Funded by a $2 million award from the National institutes of Health RADx-UP program, part of the Rapid Acceleration of Diagnostics (RADx) initiative, University of Chicago Medicine and University of Illinois at Chicago (UIC) researchers are investigating the effects of increased education and access to rapid, FDA-approved COVID-19 testing on community perceptions, access and use of COVID-19 testing resources. Led by Ayman Al-Hendy, MD, professor of obstetrics and gynecology at UChicago Medicine, and Renee Taylor, PhD, professor of occupational therapy and Nahed Ismail MD, PhD, D(ABMM), D (ABMLI), professor of pathology and medical director of clinical microbiology at UIC, the team will leverage existing university-community partnerships and expertise in clinical microbiology, community engagement, and epidemiological infrastructures to expand access to rapid COVID-19 testing. A fundamental underlying premise of these RADx-UP studies is the lack of participation in COVID-19 research among underrepresented populations, such as African Americans, Hispanics, the elderly, and other groups such as Native Americans. The RADx-UP program supports research that aims to better understand COVID-19 testing patterns among underserved and vulnerable populations; strengthen the data on disparities in infection rates, disease progression and outcomes; and develop strategies to reduce the disparities in COVID-19 testing.
The recent announcement by the Chicago-based universities represents an attempt to address material gaps in medicine and care manifested not only during the pandemic but that are seemingly a permanent reality of life in America; significant pockets of Chicago’s south and west sides, for example, can be thought of during the COVID-19 pandemic as ‘testing deserts’ where according to Renee Taylor with University of Illinois at Chicago “…any people don’t have easy or affordable access to testing.” In a bid to introduce standard care along with research, Taylor continued, “We can reach individuals who maybe don’t have health insurance or are concerned about having a COVID-19 test on their medical record and provide them with an easy and private opportunity to get tested.” Of course, this particular effort has a specific goal of impacting engagement to reduce disparities in COVID-19 testing, the hope is that longer lasting ties can lead to broader health engagement and improved outcomes over time.
COVID-19 in Chicago
Chicago has faced some challenging times during this pandemic. Illinois ranks fourth in the nation in terms of total COVID-19 cases with 685,467; the state ranks sixth for COVID-19 related deaths at 12,440. Chicago is the largest city in Cook County. The county, with 5.1 million residents, reports 291,000 COVID-19 cases or 42% of the total number of cases in the state. Cook County makes up about 40% of the state’s total population. Chicago’s 2.7 million residents represents 52% of Cook County with 152,908 cases reported directly in Chicago.
The High Risk Populations
Generally across the United States Blacks, Hispanics and Native Americans face up to four times the risk than whites to die from COVID-19. According to the CDC, Blacks dies at 2.1 times the rates of whites due to the virus; Hispanic/Latinos die at 1.1 times the rate of whites while non-Latino Native Americans fall 1.4 times higher. Hospitalization trends reveal even starker gaps as Blacks are hospitalized at 4.7 times the rate of whites in America, for example. Perhaps the most at risk are the elderly in long term care facilities where its reported that up to 40% of the deaths during the pandemic occur among this population. As reported in a recent Wall Street Journal article, over 100,000 elderly residing in long term care facilities have passed due to this virus.
During the first peak of the pandemic, the disproportionate impact along racial lines in Chicago was clear: although about 30% of the city’s population is Black, 60% of deaths due to COVID-19 were recorded among this same demographic. Deep chasms in society along race and ethnicity, class and cultural lines are challenging enough but mix in a historical legacy of abusive, predatorial research targeting Blacks (such as Tuskegee) and the divide seems, at times, almost too far to overcome.
A key program goal here is to improve rates of minority COVID-19 testing while opening up engagement channels and hopefully, increasing levels of vaccine acceptance. As at least one COVID-19 vaccine (Pfizer/BioNTech) is now going through the U.S. Food and Drug Administration (FDA) emergency use authorization decision making process—while another one imminently will follow (Moderna)—actually preparing hard-hit communities in Chicago’s Black and Hispanic neighborhoods, such as the South Side, to be ready has its challenges.
