A Tale of Three Pandemics – SARS-CoV-2, HCV, and HIV in an Urban Emergency Department in Baltimore, Maryland

Abstract Background Emergency Departments (EDs) serve as a window for detecting and tracking emerging infectious disease epidemics. We sought to determine the prevalence, socio-demographic and clinical correlates of acute and convalescent SARS-CoV-2, HCV, and HIV infections among ED patients in Baltimore. Methods Remnant blood samples from 7450 unique ED patients were collected over four months in 2020 for SARS-CoV-2 antibody (Ab), HCV Ab, and HIV-1/2 antigen (Ag) and Ab. 5012 patients were tested by PCR for SARS-CoV-2 based on clinical suspicion. Socio-demographics, ED clinical presentations and outcomes associated with co-infections were assessed. Results Overall, 729 (9.8%) had SARS-CoV-2 (acute or convalescent), 934 (12.5%) HCV, and 372 (5.0%) HIV infection. There were 211 patients (2.8%, 95% CI: 2.5%, 3.2%) with evidence of any co-infection (HCV/HIV: 1.5%, SARS-CoV-2/HCV: 0.7%, SARS-CoV-2/HIV: 0.3%, SARS-CoV-2/HCV/HIV: 0.3%). The prevalence of SARS-CoV-2 (acute or convalescent) was significantly higher in those with HCV or HIV versus those without (13.6% vs. 9.1%, p<0.001). Key socio-demographic disparities (race, ethnicity, and poverty), and specific ED chief complaints, diagnoses, and disposition were significantly correlated with having any co-infections versus no infection or individual mono-infection. Among those with HCV or HIV, age 18-34 years, Black, Hispanic, and having a cardiovascular-related chief complaint had a significantly higher odds of having SARS-CoV-2 (prevalence ratio: 2.02, 2.37, 5.81, and 2.07, respectively). Conclusions The burden of SARS-CoV-2, HCV, and HIV co-pandemics and their associations with specific socio-demographic disparities, clinical presentations and outcomes suggest that urban EDs should consider implementing integrated screening and linkage-to-care programs for these three infections.