Low-income and racialized people face numerous social and health inequities posing daily challenges that are worsened during times of crises. Lessons learned from previous public health crises suggest that inappropriate communication strategies jeopardize risk reduction for these populations. Current pandemic responses fail to identify the needs and barriers of marginalized populations, including but not limited to a high prevalence of illiteracy, chronic conditions, and poor access to social services. Acknowledging the interaction between marginalization and health disparities that are embedded in the social determinants of health is necessary to evaluate the social, policy, and public health response of COVID-19 and understand the related indirect consequences on vulnerable populations. Using a mixed-method design, the objective of the COVID Impact project is to scale up the ongoing pilot trial to measure the biopsychosocial impacts of COVID-19 public health emergency response efforts and communication strategies on Ottawa’s low-income, homeless (or at-risk for homelessness), and visible minority populations.
A survey (n=400) will be shared through relevant social service networks by individuals with lived experience of (or at-risk for) homelessness and poverty (community peers) that currently work at partnering organizations or the Bridge Engagement Centre, a community-based research centre with over six years of experience partnering with marginalized communities. The survey consists of questions specific to COVID-19 and validated questionnaires designed to collect data regarding the physical health, mental health, socioeconomic characteristics, and health and digital literacy skills of vulnerable populations during the COVID-19 pandemic. A sub-sample (n=30) will complete telephone based semi-structured interviews that further explore the experiences of vulnerable populations with physical distancing, exposure to public health messaging and COVID-19 related misinformation, and food and housing insecurity during the pandemic response. A mixed-method analysis will be conducted to examine the patterns and relationships between the study variables of interest. The findings of the proposed study will support public health strategies in bridging digital and health (literacy) gaps and will inform public health risk messaging strategies and pandemic approaches, proposing equity informed risk management and communication strategies for vulnerable populations. The impact at the individual, community, and societal level will ultimately ensure pandemic responses address and mitigate the differential exposure and susceptibility of vulnerable populations and respond to the unique communication and outbreak disease management needs of said populations. We received funding from the Ottawa Hospital COVID-19 Emergency Response Fund, Canadian Institutes of Health Research, and the Ontario Government COVID-19 rapid research fund to facilitate this project.
Other COVID-19 collaborative projects:
The Effects of Traditional Chinese Medicine as an Auxiliary Treatment for COVID-19: A Systematic Review and Meta-analysis
Background: Coronavirus disease 2019 (COVID-19) has become a pandemic with no specific and widely accepted effective drug or vaccine. However, studies have shown that Traditional Chinese Medicine (TCM) may play a significant role as an auxiliary treatment for COVID-19.
Objective: This study aimed to assess the effects of TCM as an auxiliary treatment for COVID-19 through a systematic review of randomized-controlled trials (RCTs).
Methods: Four English and three Chinese language databases were searched from December 1, 2019, to June 30, 2020. RCTs comparing TCM in combination with Western medicine (WM) with the same WM therapies alone for confirmed COVID-19 patients were included. The outcome measures were cure rate, lowering of body temperature, cough relief, improvement in chest computed tomography (CT) images, deterioration of condition, and adverse effects. Methodological quality was assessed using the Cochrane risk-of-bias tool. A series of meta-analyses were conducted for selected outcomes using RevMan 5.3 software. The quality of evidence was appraised using the grading of recommendation, assessment, development, and evaluation (GRADE) recommendations.
Results: Ten RCTs with a total of 1,285 patients were included. Compared with WM alone in treating COVID-19, WM with auxiliary treatment by TCM appears to have increased the cure rate (risk ratio [RR] 1.15 [95% confidence interval (CI) 1.04-1.26]), relieved cough (RR 1.32 [95% CI 1.15-1.52]), improved chest CT images (RR 1.23 [95% CI 1.11-1.37]), and reduced the number of cases transitioning from a moderate to severe condition (RR 0.58 [95% CI 0.43-0.77]). The authors are uncertain whether TCM combined WM has effects on fever normalization (RR 1.10 [95% CI 0.94-1.29]) or adverse effects (RR 0.81 (95% CI 0.42-1.57]). Although they evaluated the certainty of evidence for lowering body temperature and adverse effects as very low, and low for cure rate, certainty was evaluated as moderate for improvement in chest CT images, cough relief, and deterioration of condition.
Conclusion: TCM may be an effective auxiliary treatment for COVID-19 patients, which is likely to help improve the main symptoms and reduce disease progression. However, due to the limited number of studies and apparent heterogeneity among them, a more definitive conclusion on the effect of TCM on lowering body temperature and adverse effects cannot be drawn at this time.
An Effective Off-Campus Triage System During the COVID-19 Outbreak
Background: In January 2020, the outbreak of COVID-19 in Wuhan, Hubei spread to Guangdong that became the province with the second largest number of COVID-19 patients in China. Nanhai Hospital, one of the teaching hospitals of Southern Medical University in Guangdong, was designated by the government as one of the hospitals for suspected COVID-19. This presented challenge of how to effectively handle the suspected cases of COVID-19, while avoiding in-hospital cross-infection and maintaining other important services in the hospital. An off-campus triage system has been demonstrated as an effective method to reduce spread of Ebola and other infectious diseases during outbreaks. However, the effectiveness of off-campus triage system for the COVID-19 outbreak has not been reported.
Methods: We created an off-campus triage system at entry points to the outpatient, emergency, and inpatient departments in the hospital, to triage patients to the appropriate care areas. To support this off-campus triage system, we developed an intensive staff training and evaluation including personal protection measures, a detailed triage procedure and staff scheduling, accurate assessment, and timely referral.
Findings: Of the 85,414 patients and visitors to the hospital between January 22 and March 10 of 2020 in Nanhai Hospital, 359 patients were triaged to the COVID-19 fever clinic and 1,218 were triaged to the general fever clinic; 187 were suspected of COVID-19 infection and quarantined; and 4 cases of COVID-19 were confirmed and referred. During the outbreak, no in-hospital infection and no complaint from patients and their family members occurred, and up to March 25, 2020, no new cases of COVID-19 in this hospital or its catchment area were detected.
Interpretation: The off-campus triage system is an effective approach to improve detection of COVID-19 infection, reduce in-hospital cross-infection, and improve patient satisfaction. This triage system could be applied in future infectious disease outbreaks.
Feasibility and Preliminary Results of Effectiveness of Social Media-based Intervention on the Psychological Well-being of Suspected COVID-19 Cases during Quarantine