Category 1
COVID-19

Background: The Interprofessional Education Collaborative (IPEC) core competencies include communication, values/ethics, teamwork and roles and responsibilities. COVID-19 vaccination clinics require collaboration among academic-community partnerships including health departments, capacity-building and infrastructure for sustainability.

Goal: Discuss collaboration and strategies for partnerships among interprofessional healthcare professions faculty and students with health departments and implication for COVID-19 vaccination clinic.

Objectives: Describes the incorporation of IPEC competencies in developing, implementing and evaluating emergency preparedness point-of-dispensing (POD) exercises among inter-institutional and interprofessional faculty and students in collaboration with state and local health departments over 7 years and its implications for COVID-19 vaccination clinic.

Approach/Methods: POD drill was developed and implemented by faculty at University of Maryland Eastern Shore School of Pharmacy and Health Professions in collaboration with Maryland Department of Health Office of Preparedness and Response, Maryland Board of Pharmacy Emergency Preparedness Taskforce, and Somerset County Health Department, then expanded to Salisbury University.

Results: Interprofessional POD drill was conducted seven times during 2013-2019 and involved dietetics, kinesiology, nursing, pharmacy, physician assistant, physical therapy and respiratory therapy for simulated emergency preparedness training for over 850 students. During POD exercise, interprofessional students rotated through simulated activities at five stations: registration, triage, dispensing, special needs, and consultation. All planners and participants provided feedback through survey and post-action reports. POD exercise facilitated opportunity for students to sign up as volunteers for Maryland Respond.

Importance to Public Health: POD drill provided a collaborative opportunity for interdisciplinary faculty and dynamic educational setting for students to learn about, from and with each other in ensuring the safety and healthcare, including mass dispensing of medications for a rural community and population during a large-scale emergency. Benefits included partnership with state and local health departments for real-world application of classroom lessons, including application to the COVID-19 vaccination clinic to address a pandemic and public health emergency.

Background: The COVID-19 pandemic declaration placed local health departments such as the Howard County Health Department (HCHD) at the front lines of emergency response. Early in the pandemic, the HCHD focused efforts on COVID-19 testing and utilized the principles of Continuous Quality Improvement (CQI) to improve its operation.

Goal: To apply the principles of CQI to the COVID-19 public health emergency response.

Objectives:

1. Make timely changes based on feedback from staff/volunteers and partners to continuously improve and adapt the COVID-19 testing operation

2. Review and document the overall response effort to prepare for the next phase of the pandemic response in a Mid-Course After Action Report (MAAR) and Improvement Plan (IP)

Approach/Methods: A survey link was sent to all staff/volunteers after each testing day. The feedback were subsequently reviewed, and changes made to the following day of operation. The overall response was reviewed also and documented.

Results: Both quantitative and qualitative data were gathered from the 403 responses received from the staff/volunteer survey between April and September 2020. 81 percent of respondents rated the overall process “Above Average” while 19 percent rated it “Average.”

In terms of the MAAR, 53 responses were received from the internal survey sent to 83 staff. The overall prompt response, public education and communication were noted as success. 13 responses were received from the external partner survey. Over 90% of the responding partners indicated that the HCHD was successful in communicating and working with their organization during the pandemic.

Importance to Public Health: The framework utilized by the HCHD for the CQI of its COVID-19 operations is a model for other emergency response operations in accordance with the Federal Emergency Management Agency (FEMA) guidelines. Additionally, it allowed the planning team to be more proactive in its responsive to the early dynamic nature of the pandemic.

Background: In Bangladesh, high poverty and low education in the manufacturing-based economy, along with conflicts with Islamic law, pose serious threats to COVID-19 vaccination uptake. This puts the well-being of the country’s 163 million people.

Goal: Representing the Ministry of Health and Family Welfare of Bangladesh, we created a COVID-19 vaccine distribution and messaging campaign that addressed national inequities and unique factors contributing to vaccine hesitancy.

Objectives: Through background research & root cause analysis, we hypothesized that challenges were influenced by the following:

• Illiteracy & lack of education

• Widespread hunger and poverty

• Confusion and lack of transparency from authority figures (i.e. religious leaders)

Because of this, we hypothesize that the best methods to combat the above challenges is through:

• Building community trust through using respected leaders and media campaign promotion to spread the word on vaccination importance and guideline adherence

• Increasing vaccine accessibility through mobile vaccination units and on-site vaccination

Approach/Methods: To build community trust, we relied on existing models with widespread use in Bangladesh, such as jiggashas and partnerships with local imams (utilising BRAC and the ministry of religious affairs, for example) For the accessibility, we worked to vaccinate garment factory workers on-site as they are a huge part of the population, and incentivized them with food. We also designed setting-friendly MVU’s for rural and urban impoverished areas.

