 10-14 year olds (27.3%). Seropositivity was also high among non-Hispanic Black (24.5%) and Hispanic (30.6%) testers, and residents of the Bronx (31.3%) and Queens (30.5%). Using PCR as the gold standard, SARS-CoV-2 rapid tests had a false positive rate of 5.4% (95%CI 5.3-5.5). Conclusion: Urgent care centers can provide broad access to critical evaluation, diagnostic testing and treatment of a substantial number of ambulatory patients during pandemics, especially in population-dense, urban epicenters.

A tale of two pandemics: evolutionary psychology, urbanism, and the biology of disease spread deepen sociopolitical divides in the U.S.

The COVID-19 pandemic has spread uncertainty and social disruption, and exacerbated political divides in the United States. Most studies of the drivers of the epidemic focus on victim characteristics without consideration of drivers in the general population. This study presents statistical models that track the underlying factors in the general population associated with the spread of the pandemic and addresses how social learning mechanisms have led people to adopt perspectives and behaviors depending on their social context. Despite many social, physiological and economic factors, the statistical drivers of the pandemic primarily relate to the presence of vectors and the probability of transmission. However, the relationship between these drivers and COVID-19 deaths is weak and variable outside of the New York metropolitan area. Furthermore, the per capita death rate in much of the country has been much lower than the New York metropolitan area. There have been two very different experiences with the pandemic, one where the signals of its danger have been obvious from the start and one where the signals have been much weaker. Social learning mechanisms (in-group information sharing, imitation, costly punishment) have amplified the effect of people’s experiences with the pandemic. Sheltering in cities and protesting shutdowns in rural areas probably were initially adaptive somatic efforts in the evolutionary sense, given the different realities of the pandemic versus its economic costs in urban versus rural environments. These adaptations, however, have deepened the political divides in an already Balkanized country. The paper concludes with practical recommendations for how to use social learning theory for disseminating information on how to combat the pandemic.

“This Guy Does Not Look Latin”

This chapter covers the overlooked legacy of the Panamanian musical community of Brooklyn and the greater New York metropolitan area. It explores how Panamanian musicians positioned themselves and were positioned both musically and socially by their Latino and non-Latino colleagues in New York. As Latinos of Black West Indian descent, the New York Panamanians encountered racism among both Latinos and African Americans, but worked with these groups of musicians and others in a variety of settings. The chapter presents numerous Panamanian musicians who successfully negotiated classical, jazz, Broadway, Caribbean, and Latin music scenes (often simultaneously) and created a considerable body of work that has not been previously analyzed or contextualized. Ultimately, the chapter demonstrates a number of the themes discussed in the introduction, including engagement with jazz, musical biculturalism, inter-ethnic collaboration, emphasis on music education, and family lineages of musicians.