key: cord-347119-w780f0om authors: Blitz, Matthew J.; Rochelson, Burton; Prasannan, Lakha; Shan, Weiwei; Chervenak, Frank A.; Nimaroff, Michael; Bornstein, Eran title: Race/ethnicity and spatiotemporal trends in SARS-CoV-2 prevalence on obstetrical units in New York date: 2020-08-17 journal: Am J Obstet Gynecol MFM DOI: 10.1016/j.ajogmf.2020.100212 sha: doc_id: 347119 cord_uid: w780f0om nan Coronavirus disease 2019 , caused by the virus known as severe acute 2 respiratory syndrome coronavirus 2 (SARS-CoV-2), disproportionately affects racial and 3 ethnic minorities and socioeconomically disadvantaged groups. 1-3 Among pregnant 4 women from socially vulnerable populations, it remains uncertain how the proportions of 5 positive SARS-CoV-2 tests have changed over time after closure of non-essential 6 businesses and schools, and promotion of social distancing measures. We evaluated 7 temporal trends, regional geographic variation, and racial/ethnic disparity in SARS-CoV-8 2 prevalence among gravid women presenting to obstetrical units within a large health 9 system in New York during the COVID-19 outbreak. 10 11 This retrospective study included all pregnant women who had SARS-CoV-2 testing 13 (both symptomatic and asymptomatic) at 7 hospitals within a 30-mile radius from April 14 1, 2020, before the peak of the outbreak in New York State, 4 to June 9, 2020. These 15 facilities, located in New York City and Long Island, include tertiary academic medical 16 centers as well as community hospitals. The population served is one of the most 17 diverse in the world; patients reside in both urban and suburban communities and 18 represent a wide socioeconomic spectrum. To reduce occult transmission of the virus 19 from asymptomatic or presymptomatic carriers, universal SARS-CoV-2 testing protocols 20 were implemented on all obstetrical units at the beginning of the 10-week study period 21 with the exception of two hospitals, Lenox Hill Hospital (LHH) and Staten Island 22 were excluded if results were not available or, for LHH and SIUH, if they were 25 performed prior to implementation of universal testing. Data analyzed in this study 26 included SARS-CoV-2 test results, race/ethnicity, delivery hospital, and week of hospital 27 visit. Temporal trends in SARS-CoV-2 prevalence per week were compared among 28 obstetrical units and across racial/ethnic groups. The Cochran-Armitage trend test was 29 used to evaluate the significance of trends in test positivity over time. Multiple logistic 30 regression analysis was used to model the binary outcome of having a PCR positive or 31 negative result, using time (study week), race/ethnicity, hospital site, and their 32 interactions as predictors. The Northwell Health Institutional Review Board approved the 33 study as minimal-risk research using data collected for routine clinical practice and 34 waived the requirement for informed consent. 35 Of 4,811 pregnant women presenting to the 7 hospital sites after implementation of 38 universal SARS-CoV-2 testing, PCR results were obtained for 4,674 patients: 500 39 (11%) were positive. Test results were not available for 3% (n=137) of patients, either 40 because the test was not performed or because it was performed offsite and not 41 retrievable via our electronic medical record systems. The overall prevalence of the 42 virus throughout the health system's obstetrical units declined from 25% in the first 43 week to 4% in the tenth week; the trend of PCR positivity decreasing over time was 44 statistically significant (p<0.0001). 45 46 Differences in SARS-CoV-2 test positivity were observed between racial/ethnic groups (p<0.0001). Hispanic women constituted 18% (n=836) of the study population but 48 accounted for 31% of all positive tests, with a test positivity rate of 18% (n=153); this 49 was the most affected racial/ethnic group in the study. Non-Hispanic black women 50 constituted 12% (n=567) of the study population, had a test positivity rate of 14% 51 Considerable heterogeneity in SARS-CoV-2 prevalence was observed across hospitals 64 in the region (p<0.0001; Table 1 ). Overall test positivity ranged from 6% to 19% across 65 obstetrical units, and the peak prevalence at each site varied from 13% to 41%. A 66 significant decrease in weekly test positivity was observed at all sites but the rate of 67 decline was significantly higher at some sites compared to others. Interaction between 68 site and race/ethnicity was not detected. 69 Within a large health system in New York, Hispanic and non-Hispanic black pregnant 72 women were disproportionately affected by SARS-CoV-2; despite constituting 73 approximately one-third of the study population, they accounted for nearly half of all 74 cases. While a decrease in the prevalence of the virus was observed in all racial/ethnic 75 groups during the 10-week study period, there was no difference in the rate of decline 76 among groups. This may indicate that all groups benefitted from implementation of 77 social distancing measures despite the legitimate concern that vulnerable populations 78 may have more difficulty adhering to such guidelines. Week 1 April 1-7 Week 2 April 8-14 Week 3 April Week 4 April 22-28 Week 5 April 29 -May 5 Week 6 May 6-12 Week 7 Week 8 May 20-26 Week 9 May 27 -June 2 Week 10 June 3-9 (83) a Universal SARS-CoV-2 PCR testing protocol implemented during 2nd week of study period. COVID-19: data Hospitalization Rates and Characteristics of 96 Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 14 States Prevalence and Severity of Coronavirus 100 Disease 2019 (COVID-19) Illness in Symptomatic Pregnant and Postpartum 101 Women Stratified by Hispanic Ethnicity New York State Department of Health COVID-19 Tracker