School meals at home: contributions of the Sintra municipality initiative during the COVID-19 pandemic to the design of interventions in public health emergencies.

School meals play a vital role in supporting student health. Access to school meals was disrupted during COVID-19-related school closures, impacting student nutritional intake and household food insecurity. Data from the National School COVID-19 Prevention Study Survey and school staff focus groups were used to examine challenges to school meal provision in K-12 public schools. Data were analyzed using R and MAXQDA. Survey data indicated that most schools served breakfast and lunch in the cafeteria or classroom during the 2021-2022 school year. City schools were less likely to experience challenges with receiving the foods and supplies needed for school meal programs. Qualitative data revealed that school meal participation increased during the COVID-19 pandemic, however schools encountered challenges when implementing the program including staff shortages and supply chain issues. Findings from this study can help strengthen the K-12 school meal system to equitably serve students in future public health emergencies.

Despite difficult challenges during responses to the terrorist attacks of September 11, 2001, Hurricane Katrina, and the 2009 Pandemic Influenza A/H1N1 and severe acute respiratory syndrome outbreaks, no North American emergency to date has overwhelmed intensive care unit (ICU) services on a widespread basis since the modern development of the field of critical care. However, planners have recognized that in a future public health emergency we may not be so fortunate. To deal with very large emergencies involving many patients whose survival depends on immediate access to intensive care, an international Task Force for Mass Critical Care proposed recommendations in January 2007 to extend critical care resources for the adult population, referred to as the Emergency Mass Critical Care (EMCC) approach (1–5). The EMCC approach triples critical care capabilities for a period of up to 10 days in a very large public health emergency by focusing on immediately life-saving interventions, while delaying or forgoing less urgent care. Crisis standards of care in a large public health emergency would attempt to optimize population outcomes, rather than use unlimited efforts to maximize survival of each individual. Available resources would be substituted or adapted for equivalent or nearly equivalent unavailable resources. Resources would be conserved, reused, and reallocated to those patients most likely to benefit from them. Modest increases in stockpiles and major changes in the organization of care would be essential. While planners in the field acknowledge that mass critical care is a reasonable concept, we lack evidence that such an approach is feasible. However, failure to begin operational planning for mass critical care guarantees a failed response. As public health emergency planners begin to consider the EMCC framework, it is urgent that pediatric implications be detailed for integration into these developing plans. This supplement represents the discussions of a multidisciplinary panel convened by the Oak Ridge Institute for Science and Education (supported financially by the Centers for Disease Control and Prevention), and provides guidance for pediatric EMCC (PEMCC). Work of the PEMCC Task Force was directed by a 17-member Steering Committee selected on the basis of their expertise and experience, and included representatives from the Task Force for Mass Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, American Academy of Pediatrics, American College of Critical Care Medicine, American College of Emergency Medicine, Royal College of Physicians (Canada), and National Commission on Children and Disasters, as well as several unaffiliated disaster preparedness experts. This Steering Committee led development of all manuscripts and selected individuals for the PEMCC Task Force. The full PEMCC Task Force comprised 44 experts from fields including bioethics, pediatric critical care, pediatric trauma and surgery, neonatology, obstetrics, general pediatrics, emergency medicine, pediatric emergency medicine, disaster preparedness and response, emergency medical services (EMS), infectious diseases, toxicology, military medicine, nursing (including critical care nursing), pharmacy, veterinary medicine, information sciences, public health law, maternal and child public health, and local, state, and federal government emergency planning and response agencies. Priority topics were organized on the basis of MEDLINE and Ovid database literature searches, bibliographies, state and federal government planning documents, after-action reports of recent medical responses to catastrophes, and through participation in local, state, and federal government working groups on hospital and disaster preparedness. Where evidence was available, it was utilized in formulating recommendations. Where evidence was lacking, recommendations represent expert opinion. Wherever possible, recommendations are consistent with and easily integrated into prior recommendations of the adult Task Force for Mass Critical Care. The Steering Committee produced draft outlines by synthesizing information obtained in the evidence-gathering process and convened October 6–7, 2009, to review and revise each outline. Eight draft manuscripts were subsequently developed from the revised outlines. The full PEMCC Task Force