Results:

• Our total budget utilized was $88 million USD

• We did not place in finals with our presentation.

Importance to Public Health: We see this competition as an avenue to understanding global health through a beginner-friendly context. The competition got us thinking of multidisciplinary methods to introduce cultural competency and gather methodologies from successful initiatives as we worked to design our own initiative to tackle this important challenge.

Background: COVID-19 messages vary around the world and populations receive these messages in different ways. Children are a vulnerable audience, especially in terms of risk communication. As messages are being developed, communicated, and disseminated about this pandemic, it is important to know the relation between COVID-19 knowledge and concern among preadolescents.

Goal: Examine the relationship between COVID-19 knowledge and concern among preadolescents globally.

Objectives: We wanted to explore the relation between children’s knowledge and concern about COVID-19. Are children who were more knowledgeable about the pandemic more or less concerned about the disease and its effects? Did this relation vary by geographic region?

Approach/Methods: We collected data from children between the ages of 9 to 13 years. In our analyses, we clustered data geographically, forming 8 regions from 42 countries. Only countries with data from more than 50 children were included in the analysis. Given that sample sizes varied, we statistically weighted the data by number of participants, gender, age, and country. The online survey had around 160 items, including demographics, COVID-19 knowledge, COVID-19 concerns, as well as sections about media use. To measure children’s knowledge about COVID-19, we asked 43 items about prevention and symptoms (Cronbach’s alpha= 0.62). Children received knowledge scores based on correct and incorrect responses about COVID-19. We gave children a score of +1 for a correct answer, and -1 for an incorrect answer. We also assessed children’s personal worries about getting sick, family members and friends getting sick, missing classes and being out of school, and interruption of social activities. An overall concern score had 10 items, and a Cronbach’s alpha of 0.76. The analyses began with exploring univariate and bivariate relations around the different variables, considering significant associations at a p< 0.05 level. We looked at patterns within and regions. We estimated regression models predicting overall and different types of concern, controlling for sex, age, and region (all which were dummy variables). Into these models, we entered children’s knowledge about COVID-19 and interactions between knowledge and region.

Results: Analyses revealed different relations between knowledge and concern by region. Children from Sub-Saharan Africa, the Arabian region, Asia, and North America with greater knowledge also had more concern. Among those from Latin America, Oceania, Europe, and Southeast Asia, the relation was flat or negative.

Importance to Public Health: When producing messages for children during a public health crisis, health communicators must know that more information is not always associated with less concern.

Background: The early months of the ongoing COVID-19 pandemic were characterized by stay-at-home orders and social distancing guidelines. While necessary, these introduced a unique combination of social isolation, acute psychological stress, and altered daily routines that may negatively impact natural behaviors such as sleep patterns and influence feelings of anxiety and depression.

Goal: This study aimed to explore how sleep quantity and quality affected measures of anxiety and depression in the early stages of the COVID-19 pandemic.

Objectives:

1. Determine the independent effect of sleep quantity on GAS and GDS scores.

2. Determine the independent effect of sleep quality on GAS and GDS scores.

Approach/Methods: Online survey of adults (n = 711, 18-90 years) in North America between April 9th - 30th, 2020. Survey included demographic questions as well as validated scales such as the Geriatric Anxiety Scale (GAS), the Geriatric Depression Scale (GDS) and sub-scales of the Pittsburgh Quality Index (PSQI). Multiple linear regression was employed to determine the effect of sleep quantity and quality on GAS and GDS scores controlling for age, sex, race, and education.

Results: The total number of recorded sleep hours was found to be a significant predictor of GAS (p<0.001, R2=0.10) and GDS (p<0.001, R2=0.07) scores. Indices of sleep quality such as sleep disturbance scores and subjective sleep quality were also found to be significant predictors of GAS (S.Disturb= p<0.001, R2=0.26; Subj. S.Qual = p<0.001, R2=0.22) and GDS S.Disturb= p<0.001, R2=0.15; Subj. S.Qual = p<0.001, R2=0.15), and in general, individuals with poor sleep quality were found to have significantly greater GAS and GDS scores (p<0.0001).

