Assessing COVID-19 risk, vulnerability and infection prevalence in communities

BACKGROUND: The spread of coronavirus in the United States with nearly five and half million confirmed cases and over 170,000 deaths has strained public health and health care systems. While many have focused on clinical outcomes, less attention has been paid to vulnerability and risk of infection. In this study, we developed a planning tool that examines factors that affect vulnerability to COVID-19. METHODS: Across 46 variables, we defined five broad categories: 1) access to medical services, 2) underlying health conditions, 3) environmental exposures, 4) vulnerability to natural disasters, and 5) sociodemographic, behavioral, and lifestyle factors. The developed tool was validated by comparing the estimated overall vulnerability with the real-time reported normalized confirmed cases of COVID-19. ANALYSIS: A principal component analysis was undertaken to reduce the dimensions. In order to identify vulnerable census tracts, we conducted rank-based exceedance and K-means cluster analyses. RESULTS: All of the 5 vulnerability categories, as well as the overall vulnerability, showed significant (P-values <<0.05) and relatively strong correlations (0.203<ρ<0.57) with the normalized confirmed cases of COVID-19 at the census tract level. Our study showed a total of 722,357 (~17% of the County population) people, including 171,403 between the ages of 45–65 (~4% of County’s population), and 76,719 seniors (~2% of County population), are at a higher risk based on the aforementioned categories. The exceedance and K-means cluster analysis demonstrated that census tracts in the northeastern, eastern, southeastern and northwestern regions of the County are at highest risk. CONCLUSION: Policymakers can use this planning tool to identify neighborhoods at high risk for becoming hot spots; efficiently match community resources with needs, and ensure that the most vulnerable have access to equipment, personnel, and medical interventions.