Andrew Wallach

This commentary presents lessons learned and unique aspects of the public health response of infectious disease physicians, infection prevention and control specialists, and the New York City Health Department to the 2025 Legionella outbreak in Harlem.

Background: In May 2022, mpox (formerly monkeypox) began spreading globally through LGBTQ+ sexual networks. By August 2022, New York City (NYC) became the global epicenter of the mpox outbreak, with the highest number of cases reported in the United States. Here, we quantify the mpox vaccination effort, focusing on flexible and community-responsive mobile vaccination. Methods: We describe an on-site mpox vaccination strategy at commercial sex venues, nightlife venues, and pride and health centers, during August 1–November 15, 2022. Data were collected on doses, demographics, and event size to determine and evaluate vaccine uptake. Results: The on-site vaccination strategy resulted in 3358 JYNNEOS doses administered at 363 events at 58 locations, including 22 events at 2 commercial sex venues. Commercial sex venues in New York City closed at the height of the mpox epidemic. We show high uptake of the JYNNEOS vaccine at commercial sex venues, with as many as 60% of attendees of 1 event receiving a JYNNEOS vaccine dose on site. This was possible after New York City health agencies responded to community demand for second doses. Messaging about the importance and availability of vaccination at these parties was community-led. JYNNEOS vaccination via mobile clinics demonstrated less racial and geographic disparity compared with nonmobile vaccinations. We show no increase in mpox cases as commercial sex venues reopened with vaccination on site. Conclusions: These results demonstrate the success of a community-led rapid response to an emergent mpox outbreak, including at places where people meet for sex.

Background: COVID-19 has caused over 46,000 deaths in New York City, with a disproportional impact on certain communities. As part of the COVID-19 response, the city has directly administered over 6 million COVID-19 tests (in addition to millions of indirectly administered tests not covered in this analysis) at no cost to individuals, resulting in nearly half a million positive results. Given that the prevalence of testing, throughout the pandemic, has tended to be higher in more affluent areas, these tests were targeted to areas with fewer resources. Objective: This study aimed to evaluate the impact of New York City’s COVID-19 testing program; specifically, we aimed to review its ability to provide equitable testing in economically, geographically, and demographically diverse populations. Of note, in addition to the brick-and-mortar testing sites evaluated herein, this program conducted 2.1 million tests through mobile units to further address testing inequity. Methods: Testing data were collected from the in-house Microsoft SQL Server Management Studio 18 Clarity database, representing 6,347,533 total tests and 449,721 positive test results. These tests were conducted at 48 hospital system locations. Per capita testing rates by zip code tabulation area (ZCTA) and COVID-19 positivity rates by ZCTA were used as dependent variables in separate regressions. Median income, median age, the percentage of English-speaking individuals, and the percentage of people of color were used as independent demographic variables to analyze testing patterns across several intersecting identities. Negative binomial regressions were run in a Jupyter Notebook using Python. Results: Per capita testing inversely correlated with median income geographically. The overall pseudo r ² value was 0.1101 when comparing hospital system tests by ZCTA against the selected variables. The number of tests significantly increased as median income fell (SE 1.00000155; P< .001). No other variables correlated at a significant level with the number of tests (all P values were >.05). When considering positive test results by ZCTA, the number of positive test results also significantly increased as median income fell (SE 1.57e ^–6 ; P <.001) and as the percentage of female residents fell (SE 0.957; P =.001). The number of positive test results by ZCTA rose at a significant level alongside the percentage of English-only speakers (SE 0.271; P =.03). Conclusions: New York City’s COVID-19 testing program was able to improve equity through the provision of no-cost testing, which focused on areas of the city that were disproportionately impacted by COVID-19 and had fewer resources. By detecting higher numbers of positive test results in resource-poor neighborhoods, New York City was able to deploy additional resources, such as those for contact tracing and isolation and quarantine support (eg, free food delivery and free hotel stays), early during the COVID-19 pandemic. Equitable deployment of testing is feasible and should be considered early in future epidemics or pandemics.

