Background: The COVID-19 pandemic has exposed disproportionate health inequities among underserved populations, including refugees . Public safety net health care systems play a critical role in facilitating access to care for refugees, and informing coordinated public health prevention and mitigation efforts during a pandemic crisis .

Objective: To evaluate the prevalence of SARS-CoV-2 among refugee women admitted for delivery relative to non-refugee parturient patients . We suspect the burden of infection is disproportionately distributed across refugee communities which may act as sentinels for community outbreaks . Study

Design: A cross-sectional study was performed examining parturient women admitted to the maternity unit between May 6 and July 22, 2020, when universal testing for SARS-CoV-2 was first employed . Risk factors for SARS-CoV-2 positivity were ascertained, disaggregated by refugee status, and other clinical and socio-demographic variables examined . Prevalence ratios (PR) were calculated and comparisons made to county level community prevalence over the same time period .

Results: The percent positive at the County level during this study period was 21.6% . Of 350 women admitted for delivery, 33 (9.4 %) screened positive for SARS-CoV-2 . When disaggregated by refugee status , 45 (12.8 %) were refugees, of whom 8 (17.8 %) tested positive, compared to 25 (8.19 %) non-refugee patients testing positive, PR 2.16 (95% CI 1.04-4.51). Seven of the SARS-CoV-2 positive tests were among refugees from Central Africa . Conclusion: The SARS-CoV-2 outbreak has disproportionately affected refugee populations . This study highlights the utility of universal screening in mounting a rapid response to an evolving pandemic and how we can better serve the refugee community . Focused response may help achieve more equitable care related to SARS-CoV-2 among vulnerable communities . Identification of such populations may help mitigate spread and facilitate a timely, culturally and linguistically enhanced public health response.