As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University’s Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.

The objective of this case report is to highlight critical findings of a cesarean scar partial molar ectopic pregnancy and review the counseling and management strategies. A 43-year-old G3P0201 patient with a history of two cesarean deliveries at 10 weeks 3 days by last menstrual period presented to the ED with a week of dark brown discharge. The patient had previously been diagnosed with a pregnancy of uncertain viability five weeks prior at an outside institution but was lost to follow-up. Transvaginal ultrasound and pelvic computed tomography were performed to guide counseling and recommendations for the management of what was concerning for both a partial molar pregnancy and a cesarean scar ectopic pregnancy (CSEP). After counseling, the patient underwent a gravid total abdominal hysterectomy and bilateral salpingectomy for definitive management of the CSEP, as she had satisfied her fertility goals. Pathology of the specimen confirmed a partial molar pregnancy in the cesarean scar without evidence of an accreta. Close review of early pregnancy imaging is critical in making a diagnosis of a caesarean scar ectopic pregnancy complicated by a molar pregnancy. A gravid hysterectomy may reduce the morbidity of this combination of rare pregnancy pathologies.