Importance to Public Health: These data suggest that retaining good sleep quantity and quality may benefit mental health during uncertain and socially isolating public health crises such as the COVID-19 pandemic. Moreover, improving sleep quality, may aid combat the growing mental health burden of the COVID-19 pandemic.

Background: Increasing epidemiological evidence, especially from super-spreading events, implicates aerosol inhalation as an important mode of transmission of the SARS-CoV-2 virus. However, little is known regarding the amount of virus shed into exhaled breath by COVID-19 cases.

Goal: This study aims to characterizeSARS-CoV-2 virus in the exhaled breath of COVID-19 cases and identify potential predictors of shedding in the exhaled breath.

Objectives: (1) Using samples from COVID-19 cases recruited from College Park, we quantified the fraction of participant with detectable SARS-CoV-2 RNA in their coarse, droplet, and fine aerosol specimens.

(2) We would also like to explore potential predictors for detectable viruses in exhaled breath among patients with SARS-CoV-2.

Approach/Methods:This analysis involved those with laboratory evidence of SARS-CoV-2 infection, from whom we collected mid-turbinate swabs, saliva, venous blood, phone swab, exhaled breath samples, and self-reported symptoms (on a scale of 0 = “no symptoms,” to 3 = “quite bothersome most or all of the time and stopped me from participating in activities”). Composite scores are calculated by summing individual symptom scores: systemic (malaise + headache + muscle/joint ache + sweats/fever/chills), gastrointestinal (loss of appetite + nausea + vomit + diarrhea), lower Respiratory (chest tightness + shortness of breath + cough), and upper Respiratory (runny nose + stuffy nose + sneeze + earache + sore throat). Crude and adjusted odds ratios were estimated for potential characteristic factors defined a priori and the four symptoms scores using generalized linear mixed-effects models. Sensitivity analyses were done excluding those with positive antibody at their first visit.

Results: Among 39 participants infected with SARS-CoV-2, 8 (20%) volunteers had detectable SARS-CoV-2 RNA in their breath specimen, among whom 6 had detectable virus in each of their coarse, droplet, and fine aerosol specimens, while the remaining 2 had detectable SARS-CoV-2 RNA only in their fine aerosol. In the crude analysis of potential predictors, number of coughs during the exhaled breath collection was a significant predictor for fine aerosol (COR=1.148, 95% CI: 1.001-1.316), while systemic symptom score was positively associated with coarse(COR=1.481, 95% CI: 1.032-2.123) and fine (COR=1.517, 95% CI: 1.110-2.071) aerosol. However, after adjusting for sex, age, BMI, and time since illness onset, none of the variables turned out to be significantly related to the exhaled breath shedding. In the sensitivity analysis, number of coughs during exhaled breath collection and systemic symptom score were positively related to coarse and fine aerosol in the crude analyses, while none of the variables seemed to play a role in the adjusted models.

Importance to Public Health:Characterizing the shedding of SARS-CoV-2 in the exhaled breath and its potential predictors helps identify potential super shedders in the population and inform measures taken to contain the spread of the virus.

Background: Public health jurisdictions are tasked with dispensing medical countermeasures through points of dispensing (POD), despite receiving limited national, regional, or state guidelines. RealOpt-PODv8.0.2© (RealOpt) software, developed by Lee and colleagues, is recommended for planning the distribution of countermeasures within 24 hours to the area’s population with minimal staffing requirements.

Goal: This study aims to parameterize RealOpt-based planning models to support planning for population-based medical countermeasures, such as vaccines, to combat emerging pandemics.

Objectives: For this case study, RealOpt was used to optimize a POD model for delivering anthrax countermeasures to Union County's entire population of 52,300 in 24 hours.

Approach/Methods:In an iterative process, RealOpt software was initially used to understand the layout for minimizing throughput time. External data informed additional simulation parameters, while a Union County Health Department drill provided process timings. This information was then used to refine the RealOpt model.

Results: Using RealOpt, we identified an optimal ratio of screeners, dispensers, and quality control workers for Union County to provide medical countermeasures to 9,614 heads of household in 12 hours +/- 41 minutes (~801/hour). This included avoiding POD worker overutilization and promoting flow times for individuals with small queue lengths as possible.

