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Brock Santi graduated from JABSOM less than a year ago. Today, he works for the Department of Health and is about to start an internship with Kaiser Hawaiʻi. Dr. Santi specializes in Internal Medicine and is considering going into infectious medicine, which is fitting because the research he conducted on COVID-19 while a student was published in JAMA this week. We caught up with Dr. Santi to learn more about this research.
Q: We've seen many studies about COVID-19, but your research covers the intersection the virus has with insurance?
A: Yeah, exactly. I think another big difference is that we really examined different ethnicities. Different studies have looked at race and ethnicity and how they influence COVID-19, but Hawaiʻi is one of the only places where we actually disaggregate. So instead of just saying "Asians and Pacific Islanders," we would look at different ethnicities within that. So that was also a pretty special part of our study. We parsed out Japanese, Filipino, and Native Hawaiian instead of just being in one big group.
Q: What were you looking to find?
A: Initially, we wanted to see if insurance influenced how people were being cared for in the hospital. We know socioeconomic status affects people's health, but that's generally the case outside the hospital. We wanted to ensure that patients in the hospital, as soon as they were admitted for COVID-19, were receiving equal care.
Q: Is that what you found?
A: We looked at the outcomes of anyone who came into the hospital with acute respiratory COVID-19. One outcome was being transferred to the ICU for a higher level of care or if they died in the hospital. We looked at that, including their insurance status, race, ethnicity, and vaccination status. When we looked at their insurance status, we found that there wasn't a difference between Medicaid, Medicare, and commercially insured, meaning people who get their insurance through work or something like that. There wasn't a difference in the rate of death or ICU transfer between them. We wanted to make sure that we controlled for age because age causes people to be at higher risk of COVID. So older individuals were more likely to die of COVID, but people on Medicare weren't necessarily more likely to die of COVID if you didn't take into account their age.
Q: Thankfully, it appears that being uninsured didn't affect the outcomes of the patients you studied. Were there other highlights you noted?
A: Those came from the secondary metrics I discussed, such as vaccination status, race, ethnicity, and zip code. One of the more interesting things that we looked at across the pandemic was that before the vaccine was readily available in Hawaiʻi, there were a lot of discrepancies in people's outcomes by race. For example, Filipinos were much more likely to die in the hospital. Then, after the vaccine was available, we separated the data, looking at the periods before and after the vaccine was available. Many of those disparities lessened or went away entirely. There are still disparities. There are still differences in the odds ratios, but they were significantly lessened, so I think that that was a win from a public health perspective. Not only did the availability of the vaccine make people less likely to die of COVID in the hospital, but it also helped in the communities it needed to help the most.
Q: How many people were studied in this research?
A: 1,176. The research started at the beginning of the pandemic in March 2020, and for the published paper, it ended in March 2022. We studied everybody who was admitted to Kaiser with an acute COVID-19 infection. Patients who came in for another reason but still tested positive for COVID-19 were not included. We really wanted it to be people who came in with acute COVID-19 as their main reason for visiting the hospital. Pediatric patients were not included. We still have the data for 2023, and we're looking at that right now, but for the study published in JAMA, the research ended in March 2022, covering the two most severe years of the pandemic.
Q: You conducted all this research while you were a student at JABSOM. What was that like?
A: In my third year, I was doing a rotation at Kaiser and met Dr. Verhoef, my research mentor. I started to get into it at the end of my third year. In the fourth year at JABSOM, they give you a lot of time for research, which is great if you're interested in it, so I took two research blocks, and basically, my contribution to the research was doing all of the statistical analysis. This is something I picked up in college as an economics major. I had a lot of time to dive into it in the 4th year because you can have a dedicated research block.
Q: During orientations for incoming students, we hear about the importance of doing research as a medical student. What's your advice for incoming students and current students?
A: Research is important, but find something that you're passionate about. For me, this was a great intersection of my interest in economics and statistical analysis and how I could use it in medicine. I did have other research projects, but I think this was something that I found interesting. I think that would be my advice for the first years. There's magic to it if you find something that you really love. I think it'll go well because at the end of the day, when you're on the wards or studying, if you really love something, you'll put the time into it. I think everyone feels like they need research, and research is important, but I also think it's essential that it's something that you're passionate about.
Q: And the research you're passionate about can lead to being published in JAMA! Did you ever think it would be featured in such a prominent publication?
A: Not at all. Dr. Verhoef is much more experienced in submissions than I was. I was just interested in it because it was a passion project, it was about Hawaii, and it looked at a specific period that I lived through as a medical provider. Dr. Verhoef was the one who suggested we should publish it, and I think it speaks to the uniqueness of the data set we have, especially regarding race. We have all of these different subsets of people, and the population of Hawaiʻi is unique. I think that's one of the reasons JAMA accepted it.
Q: Does this experience boost your enthusiasm for research? Do you plan to continue doing research while you're a physician?
A: Yeah! That's another thing that I would say to the first-year students. When you gain these skills from doing research, it's something that sort of snowballs. You learn more, and it is a skill you keep up, so I look forward to keeping it up when I'm a physician. Actually, as you may have seen in the news, they're talking about RSV and flu, so we will try to expand it to that. It's great to be in Hawaiʻi and to be in a community that I care deeply for. There's a lot of research to be done in Hawaiʻi.