COVID-19 risk lower in US counties with robust primary care infrastructure
U.S. counties with the strongest primary care and public health infrastructures and social assets had the fewest SARS-COV-2 infections and related deaths, according to a report from the Primary Care Collaborative and Robert Graham Center.
In contrast, the report showed that counties on the other end of the spectrum had the highest number of infections and deaths.
Those affiliated with the report said the findings highlight the important role of primary care, public health and social assets in combating COVID-19. They also said they hope the report helps decisionmakers ascertain if they are correctly leveraging existing health infrastructure and funding primary care as well as sufficiently investing in them for the future.
Yalda Jabbarpour, MD, the medical director of the Robert Graham Center and co-author of the report, and colleagues used a Community Health Index (CHI) to rank each county in the United States based on: the number of primary care physicians available; the level of public health preparedness; and the extent that social determinants of health had on the residents’ wellbeing. The CHI, which was developed at the Robert Graham Center, was then compared with the incidence of SARS-CoV-2 infections and related deaths in each county before and after the COVID-19 vaccine became widely available.
According to Jabbarpour, the mean CHI score was 26.7 among the counties in the top quintile and 8.6 among counties in the lowest quintile. Residents in counties with the highest CHI, who represented 17% of the U.S. population, were 42% less likely to die from COVID-19 and 12% less likely to become infected with SARS-CoV-2 than residents in counties with the lowest CHI, who represented 20% of the U.S. population.
The report further showed that residents in counties with the highest CHI were 26% more likely to receive a COVID-19 vaccine than residents in counties with the lowest CHI. Although SARS-CoV-2 infection and death rates fell in all counties after the availability of COVID-19 vaccines, these rates fell more quickly in the highest CHI quintile vs. the lowest quintile.
“It’s not just having the vaccine available,” Jabbarpour said during a press conference. “There’s something else that is happening here. Because whether it was before or after vaccinations, counties with the better CHI scores had less cases and less deaths compared with those who had the lowest scores. It’s a combination of good primary care access, robust public health preparedness and social assets that also matters.”
During the press conference, other experts assembled by the Primary Care Collaborative said the data paint a troubling picture.
“This is horrendous,” Seiji Hayashi, MD, MPH, FAAFP, chief transformation officer and medical director at Mary’s Center in Washington, D.C., said. “We could have done so much more to save lives. But at the same time, it could have been worse.”
Sinsi Hernández-Cancio, JD, the vice president for health justice at the National Partnership for Women and Families, agreed.
“I invite you all to consider what those maps would look like if we had not controlled for being a person of color in this country or living in a rural area,” she said. “We’re seeing in the newspapers daily how if you were a Black person or a Latino person, you are much more likely to be exposed, contract and die from COVID-19.”
Panelist Glen Mays, PhD, MPH, a professor and the chair of the department of health systems, management and policy at the Colorado School of Public Health, said the findings, reached with barely a year’s worth of COVID-19 data, were eye-opening.
“When we study public health, we usually have to look at long-term effects of public health interventions,” he said. “What’s striking here is that we can see immediate effects from having all three sectors being strong together, being able to work as effective partners for each other.”
Although the experts agreed that collaborations between primary care, public health and social organizations need to be established and maintained, questions remain about who should be responsible for taking the lead on forming such collaborations.
“It needs to be somebody who can bring together all the pieces and bring it together in ways that are not just responding to market forces, but what actually is needed for a given community. State leadership is extremely important because they are able to step back and have a 30,000-foot view of where things are,” Hernández-Cancio said.
“When you get to the micro level of communities, it’s incumbent on the provider and the public health system to reach out to the nonprofits, to the community-based organizations, the ones who actually have the trust and understanding and language capacity and ... understand how to navigate all the barriers of the community that they work in,” she said.
Hayashi said that steps to cultivate such collaborations, if not already in place, must begin immediately, before the next public health emergency.
“There’s an adage in the business world that a disaster is not the time where you want to be exchanging business cards or getting your partners for the first time,” Mays said.
References
- New report shows primary care helped to reduce risk of death, infection from COVID-19. https://www.pcpcc.org/2021/10/15/new-report-shows-primary-care-helped-reduce-risk-death-infection-covid-19. Published Oct. 18, 2021. Accessed Oct. 18, 2021.
- Primary care and COVID-19: It’s complicated — Leveraging primary care, public health and social assets. https://www.pcpcc.org/sites/default/files/resources/PCC_Primary_Care_&_COVID-19_Its_Complicated.pdf. Published Oct. 18, 2021. Accessed Oct. 18, 2021.