Disparities in COVID Disease Severity and Outcomes in New York City

PROJECT Summary: This application is being submitted in response to Notice Number: NOT-TR-20-011 to highlight the urgentneed for research on the 2019 novel Coronavirus (COVID-19), and is an administration supplement to our parentgrant. The outbreak of COVID-19 and the life-threatening acute respiratory syndrome caused by the virus(SARS-CoV-2/2019-nCoV) have led to a severe, global public health crisis, and economic disruption. Sadly, inthis epidemic, NYC is the epicenter of epicenters. Some neighborhoods in NYC have been more exposed thanothers to COVID, and there seems to be clear correlation with the prevalence of COVID and its severity betweencertain ethnic and racial populations. Importantly, it is recognized that biology factors alone do not exclusivelyaccount for disease outcomes in those stricken with Covid-19. Social determinants have a significant impact onvarious health-related outcomes such as hypertension, diabetes, obesity, kidney and lung disease (1,2).Evidence also indicates that a myriad of social risk factors- such as low income, poor education, minority raceor ethnic background- coupled with inadequate community housing and resources, together with limited healthcare access and decreased health utilization, results in poor health outcomes and increased susceptibility andseverity to Covid-19 (3-14). For this study, we assembled a multidisciplinary team from Weill Cornell Medicine'sClinical Translational Science Center (CTSC); Englander Institute for Precision Medicine (EIPM), the WeillCornell's Center for Health Equity. The initial study will be conducted with the New York Presbyterian (NYP)Hospital health care system database involving "hotspot" areas in NYC with COVID. The NYP network is thelargest healthcare system by bed counts in New York City and is on the frontlines of the struggle against theCOVID pandemic. By discerning the interaction/relationship of the biology with the Social Determinants of Health(SDoH), we will gain further insight into why certain racial and ethnic groups are more susceptible to Covid -19,and why they develop the more severe forms of the virus. Furthermore, if we are able to identify the especiallyvulnerable, and provide adequate isolation and early medical intervention in the disease process- then we cansave lives. Protecting and providing preventive and early care for the vulnerable would also allow the remainderof society to interact in daily activities and prevent the economy from a major collapse. The less vulnerable whoare out in society would on average develop mild coronavirus infections. Consequently, once the larger andmildly affected less vulnerable population recover and gain natural immunity, the risk to the most vulnerablewould fall dramatically and the country would stabilize.