Since its launch in 1972, the Emergency Medicine Foundation (EMF) has awarded grants totaling more than $17 million to support research projects developed to improve and advance the field of emergency medicine. Recently, the organization awarded $163,967 in grants to fund four active COVID-19 research projects led or co-led by U.S.-based emergency physicians.

Among these grantees is John D. Purakal, MD, MSc, assistant professor of emergency medicine at Duke University School of Medicine in Durham, North Carolina. Dr. Purakal received a $50,000 COVID-19 research grant award from the EMF to support his project “Social Determinants of Health and COVID-19 Infection in North Carolina: A Geospatial and Qualitative Analysis.” To learn more, we spoke with Dr. Purakal about the impetus behind the project and the short- and long-term goals that he and his team set out to achieve.

EMF: Tell us about your EMF grant project.

JP: This project is designed to identify the highest at-risk patients in areas surrounding our hospital system so we can target our education and resources and develop a community-based strategy to address these patients’ needs. First, we look at particular census track data from the North Carolina Department of Health and Human Services and the maps showing where these social determinants of health are most disproportionate or affecting people the most. Second, we create a geospatial map of our COVID-19 outbreaks. Third, we put the two maps together and figure out which of the social determinants of health are most highly associated with outbreaks and may be contributing to COVID-19 clusters or hot spots. So, in the first part of our study we create a map of hot spots or clusters to help us identify patients in the highest-risk areas.

On the back end though, we explore this further with qualitative analysis or interviews with those identified patients to learn about their personal experience with COVID-19. In one of our early interviews, the patient said that only when they tested positive did they start talking about COVID-19 with others in their community. It took them coming forward first before anybody else would share their information. We can see how that would affect disease spread—asymptomatic spread especially—if people don’t feel the need to share their information until other people talk about it. We’re hoping to identify more such interesting findings through our interviews.

EMF: Why did you choose this topic?

Dr. John D. Purakal

JP: I’m interested in social emergency medicine, social determinants of health, and how they impact the patients that present to the emergency department. We know that minority patients and underserved patients live disproportionately in areas with high social determinants of health that impact their day-to-day life and their health outcomes. This project makes sense to me because it takes an acute need—the novel studying of a virus that’s happening in real time—and identifies problems utilizing information available here in North Carolina to determine which areas are of highest risk. In so doing, we prepare clinicians to risk-stratify patients from these areas.

EMF: What are the goals of your research?

JP: Our short-term goals for this project are to identify COVID-19 outbreak areas in our community and in the patients that we serve at Duke University and to determine which social determinants of health are most frequently or highly associated with those outbreaks. Long term, we’re hoping that this information will provide a blueprint for health care workers and for community organizers, as well as state or local government officials, so they can be more prepared for future pandemics and other outbreaks that may require education, community resources, and community-specific approaches. We will know which areas might be hardest hit sooner and be able to target them right away so these outbreaks among people who may be underinsured or underserved don’t happen at such fast or disproportionate rates. By looking at transportation needs, socioeconomic needs, and the like, we can identify patients who would be highest risk if we sent them home with a positive COVID test and/or be able to better inform them about having family members tested, social distancing, and things of that nature.

EMF: How did your EMF grant help advance your career in emergency medicine?

JP: It means the world to me that EMF believed in our team’s project and vision. It’s especially impressive to me that, during an unfolding pandemic, EMF was able to provide additional funding for people who were interested in exploring it in real time.

EMF grants are essential for researchers at all stages in their careers—without them, the field of emergency medicine would advance at a much slower pace. Everyone needs to start somewhere, and I think that this grant is going to help me get my foot in the door in terms of conducting research at a higher level. I’m very appreciative of this opportunity and for the faith that EMF has shown in our team, my mentors, and collaborators to accomplish this project. We’re very grateful that the organization was able to help us fund our project and others like ours, as we all work to improve and advance the field of emergency medicine.