SEARCHCROSS-SECTIONALpublic health, epidemiology

cross-sectional·public health, epidemiology, infectious disease, observational study·PMC10431654

Interplay of demographics, geography and COVID-19 pandemic responses in the Puget Sound region: The Vashon , Washington Medical Reserve Corps experience

PLOS ONE · 7 authors, 7 centres

AI SUMMARY

FIDELITY 100%

POPULATIONVashon Island, King County (including metropolitan Seattle), and Whidbey Island communities in the Puget Sound region, Washington

INTERVENTIONVashon Medical Reserve Corps (VMRC) community-based COVID-19 response including testing, contact tracing, vaccination, and public engagement

COMPARISONKing County overall and South Whidbey Island (geographically and demographically similar remote island community)

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This observational cross-sectional study compared COVID-19 rates across King County, Vashon Island, and Whidbey Island from February 2020 through November 2021 and found that remote island geography was associated with a substantially lower case rate and that a community-based volunteer response program further reduced cases and hospitalizations.

Full summary

1,233 CHARS

This observational cross-sectional study compared COVID-19 rates and public health intervention outcomes across King County, Vashon Island, and Whidbey Island from February 2020 through November 2021. Multiple linear regression models were developed across 77 King County zip codes incorporating demographics (age, race/ethnicity, wealth, education) and expanded to include remote Whidbey Island communities to assess geographic effects. Vashon's cumulative case rate was 29% of King County's (22.2 vs 76.8 cases/K), and a demographic regression model found Vashon's rate was only 38% of predicted, indicating demographics alone did not explain the low rate. VMRC achieved 1500 doses/K vaccination four months before comparison communities and maintained 200 doses/K higher throughout late 2021. VMRC case investigation interviewed 96% of referred cases in 1.7 days on average. VMRC efforts were associated with a 30% lower case rate and 55% lower hospitalization rate versus South Whidbey. Limitations include non-generalizability to other regions, small number of remote community observations, inability to separate contributions of individual response elements, and uncertainty about replicability of the volunteer program model.

PICO

PPOPULATION

Vashon Island, King County (including metropolitan Seattle), and Whidbey Island communities in the Puget Sound region, Washington

IINTERVENTION

Vashon Medical Reserve Corps (VMRC) community-based COVID-19 response including testing, contact tracing, vaccination, and public engagement

OOUTCOME

Cumulative COVID-19 case rates, hospitalization rates, vaccination rates, and contact tracing performance metrics

STUDY TYPE

cross-sectional

SPECIALTY

public health

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10431654

Interplay of demographics, geography and COVID-19 pandemic responses in the Puget Sound region: The Vashon , Washington Medical Reserve Corps experience

PLOS ONE

READ THE FULL PAPER

ABSTRACT

Abstract Background Rural U.S. communities are at risk from COVID-19 due to advanced age and limited access to acute care. Recognizing this, the Vashon Medical Reserve Corps (VMRC) in King County, Washington, implemented an all-volunteer, community-based COVID-19 response program. This program integrated public engagement, SARS-CoV-2 testing, contact tracing, vaccination, and material community support, and was associated with the lowest cumulative COVID-19 case rate in King County. This study aimed to investigate the contributions of demographics, geography and public health interventions to Vashon’s low COVID-19 rates. Methods This observational cross-sectional study compares cumulative COVID-19 rates and success of public health interventions from February 2020 through November 2021 for Vashon Island with King County (including metropolitan Seattle) and Whidbey Island, located ~50 km north of Vashon. To evaluate the role of demography, we developed multiple linear regression models of COVID-19 rates using metrics of age, race/ethnicity, wealth and educational attainment across 77 King County zip codes. To investigate the role of remote geography we expanded the regression models to include North, Central and South Whidbey, similarly remote island communities with varying demographic features. To evaluate the effectiveness of VMRC’s community-based public health measures, we directly compared Vashon’s success of vaccination and contact tracing with that of King County and South Whidbey, the Whidbey community most similar to Vashon. Results Vashon’s cumulative COVID-19 case rate was 29% that of King County overall (22.2 vs 76.8 cases/K). A multiple linear regression model based on King County demographics found educational attainment to be a major correlate of COVID-19 rates, and Vashon’s cumulative case rate was just 38% of predicted (p < .05), so demographics alone do not explain Vashon’s low COVID-19 case rate. Inclusion of Whidbey communities in the model identified a major effect of remote geography (-49 cases/K, p < .001), such that observed COVID-19 rates for all remote communities fell within the model’s 95% prediction interval. VMRC’s vaccination effort was highly effective, reaching a vaccination rate of 1500 doses/K four months before South Whidbey and King County and maintaining a cumulative vaccination rate 200 doses/K higher throughout the latter half of 2021 (p < .001). Including vaccination rates in the model reduced the effect of remote geography to -41 cases/K (p < .001). VMRC case investigation was also highly effective, interviewing 96% of referred cases in an average of 1.7 days compared with 69% in 3.7 days for Washington Department of Health investigating South Whidbey cases and 80% in 3.4 days for Public Health–Seattle & King County (both p<0.001). VMRC’s public health interventions were associated with a 30% lower case rate (p<0.001) and 55% lower hospitalization rate (p = 0.056) than South Whidbey. Conclusions While the overall magnitude of the pre-Omicron COVID-19 pandemic in rural and urban U.S. communities was similar, we show that island communities in the Puget Sound region were substantially protected from COVID-19 by their geography. We further show that a volunteer community-based COVID-19 response program was highly effective in the Vashon community, augmenting the protective effect of geography. We suggest that Medical Reserve Corps should be an important element of future pandemic planning.

CITATION EXPORT

James Bristow, Jamie Hamilton, John Weinshel et al.. Interplay of demographics, geography and COVID-19 pandemic responses in the Puget Sound region: The Vashon, Washington Medical Reserve Corps experience. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0274345

AUTHORS

7 · 7 CENTRES

James Bristow, Jamie Hamilton, John Weinshel, Robert Rovig, Rick Wallace, Clayton Olney, Karla J Lindquist

1Vashon Medical Reserve Corps, Vashon, Washington, United States of America
2Island County Public Health Department, Coupeville, Washington, United States of America
3VashonBePrepared, Vashon, Washington, United States of America
4Atlas Genomics, Seattle, Washington, United States of America
5Madigan Army Medical Center, Joint Base Lewis McChord, Washington, United States of America
6Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
7National Center for Global Health and Medicine, JAPAN