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News Scan for Mar 31, 2021

Racial disparities in COVID vaccine uptake noted, even in health workers

Racial and ethnic differences in intention to receive a COVID-19 vaccine were comparable across both healthcare workers (HCWs) and the general public in the San Francisco Bay area this winter, according to survey results published yesterday in JAMA Internal Medicine.

The survey, led by researchers from the University of California San Francisco and Stanford University, included 1,803 HCWs from three large medical centers who volunteered for regular COVID-19 testing and 3,161 randomly selected members of the general public in six San Francisco Bay area counties from Nov 27, 2020, to Jan 15, 2021.

While more HCWs than their randomly sampled peers said they were likely to be vaccinated, racial and ethnic differences in planned uptake were similar among both groups.

Among the HCWs, the adjusted odds ratio (aOR) of planned vaccine receipt relative to White participants was 0.24 for Black participants, 0.50 for Latin American respondents, 0.37 for Asian participants, 0.28 for respondents of other races, and 0.49 for those of mixed race.

Among the general population, the aOR relative to White respondents was 0.29 for respondents who were Black, 0.55 for Latin Americans, 0.57 for Asians, 0.62 for those of other races, and 0.65 for mixed-race respondents.

Black, Latin American, and Asian participants were significantly more likely than White respondents to cite reasons not to be vaccinated, expressing skepticism about vaccine effectiveness (aOR, 2.39 for Black, 2.04 for Latin American, and 1.85 for Asian respondents), low levels of trust in vaccine manufacturers (aOR, 3.08, 1.85n, and 1.34, respectively), and concerns that the government rushed vaccine approval (aOR, 2.10, 1.68, and 1.81).

The authors said that intention to be vaccinated is a deliberative, dynamic process that must not distract from the importance of ensuring equitable vaccine access.

“Special effort is required to reach historically marginalized populations,” the researchers wrote. “Efforts must acknowledge a history of racism that has degraded the trustworthiness of health and medical science institutions among historically marginalized populations, undermined confidence in COVID-19 vaccines, and perpetuated inequitable access to care.”
Mar 30 JAMA Intern Med research letter

Study highlights aerosols generated by exertional respiratory activity

New research published yesterday in Anaesthesia indicates that respiratory activities such as shouting, coughing, and deep breathing produce substantially more aerosols than non-invasive respiratory procedures, a finding the study authors say challenges current healthcare guidelines on protective equipment for COVID-19 and has implications beyond healthcare settings.

In the study, researchers from Australia, Scotland, and England set out to measure the size, total number, and volume of all human aerosols exhaled during respiratory activities that mimic patterns during illness (including quiet breathing, talking, shouting, forced expirations, exercise, and coughing) and respiratory therapies commonly used in hospitalized patients with severe COVID-19 (high-flow nasal oxygen and non-invasive ventilation). To do so, they recruited 10 healthy volunteers to sit in a chamber with clean air and breathe directly into a cone.

Using an optical particle counter, the researchers then measured the number and size of the particles (from 0.5 to 25 micrometers) emitted by the volunteers during the respiratory activities and while receiving the oxygen therapies. The volunteers repeated the activities wearing surgical facemasks.

The researchers found that, compared with quiet breathing, shouting, deep breathing, and coughing increased particle counts 163.6-fold, 227.6-fold, and 370.8-fold, respectively. High-flow nasal oxygen increased particle counts 2.3-fold, while single and dual-circuit non-invasive ventilation increased particle counts by 2.6-fold and 7.8-fold, respectively. During exertional activities, facemasks reduced emissions 60% overall compared with activities alone, while respiratory therapies reduced them 30% to 60%, depending on the therapy.

The authors says the findings suggest exertional respiratory activities are the primary modes of aerosol generation and represent a greater disease transmission risk than is currently recognized. That’s significant because many international COVID-19 guidelines recommend fit-tested N95/FFP3 respirators only for healthcare workers performing aerosol-generating procedures like high-flow nasal oxygen and non-invasive ventilation in COVID-19 patients.

“The coughing and laboured breathing common in patients with COVID-19 produces a lot more droplets and aerosols than is produced by patients being treated with oxygen therapies,” study co-author Euan Tovey of the University of Sydney said in a press release from the Association of Anaesthetists of Great Britain and Ireland (AAGBI), which publishes the journal. “Surgical facemasks provide inadequate protection against aerosols and staff safety can only be increased by more widespread use of specialised tight-fitting respirators (N95 or FFP3 masks) and increased indoor ventilation.”
Mar 30 Anaesthesia study
Mar 30 AAGBI press release

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