convened March 29–30, 2010, to present and discuss the draft manuscripts. Feedback on each manuscript was compiled and the Steering Committee modified the draft documents to reflect this input, in addition to updating the manuscripts based on the most current medical literature. The Steering Committee revised the manuscripts from March to October, 2010, working primarily via email and conference calls. New versions were electronically transmitted to all Task Force members to obtain concurrence with manuscript revisions. All authors and reviewers completed disclosure statements; there were no conflicts of interest. The authors were given complete autonomy by the Oak Ridge Institute for Science. The views expressed in these summaries are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Based on the recognition of the special needs of children during disasters and extensive discussion, the following recommendations are made by the PEMCC Task Force. These recommendations are described in detail in nine subsequent articles. Readers should refer to individual articles for all recommendations rather than those highlighted in this executive summary. Treatment and Triage Recommendations for PEMCC (p. S109) PEMCC in Pediatric Hospitals. These recommendations provide the basis for hospitals to prepare for PEMCC: Every hospital with a pediatric ICU or neonatal ICU should plan and prepare to provide PEMCC, and should do so in coordination with regional health planning efforts. Hospitals with ICUs should plan and prepare to provide PEMCC every day of the response for a total critically ill patient census at least double the pediatric ICU bed capacity and at least triple usual ICU capability. Hospitals should prepare to deliver PEMCC for 10 days without sufficient external assistance. Care should be coordinated with the emergency department for triage and transfer of patients to/from ICUs. All communities should develop a graded response plan for events across the spectrum from multiple casualties to catastrophic critical care events. To optimize medication availability and safe administration, the Task Force suggests that modified processes of care should be considered before an event, such as the following: rules for medication substitutions and restrictions; safe dose and frequency reduction; conversions from parenteral to oral/enteral administration; shelf-life extension; and use of length-based weight estimations. PEMCC for pediatric patients ideally should occur in hospitals or similarly designed and equipped structures with experience in providing critical care to pediatric patients. Principles for staffing models should include the following: strategies to achieve and maintain adequate staffing levels; patient care assignments for the unit should be managed by the most experienced clinician available; and assignments should be based on staff abilities and experience, with delegation of some duties and efforts to reduce care variability and complications. PEMCC in Nonpediatric Hospitals All hospitals must plan to care for children in their proportion to the population or for those affected by the mass casualty event. To facilitate such planning, nonpediatric hospitals should include a pediatrician or pediatric medical liaison in those committees responsible for disaster planning, appeals, and determining when crisis standards of care should be implemented. During a disaster, it may be more efficient to transfer skilled pediatric critical care teams to nonpediatric centers to support those facilities in providing care to critically ill pediatric patients. Nonpediatric hospitals may not have the pediatric equipment needed to sustain critically ill patients; therefore, these teams may need to take their own equipment. Establish referral network for pediatrics consultation or transfers to support hospitals that do not normally receive pediatric patients. Nonpediatric hospitals should preidentify hospital staff with experience in care of pediatric patients and create key positions in which these individuals would serve. The Task Force was unable to recommend a protocol for allocating scarce pediatric critical care resources (tertiary triage) during PEMCC. However, they suggest that: Resources should be allocated on the basis of need, benefit, the conservation of resources, and finally lottery or queuing. Younger children should not be discriminated against based on age alone. While a validated pediatric scoring system is being developed, tertiary triage should be based on expert opinion and conducted by triage teams, including experienced trauma surgeons and/or intensivists, using their best medical judgment as is the current standard of practice. The Task Force recommends that the American Academy of Pediatrics and the Institute of Medicine, bodies with subject-matter expertise and necessary positioning, develop a set of research priorities for disaster pediatric medicine such that the evidence base can be established to facilitate the development of necessary tools (i.e., decision matrices). Supplies and Equipment for PEMCC (p. S120) This chapter focuses on strategies and paradigms for purchasing and stockpiling equipment that will be necessary in PEMCC. This includes specific equipment (not including personal protective equipment, which is beyond the scope of this chapter) and supply lists necessary to triple pediatric ICU capacity for up to 10 days for a scenario in which the surge includes patients across all ages, and another scenario in which most patients