Importance to Public Health:The findings provide an early methodological basis of future resource-typing for widely adaptable and scalable dispensing operations, particularly for rural areas. The approach and resulting model presented can be tailored to support planning for population-based vaccine administration to combat emerging pandemics.

Background: Employment status, fast food access, and obesity are associated with health outcomes that may relate to COVID-19 morbidity and mortality. In order to assess the correlations between these social determinants of health and COVID-19 outcomes, we conducted an ecological study in the Commonwealth of Virginia.

Goal: To investigate the impact of social determinants of health on COVID-19 infections, hospitalizations, and case-fatality rates in Virginia.

Objectives: To identify correlations between 1) employment-related factors and COVID-19 outcomes, 2) fast food access and COVID-19 outcomes 3) obesity and COVID-19 outcomes.

Approach/Methods:We analyzed data from the U.S. Census American Community Survey (2014-2019), U.S.D.A. Food Atlas (2011-2016), Institute of Health Metrics and Evaluation (2001-2009), and the Virginia Department of Health to correlate county-level social exposures with COVID-19 incidence, hospitalization, and case-fatality rate in Virginia. All statistical analyses were performed in Excel and STATA version 16.

Results: We found several significant correlations between our social exposures of interest and COVID-19 outcomes at the county-level in Virginia. COVID-19 infections were negatively correlated with labor force participation (r=-0.1742, p=0.0449), employment rate (r=-0.2286, p=0.0081), and work-at-home status (r=-0.3243, p=0.001). Contrarily, unemployment rate was positively associated with infections (r=0.2786, p=0.0012), hospitalizations (r=0.4607, p<0.0001) and case-fatality rates (r=0.3001, p=0.0004). Likewise, service occupation was positively correlated with both infections (r=0.4049, p<0.0001) and hospitalizations (r=0.2139, p=0.0134). The number of fast food restaurants per capita in 2016 was positively correlated with COVID-19 cases (r=0.1770, p=0.0415), hospitalizations (r=0.2249, p=0.0092), and case-fatality rates (r=0.1882, p=0.0301). Finally, COVID-19 outcomes were positively associated with 2001 and 2009 male and female obesity. Notably, 2001 female obesity prevalence was correlated with all three outcomes: infections (r=0.3037, p=0.0004), hospitalizations (r=0.3916, p<0.0001), and case-fatality rates (r=0.1771, p=0.0414).

Importance to Public Health:Our findings support temporary need for employment security, economic relief, and protections against occupational hazards of infection during the pandemic. Further, we identify infectious disease risks associated with fast food access and obesity as objectives for longer term reform.

Background: The COVID-19 pandemic has drastically changed the research environment with institutions struggling to maintain networks and career development links for Doctoral Students and Early Career Investigators (ECRs) now and in the future. The decrease in funding and travel opportunities impacts individuals in the early stage of their research careers, especially investigators that have been historically underrepresented in Health Management, Services, and Policy disciplines.

Goal: To develop and implement a virtual translational science research platform for Universitas 21 (U21) members and centers. Via collaboration between the University of Maryland College Park (UMD) and University of Birmingham (UoB) to identify research and career development resources and strategies across academic and non-academic research institutions. This project was funded by the Universitas 21 (U21) Researcher Resilience Fund.

Objectives: To support development of the U21 network’s Doctoral, and ECR and address health systems needs through a virtual translational science research platform “Health Research Exchange (HREx)”. HREx will build digital capacity within the U21 network and minimize barriers to career enhancement in times of unforeseen rapid social, economic, environmental, and political changes through culturally sensitive evidence-based mentorship and professional development opportunities emphasizing diversity and inclusivity.

Approach/Methods:Doctoral students and ECRs affiliated with UMD and UoB were recruited using institutional email, listservs, and social media groups/handles. A 20-minute Qualtrics survey was fielded from November-December 2020, asking participants about their experiences with research collaboration and career development. Responses were used to inform the development of HREx content areas. This project was approved by the Institutional Review Board of the UMD Office of Research Compliance.

Results: There were 32 completed responses: 19 from doctoral students (UMD=12, UoB=7) and 13 from early career investigators (UMD= 6, UoB= 7). Doctoral students and ECRs were predominately women across UMD and UoB institutions (UMD=94%, UoB = 64%). The sample was racially and ethnically diverse among doctoral students primarily from UMD (identifying as White/Caucasian = 4, Asian = 2, Black/African-American = 2, Pacific Islander = 1, Hispanic/Latinx = 1, American Indian or Alaskan Native, Mixed Race= 2), compared to UoB students who predominately identified as White/Caucasian. The average age for doctoral students was younger (33.4 years) compared to ECRs (36.7 years). Overall, respondents expressed challenges in current roles and concerns about career trajectory.

Importance to Public Health: The HREx platform, set to launch by U21 this year, will provide a collaborative space for doctoral students and ECRs to access career development resources and facilitate mentorship at U.S. and International levels.

Background: During a global public health crisis, children are particularly vulnerable, making it critical to examine their unique perspectives. Countries around the world differed in their COVID-19 responses, affecting transmission, illness, and death rates. Sub-Saharan African countries faced distinct issues associated with history, leadership, differing political goals, resource allocation, infrastructural challenges, and economic burden. Hearing the voices of Tanzanian, Nigerian, and Sierra Leonean children offers important exploratory insight across three distinct regions of sub-Saharan Africa. Each country took very different tactics to the COVID-19 pandemic. It is fair to expect children of each country to face this pandemic in particular and dissimilar ways.

Goal: Our goal was to hear, capture, and learn from sub-Saharan African children’s experiences with the COVID-19 pandemic.

Objectives: To meet this goal, we set out to conduct an exploratory qualitative analysis, interviewing 51 children, ages 9 to 13, from Nigeria, Tanzania, and Sierra Leone.

Approach/Methods: We conducted semi-structured interviews with a phenomenological approach. Grounded theory coding techniques captured major themes to structure the results and frame children’s experiences. Applying Bronfenbrenner’s Ecological Systems Theory, we considered how COVID-19 affected children’s daily lives and domestic challenges, schooling and neighborhood issues, media use (and its relationship to knowledge and fear), perceptions of country/government responses, and thoughts of religion and hope.

Results: While there were differences, patterns emerged across sex, age, household size, religion, and country. Children expressed varying levels of fear and worry, media use, food insecurity, personal and familial concerns, and school struggles.

Importance to Public Health: This study offers guidance and recommendations in addressing children’s needs, especially in times of crisis. We found a need to create ways for students to continue their studies while addressing children’s stress levels and nutritional needs. Media should responsibly inform, educate, and reduce fear, with the government and media working together towards consistent and transparent messaging. Efforts should be made to allow for safe religious worship as a significant coping mechanism for children. It is important that the best science is taken into consideration when health education campaigns and policies that affect children are crafted.

Background: Testing for COVID-19 infection has largely been for symptomatic cases or persons under investigation. However, it is assumed that a significant percentage of people in the community have been infected with SARS-CoV-2 but did not experience signs and symptoms of the virus, or the test was falsely negative.

Goal: This project aimed to analyze primary serosurvey data based on the hospital setting across the state of Maryland to understand better how many infections have produced detectable antibodies.

Objectives: The main objective is to assess the true burden (or prevalence) of SARS-CoV-2 infection largely using antibody serology testing in a short-term rapid assessment.

Approach/Methods:Blood specimens collected from hospitals across the state were transported to the MDH laboratory in Baltimore for serology testing. All laboratory test results were recorded, stored in a secure developed database, and released to the research team for data analysis. Using descriptive statistics, we first described the characteristics of the study population according to race. To determine key predictors of SARS-CoV-2 seropositivity, we then exploited advanced statistical methods such as the logistic regression analysis and Chi-square test through the SAS program to estimate the odds ratios (ORs) of SARS-CoV-2 seropositivity among gender, age groups, race, and within hospital facilities.

Results: Our findings indicated no significant association between gender and SARS-CoV-2 seropositivity (OR:1.01, 95%CI:0.749-1.352, p-value=0.9658). However, there was a strong association between age and SARS-CoV-2 seropositivity (OR:1.15, 95%CI:1.065-1.236, p-value=0.0003). Interestingly, our results also showed that race was determined to be significantly associated with SARS-CoV-2 seropositivity (OR:1.32, 95%CI:1.171-1.482, p-value<0.0001). Specifically, the Black and Hispanic groups had a higher risk of COVID-19 infection than the White group. Although there were substantial differences in SARS-CoV-2 seropositivity rates across hospitals, there was no significant association between the overall hospital facilities and SARS-CoV-2 seropositivity (OR:1.01, 95%CI:0.929-1.097, p-value=0.8216).

