Objective To determine if oxygen saturation (out‐of‐hospital SpO2), measured by New York City (NYC) 9‐1‐1 Emergency Medical Services (EMS), was an independent predictor of coronavirus disease 2019 (COVID‐19) in‐hospital mortality and length of stay, after controlling for the competing risk of death. If so, out‐of‐hospital SpO2 could be useful for initial triage. Methods A population‐based longitudinal study of adult patients transported by EMS to emergency departments (ED) between March 5 and April 30, 2020 (the NYC COVID‐19 peak period). Inclusion required EMS prehospital SpO2 measurement while breathing room air, transport to emergency department, and a positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) reverse transcription polymerase chain reaction test. Multivariable logistic regression modeled mortality as a function of prehospital SpO2, controlling for covariates (age, sex, race/ethnicity, and comorbidities). A competing risk model also was performed to estimate the absolute risks of out‐of‐hospital SpO2 on the cumulative incidence of being discharged from the hospital alive. Results In 1673 patients, out‐of‐hospital SpO2 and age were independent predictors of in‐hospital mortality and length of stay, after controlling for the competing risk of death. Among patients ≥66 years old, the probability of death was 26% with an out‐of‐hospital SpO2 >90% versus 54% with an out‐of‐hospital SpO2 ≤90%. Among patients 90% versus 31% with an out‐of‐hospital SpO2 ≤ 90%. An out‐of‐hospital SpO2 level ≤90% was associated with over 50% decreased likelihood of being discharged alive, regardless of age. Conclusions Out‐of‐hospital SpO2 and age predicted in‐hospital mortality and length of stay: An out‐of‐hospital SpO2 ≤90% strongly supports a triage decision for immediate hospital admission. For out‐of‐hospital SpO2 >90%, the decision to admit depends on multiple factors, including age, resource availability (outpatient vs inpatient), and the potential impact of new treatments.

Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals’ ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m². Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.

Objective This study aimed to determine if laboratory inflammatory markers can predict critical disease in symptomatic COVID-19 pregnant women. Study Design Multicenter, retrospective cohort study of all pregnant women presenting to New York City Health + Hospitals emergency departments from March 1 to May 30, 2020. We assessed all symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pregnant women with room air oxygen saturation <95% on presentation. Logistic regression modeled the relationship of inflammatory markers to outcomes. Area under receiver operating characteristic (ROC) curve and maximum Youden index determined prognostic ability and optimal predictive cut-off values. Results A total of 498 of 5,002 pregnant women were SARS-CoV-2 RT-PCR positive of which 77 presented with hypoxemia. The absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) were highly sensitive for progression to severe illness. ROC curve analysis identified predictive cutoffs: ALC < 1.49 × 10⁹/L (96% sensitivity, 52% specificity, area under the receiver operating characteristic curve [AUC] = 0.80 (95% confidence interval [CI]: 0.70–0.90) and NLR >8.1 (100% sensitivity, 70% specificity, AUC = 0.86 (95% CI: [0.76–0.96]). Conclusion ALC and NLR on presentation are sensitive markers of progression to critical COVID-19 disease in symptomatic pregnant women. This finding provides a practical, rapid method for assessment and can assist clinicians with decision-making regarding triage, level of care, and patient management. Key Points Received: 31 December 2020 Accepted: 01 June 2021 Publication Date: 16 July 2021 (online) © 2021. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

The Person-Centered Care Framework for Reproductive Health Equity (PCC) elucidates drivers of health disparities: community determinants, health-seeking behaviors, and quality of care. Limited studies assess person-centered maternal healthcare in underserved populations. Racial and ethnic disparities in maternal health were exacerbated by the COVID-19 pandemic. We applied PCC to evaluate factors influencing maternal healthcare at two public hospitals in NYC before and during the pandemic. We conducted mixed-method, community-engaged research using PCC. A cross-sectional study using EHR data from 5,330 pregnant individuals in 2019 assessed factors related to inadequate maternity care utilization. Qualitative research in 2020 explored perceptions of maternal health equity, barriers, and healthcare quality through 17 in-depth interviews and five focus group discussions with postpartum women, clinicians, and community-organization staff. Among 3,181 women, 90% had public insurance, and 95% were people of color. Using the Adequacy of Prenatal Care Utilization index, 1,648 (51.8%) received no or inadequate prenatal care; 1,267 (40%) lacked postpartum care. Women aged 18-24, Black women, Arabic-speaking women, and those who used tobacco during pregnancy appeared more likely to experience inadequate care. Qualitative data identified community-level determinants, namely health literacy and economic status. Health-seeking barriers included social-distancing, telehealth, and immigration status. Quality of care issues included disruptions in healthcare delivery, patient-provider experience, and continuity of care. Findings indicate disparities in maternal healthcare utilization which are likely downstream effects of broader social inequities. Addressing these disparities requires rights-based, community-informed policies that guarantee equitable, respectful, and accessible maternal care for all.