are from a single age group. Recommendations include the deployment of mechanical ventilators including specifications (see p. 128 for further details), ventilation ancillary equipment (including equipment that could be disinfected or sterilized between patient uses in a pandemic situation), other options for assisted ventilation and nonconventional ventilation, suggestions for a ventilator inventory, equipment for hemodynamic management, and supplies for sedation, analgesic, antimicrobials, and nutrition. Additional equipment and supply recommendations necessary for various types of pediatric hospitals to prepare for disasters have been provided by the New York City Department of Health and Mental Hygiene's Pediatric Hospital Disaster Toolkit (http://www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml); the toolkit has been positively viewed and is an additional resource that should be considered. Neonatal and Pediatric Regionalized Systems in PEMCC (p. S128) This chapter outlines the present system of care in the United States and Canada, and the systems likely to be available for providing mass critical care. Topics discussed in this manuscript include: gaps between anticipated needs and existing resources, changes in functioning of regional systems necessary for PEMCC, protocols for patient transfer, agreements with healthcare institutions that primarily provide adult care, just-in-time training of healthcare workers, transport systems for patients, and allocating staff to other healthcare facilities. Recommendations are provided for operational planning integrated across jurisdictions necessary to implement PEMCC. All preparations for mass critical care for the general population must include pediatric aspects. For this to occur, pediatric experts must be involved in all aspects of emergency and disaster planning. States and Regions. States and regions should: Facilitate PEMCC by providing legal protections for those involved in PEMCC. Reaffirm ethical norms in PEMCC. Ensure that all hospitals are prepared to provide care for children in a mass casualty scenario, including a level or scope of care beyond what they might ordinarily provide during normal operating conditions. Plan to share scarce resources with neighboring states and ensure effective public-private collaboration to meet the needs of a pediatric patient surge and optimize pediatric critical care capacity in a mass casualty event. Develop pediatric-specific performance criteria to hold regional systems accountable for PEMCC preparations and responses. Perform vulnerability analyses to estimate anticipated pediatric mass critical care needs, including especially vulnerable populations. Inventories of functional resources (space, equipment, supplies, and staff) for mass critical care must be performed at every hospital with an ICU. State information systems must be developed to track critical care needs and resources in real time during public health emergencies. Integrate operational plans for mass critical care and triage allocation (rationing) across all jurisdictional levels and all response agencies, and integrated with all aspects of emergency preparedness planning. Define regional mechanisms to direct the distribution of patients and resources in a public health emergency. Federal. Action at the federal level should include: Plans for federal involvement are consistent with state plans for mass critical care and triage allocation (rationing). Federal expertise and guidance to promote consistency in informing state laws and regulations regarding mass critical care and triage allocation (rationing) in public health emergencies. Federal incentives, specific readiness requirements, readiness, and performance measures germane to pediatric care capabilities and capacity to ensure that all states prepare sufficiently for mass critical care and triage allocation (rationing). Federal support for research on best practices ahead of time, as well as real-time surveillance, epidemiologic research, and clinical trials during a public health emergency, which will result in better evidence-based practices at the level of regional systems of care, and better clinical care. Education in a PEMCC setting (p. S135) Prospective and just-in-time training modules for pediatric critical care providers and the public are discussed within this article. Recommended topics for skilled clinicians, particularly those who do not typically treat pediatric patients, include: training in pediatric triage, administration of EMCC coordination and planning, and training in use of nonstandard equipment. As part of comprehensive emergency preparation, educational needs should be identified and addressed. Practitioners should work to maintain their basic pediatric care levels pertinent to their job, and contemplate whether additional training might benefit them in preparation for potential mass critical care events. If they are likely to be involved in a PEMCC response, they should seek out additional proactive training. Hospitals should: identify team leaders and pediatric care providers and encourage them to receive additional training and stay current in the management of critically ill children; identify just-in-time resources that could be used in times of need, and contemplate how they could best implement those resources, particularly if infrastructure, such as internet access, is compromised; and, if they do not have pediatric critical care capabilities, establish a relationship with a regional