As reported just recently by Brett Chase in the Chicago Sun Times, the rush among Chicago’s major hospitals and health systems to recruit African Americans and other minorities is a tough sell and this spells trouble as the pandemic is not over and the viral infection rates are higher in these areas.
Mr. Chase reports that the Rev. Floyd James with Rush University Medical Center was recruited, along with a network of Black religious leaders, to help build momentum for greater African American participation in the traditionally Black West Side of town. Talking about this challenge, Rev. James noted that the vaccine will be a “tough sell” in these parts, emphasizing, “We’ve been hoodwinked so many times with vaccines.” Reminding a largely perplexed White reader: “We’ve been experimented on by the government, by the scientific community and the hospitals.”
Health Access Trends in Chicago
The research team discussed in their recent press release the importance of outreach to the uninsured as well. Black and Hispanics are persistently less insured than whites when it comes to health coverage.
By 2017, purportedly due to the Affordable Care Act, a record number of Chicagoans possessed health coverage via the government subsidized program. According to the data in 2017, 256,000 Chicagoans lacked health coverage. Since the pandemic, there is evidence this positive trend has now reversed. Overall, the Medicaid expansion between 2014 and 2017 was a fundamental driver for an expansion in health coverage for the state, county and City of Chicago’s poorest residents.
Now Chicago’s premier universities will tap into and capitalize on many years of engaging various communities in the city, as well as comprehensive and compelling research capabilities and COVID-19 testing capacity, in a bid to overcome health equity challenges, at least in the context of the present day pandemic. By offering a range of more convenient, targeted and even private home-based options, combined with committed outreach and community engagement, the team hopes to help improve the public perception of receiving a COVID-19 test. Some examples of activities follow.
The team will use a myriad of tools and techniques to identify, contact and hopefully, influence targeted populations for informative engagement. From searches in electronic health records to targeting various communities via the universities’ network of community ties, the team will employ everything from culturally sensitive advertisements to the introduction of a targeted mobile health app called the mHealth Literacy and Outreach Suite, which allows individuals to not only privately order testing, but also learn how to prevent the spread of COVID-19 and care for themselves if they fall ill.
Program investigators also plan on sending kits for participants to collect their own samples and send them for testing at UIC. Sample collection can be performed rapidly at home with a nasal swab, without the discomfort of the typical nasopharyngeal swab, prior to sending the sample to the central lab for testing.
About University of Chicago Medicine & Biological Sciences
The University of Chicago Medicine, with a history dating back to 1927, is one of the nation’s leading academic health systems. It unites the missions of the University of Chicago Medical Center, Pritzker School of Medicine and the Biological Sciences Division. Twelve Nobel Prize winners in physiology or medicine have been affiliated with the University of Chicago Medicine. Its main Hyde Park campus is home to the Center for Care and Discovery, Bernard Mitchell Hospital, Comer Children’s Hospital and the Duchossois Center for Advanced Medicine. It also has ambulatory facilities in Orland Park, South Loop and River East as well as affiliations and partnerships that create a regional network of care. UChicago Medicine offers a full range of specialty-care services for adults and children through more than 40 institutes and centers including an NCI-designated Comprehensive Cancer Center. Together with Harvey-based Ingalls Memorial, UChicago Medicine has 1,296 licensed beds, nearly 1,300 attending physicians, over 2,800 nurses and about 970 residents and fellows.
Ayman Al-Hendy, MD, professor of obstetrics and gynecology at UChicago Medicine
Renee Taylor, PhD, professor of occupational therapy
Nahed Ismail MD, PhD, D(ABMM), D (ABMLI), professor of pathology and medical director of clinical microbiology at UIC
Call to Action: Individuals who are interested in learning more about this study and how they can participate should Renee Taylor at [email protected] or by phone at 312-996-8217.