438 - Characteristics and Epidemiology of a Native American Community with a High Prevalence of COVID-19

Background: COVID research and reporting has focused on large urban populations. However, limited data suggests that rural Native American (NA) populations are disparately impacted. We serve a well-defined NA population of ≈18,000 that is relatively geographically isolated in the White Mountains of eastern Arizona. Our first case SARS-CoV-2 was confirmed April 1^st. We have since confirmed an attack rate significantly higher than most of the United States. We provide testing and case trends in addition to characteristics of the first 800 cases.

Methods: We sequentially reviewed the charts of all laboratory-confirmed COVID-19 patients from April 1 to June 3, 2020. In addition to calculating prevalence and rates, we provided summary statistics that were used to describe testing breakdown, demographics, symptoms, and co-morbidities.

Results: From April 1 to June 3, we tested 2,662 persons, of which 884 (33.2%) were positive. The estimated prevalence of the time of writing is 4.9% and the rate of 4,911 per 100,000 persons. Data compiled from the first 800 laboratory-confirmed patients is summarized in table 1. Median age for confirmed cases was 40.6 (IQR 28-54). 555 cases (72.1%) were symptomatic. The most common symptoms were cough (67.7%), subjective fever (39.5%), and muscle aches (36.8%). 30.6% of confirmed cases were asymptomatic at the time of testing. The majority of cases were among persons aged 30-39 years (22.9%). Some of the most common comorbidities in confirmed cases included cardiovascular disease (30.4%), substance abuse (30.1%), and diabetes (25.0%). There were 18 (2.04%) deaths.Clinical findings among symptomatic patients


Conclusion: We observed a significantly higher prevalence (10-times) and attack rate of (17-times) COVID-19 in a well-defined NA population, when compared to the general Arizona population. We provide characteristics of these cases and report that nearly a third were asymptomatic at the time of testing. More research is needed to understand the rapid spread of COVID-19 in vulnerable rural communities.