Context: Over 200 000 people seeking asylum have arrived in New York City from 2022 to 2024. Program: As the safety net hospital system for our city, New York City (NYC) Health + Hospitals (H + H) has taken the lead in caring for newly arrived asylum seekers. We used electronic medical record data to gain early insights into utilization and needs among these patients. Implementation: We developed a hybrid definition to identify patients who are asylum seekers and examined their demographics, insurance, utilization, primary billing diagnoses, and immunizations from the Epic EMR. We included data on other patients as a point of comparison and analyzed data separately for adult and pediatric patients. Evaluation: In 2023, 15 233 or 1.4% of H + H patients were asylum seekers. Asylum seekers had fewer visits than other patients in 2023, and utilization was particularly driven by pregnancy and childbirth. Children seeking asylum were engaged in primary care at high rates. Documented childhood vaccinations were higher among asylum-seeking children engaged in primary care compared to those who were not. The majority of adults and children were insured. Adult primary care engagement was low, as were visits for those seeking care for behavioral health issues. Discussion: For adult asylum seekers, pregnancy and childbirth are key needs for adults. Increasing vaccination rates among children is critical and promoting engagement in primary care is a promising way to do so. Coordinated efforts are required to meet the varied needs of migrant arrivals, and safety net hospitals can play a key role in addressing their health care needs.

BACKGROUND COVID-19 has caused over 45,000 deaths in New York City, with a disproportional impact on certain communities. As part of the COVID-19 response, the city has directly administered over six million COVID-19 tests (not including millions of indirectly administered tests not covered in this analysis), at no cost to the individual, resulting in nearly half a million positive results. Given that testing throughout the pandemic has tended to be higher in more affluent areas, these tests were targeted to areas with fewer resources. OBJECTIVE This study aims to evaluate the impact of this program; specifically, to review its ability to provide equitable testing in economically, geographically, and demographically diverse populations. Of note, in addition to the brick-and-mortar testing sites evaluated here, this program additionally conducted 2.1 million tests through mobile units, to further address testing inequity. METHODS Testing data was collected from the in-house Microsoft SQL Server Management Studio 18 Clarity database, representing 6,347,533 total tests and 449,721 positive tests. These tests were conducted at 48 hospital system locations. Per capita testing rates by zip code tabulation area (ZCTA) and COVID-19 positivity rates by ZCTA were used as dependent variables in separate regressions. Median income, median age, percent English speaking, and percent People of Color were used as independent demographic variables, to analyze testing patterns across several intersecting identities. Negative binomial regressions were run in a Juypter Notebook using Python. RESULTS Per capita testing was inversely correlated with median income geographically. The overall pseudo r-squared value when comparing hospital system tests by ZCTA against the selected variables was 0.1101. The number of tests significantly increased as median income fell (SE= 1.00000155, P<.001). No other variables correlated at a significant level with the number of tests. When considering positive tests by ZCTA, positive tests also significantly increased as median income fell (SE= 1.57e-06, P<.001) and as the percentage of females fell (SE= 0.957, P=.001). Positive tests by ZCTA rose at a significant level alongside the percentage of English-only speakers (SE= 0.271, P=.03). CONCLUSIONS This program was able to improve equity through the provision of no-cost testing focused in areas of the city that were disproportionately impacted and had fewer resources. By finding higher numbers of positive tests in resource-poor neighborhoods, New York City was able to deploy additional resources such as contact tracing and isolation/quarantine support including free food delivery and free hotel stays early in the course of the COVID-19 pandemic. Equitable deployment of testing is feasible and should be considered early on in future epidemics or pandemics. CLINICALTRIAL Biomedical Research Alliance of New York (BRANY) Study: 23-15-564, Sponsor ID: RH2023-814, Category: 15-Not Human Subject Research.

Access to specialty care continues to be a problem for urban underserved populations in the United States. Demand for specialty care is high, with as many as 25% of visits at community health centers resulting in referrals for specialty care,¹ yet Medicaid enrollees have difficulty obtaining specialty appointments.² In a survey of community health center directors,³ 85% reported that their uninsured patients had difficulty accessing new specialty patient visits. This results in many patients not receiving specialty care—only half of uninsured patients reported actually seeing a specialist when recommended to do so.⁴ Barriers to access include long wait times, specialists not accepting new publicly insured or uninsured patients, communication gaps between primary care physicians and specialists, and poor sharing of information.^1,3,5,6 New models of care that can bridge these gaps are sorely needed to achieve equitable access to specialty care for patients in a safety-net system.

Background: New York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City’s public hospital system. Methods: We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. Results: 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5–64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7–72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. Conclusions and relevance: This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

NYC Health + Hospitals (NYC H+H) is the largest safety net health care delivery system in the United States. Prior to the novel coronavirus disease (COVID-19) pandemic, NYC H+H served over one mill...

Ascending to the peak of the novel coronavirus disease (COVID-19) pandemic in New York City, NYC Health + Hospitals (NYC H+H), the City’s public health care system, rapidly expanded capacity across...

In early March 2020, an outbreak of the coronavirus disease 2019 (COVID-19) in New York City exerted sudden and extreme pressures on emergency medical services and quickly changed public health pol...