children's hospital to look for potential educational and training collaboration and offer these courses to their hospital staff. Regional pediatric critical care centers should: maintain an active educational role in both self-education in management of critically ill children and in regional education in their usual referral network; identify potential local hospitals that could help with surge capacity and ensure that those hospitals are receiving necessary training to manage potential surge patients; and work to develop just-in-time resources for remote assistance in training, such as telemedicine or telephone consultation. State/federal/professional societies should fund and develop additional training courses for pediatric mass critical care, both proactive courses and for development, evaluation, and distribution of just-in-time training modules. PEMCC: The role of community preparedness in conserving critical care resources (p. S141) This section of the supplement addresses the role of the wider community in preparing for disasters and PEMCC. Community preparedness reduces extraneous use of hospital resources and conserves scarce critical care resources by delivering population-based care in the community by utilizing the following: citizens, hotlines/healthlines, EMS/9-1-1, alternate care facilities, pediatric-specific agencies and organizations (i.e., schools, daycares, after-school programs), and integration with a health emergency operations center linked to community incident command systems. The Task Force recommends the following actions by pediatric leadership (those who represent, care for, and advocate for children): Actively promote programs to ensure, before and during a crisis, an informed citizenry and the education of children and families in the Centers for Disease Control and Prevention guidelines on community mitigation strategies. Advocate for a community level of preparedness that leads to empowered self-awareness, knowledge of the information that best prepares the public to provide basic lifesaving information and self-care, and builds physical and mental health resilience. Advocate for the establishment of permanent national- and state-level call systems and disease- and child-specific healthlines as crucial adjuncts during public health emergencies. Advocate for 9-1-1 telephone triage with pre-established criteria and protocols for the proper use and safety of EMS and EMS-sanctioned transportation during pandemics. Work with community planners to identify the logistic support necessary for establishing and operating alternate care facilities, and identify and create protocol-driven, patient management objectives based on assumptions about the types of patients that would be managed in such facilities. Advocate for creative operational concepts that provide guidance and protocols sensitive to the needs of the pediatric population. Legal Considerations during PEMCC events (p. S152) Liability is a significant concern for healthcare practitioners and facilities during PEMCC. While many of the legal issues associated with providing PEMCC are not unique within the context of disaster health care, the scope of parens patriae power of state, principles of informed consent, and security should be considered in PEMCC planning and response efforts since parents and legal guardians may be unavailable to participate in decision making during disasters. This article describes the legal considerations inherent in planning for and responding to catastrophic emergencies and makes recommendations for PEMCC legal preparedness. To address gaps in existing liability protections for public health and PEMCC emergency responses, the Task Force recommends strengthening several areas of legal preparedness. As outlined in the Institute of Medicine crisis standards of care guidance (6): Necessary legal protections must be provided for healthcare practitioners and institutions that implement crisis standards of care plans. Unless comprehensive, national liability protections are implemented, state governments must link existing health practitioner and entity liability protections to crisis standards of care. Courts and other adjudicators should consider whether adherence to the Institute of Medicine guidance provides evidence of meeting the standard of care and "the legal effect of changing standards of care during emergencies" in medical malpractice claims. In addition to the Institute of Medicine recommendations, the following suggestions should be considered for PEMCC preparedness: PEMCC disaster protocols should be properly vetted and accepted; when providing pediatric mass critical care, practitioners who follow such accepted and vetted protocols in good faith should be protected from civil liability (5–7). PEMCC protocols should be included in state disaster plans. Health facilities should ensure that their pediatric disaster plans are consistent with state plans and, to the extent possible, with neighboring health facilities. Facilities that care for pediatric patients should develop specific informed consent and security protocols to incorporate into their disaster plans. Facilities that do not normally care for pediatric patients or that do not routinely provide care for critically ill pediatric patients should also consider incorporating such planning or partnering with other facilities that provide such care in the event that pediatric patients arrive at their facilities during emergencies. PEMCC: Focus on family-centered care (p. S157) