Communities with more robust primary care, a stronger public health infrastructure, and fewer social vulnerabilities had some of the lowest risks of Covid-19 infection and death, according to a report released by the Primary Care Collaborative (PCC) and the Robert Graham Center (RGC).

The communities that fared the best (and worst) against Covid-19

In the report, researchers examined primary care access, strength of public health, and the degree of social vulnerability at the county level using the Community Health Index (CHI), a construct developed by RGC. The CHI is an average score based on public health preparedness, primary care provider supply rates, and social deprivation index. Each county was scored on those three measures with potential scores ranging from a low of three to a high of 30. Counties were then divided into quintiles based on their score, with the highest CHI scores in the fifth quintile and the lowest in the first quintile.

Then, the researchers examined the relationship between county-level CHI scores and three health factors, including:

• Covid-19 infection rates before and after vaccines became available
• Covid-19 death rates before and after vaccines became available
• Covid-19 vaccination rates

Overall, the researchers found that residents of counties in the quintile with the highest CHI score were 12% less likely to be infected by the coronavirus and 42% less likely to die from Covid-19 than residents of counties in the lowest quintile. People in counties with the highest CHI quintile were also 26% more likely to be vaccinated against Covid-19.

According to the report, counties in the highest CHI quintile had an average score of 26.7, suggesting that they scored high in all three categories. Counties in this quintile represent 17% of the U.S. population and had a mean population of 233,000.

In comparison, counties in the lowest CHI quintile had an average score of 8.6, which suggests they either scored high in only one category or low across all three categories. Counties in this quintile represent 20% of the U.S. population and had a mean population of 54,000.

In addition, the researchers noted that while rates of Covid-19 infections and death fell across all U.S. counties when the vaccines became available, counties in the highest CHI quintile saw faster declines in both outcomes than counties in the lowest CHI quintile.

"It's not just having the vaccine available," said Yalda Jappapour, RGC's medical director and one of the report's authors. "There's something else that is happening here. Because whether it was before or after vaccinations, counties with the better CHI scores had less cases and less deaths compared with those who had the lowest scores. It's a combination of good primary care access, robust public health preparedness and social assets that also matters."

The importance of all 3 factors in combating Covid-19

Glen Mays, chair of the department of health systems, management, and policy at the Colorado School of Public Health, who was not involved with the report, said the findings were "eye-opening," Healio News reports.

"When we study public health, we usually have to look at long-term effects of public health interventions," he said. "What's striking [about the report] is that we can see immediate effects from all three sectors being strong together, being able to work as effective partners for each other."

The authors of the report also emphasized the importance of a "multi-pronged approach" in reducing the impact of the pandemic.

"The title of this report ['Primary Care and Covid-19: It's Complicated. Leveraging Primary Care, Public Health and Social Assets'] describes interrelated and mutually reinforcing factors critical in a high-risk situation like a pandemic," Jappapour said. "Bringing all these areas closer together will be challenging but essential in our continued efforts to combat Covid-19 and in preparation for future pandemics."

In addition, the authors wrote that the report raises concerns about the level of U.S. investment in critical health infrastructure and whether existing infrastructure is being leveraged adequately.

"As we emerge from the current pandemic and reimagine and rebuild primary care, we also need to look at other factors, such as investment in public health and community-based services," said Ann Greiner, PCC's president and CEO. "It is beyond time for us all to reach beyond our silos and join forces to address the widening health inequities that the pandemic laid bare and to better prepare for a future health emergency." (Gleeson, Becker's Hospital Review, 10/21; Morse, Healthcare Finance News, 10/18; Miller, Healio News, 10/20; Primary Care Collective/Robert Graham Center report, 10/18)