Importance to Public Health:This project has provided a useful and effective means to identify key factors associated with COVID-19 infection. It contributes to the development of a strategic testing plan to address disparities in all communities with the overall goal of informing specific decisions around policies and public health prevention and control activities strategies, as well as mitigation interventions.

Background: Very little is known about COVID-19 asymptomatic carriers regarding several characteristics. Learning from historical quality data in Hong Kong can help revealing the characteristics in interest.

Goal: Revealing unclear factors of COVID-19 asymptomatic carriers can help improving future health policy when dealing with similar pandemic.

Objectives: To use a retrospective cohort study design to reveal unknown factors such as asymptomatic conditions and gender differences among COVID-19 carriers.

Approach/Methods:We collected longitudinal data from the Hong Kong Department of Health of 1108 patients who tested positive for COVID-19 between January 23 and June 11, 2020. We utilized general linear regression models, t-tests, binominal logistic regression models, multivariate linear regression models, and correspondence analysis to examine interested associations, correlations, and differences. We used Kaplan-Meier estimators and cox proportional-hazards model for survival analysis.

Results: Imported asymptomatic carriers with international flight histories had clear time-series transmission patterns. Locally acquired asymptomatic carriers showed community transmission patterns. For every 1-year increase in age, there was a 1.78% reduction in the odds of being asymptomatic (p<0.0001). Asymptomatic patients experienced a 5.8-day shorter length of stay than symptomatic ones (p<0.0001). With every 1-day increase between onset and hospitalization among symptomatic patients, there was a decrease of 0.49-day length of stay in hospitals. With every 1-year increase in age, the hazard rate increased by 8%. Gender differences of several factors were not statistically significant.

Importance to Public Health:Imported asymptomatic carriers with international flight histories had clear time-series transmission patterns. Locally acquired asymptomatic carriers showed community transmission patterns. For every 1-year increase in age, there was a 1.78% reduction in the odds of being asymptomatic (p<0.0001). Asymptomatic patients experienced a 5.8-day shorter length of stay than symptomatic ones (p<0.0001). With every 1-day increase between onset and hospitalization among symptomatic patients, there was a decrease of 0.49-day length of stay in hospitals. With every 1-year increase in age, the hazard rate increased by 8%. Gender differences of several factors were not statistically significant.

Background: The COVID-19 pandemic has had a great impact on racialized and lower socioeconomic groups, confirming existing disparities. The role that the social determinants of health, especially education, play in the COVID-19 pandemic remains unexplored.

Goal: To investigate the impact of educational attainment, quality, and investment on COVID-19 infections, hospitalizations, and case-fatality rate in the Commonwealth of Virginia.

Objectives: To identify the correlation between 1) educational attainment and COVID-19 outcomes, 2) sex differences in educational attainment and COVID-19 outcomes, 3) educational investment and quality and COVID-19 outcomes.

Approach/Methods: We analyzed data from the U.S. Census American Community Survey (2017-2018), Virginia Department of Education School Quality Profiles(2018-2019), and Virginia Department of Health (2020-2021). Three COVID-19 outcomes from the Virginia Department of Health through January 31, 2021, were used: infection, hospitalization, and death. Correlation (r) values and associated p-values <0.05 determined the relationships and statistical significance between education and COVID-19 morbidity and mortality. All statistical analyses were performed in Excel and STATA version 16.

Results: The proportion of high school graduate or higher correlated negatively with COVID-19 infection (r= -0.4292, p<0.0001),hospitalizations (r= -0.5093, p<0.0001), and case-fatality rate (r= -0.2121, p=0.0143). Within the total population of high school graduates or higher, the proportion of female high school graduates or higher correlated negatively with COVID-19 infection (r= -0.4497, p<0.0001) and COVID-19 hospitalizations (r= -0.5711, p<0.0001). The negative correlation between grade 11 reading proficiency rate and COVID-19 infection is statistically significant (r= -0.3281, p=0.0001). However, no association was found between teacher quality measured by inexperienced teacher rate and COVID-19 infection (r= 0.0491, p=0.0001).

Importance to Public Health: Our findings provide evidence-based information for educational policy initiatives to address county-level social vulnerabilities in the context of improving inequitable health outcomes. Further investigation is needed into how infectious disease risks are associated with educational attainment and quality in order to prevent negative health outcomes during respiratory virus outbreaks.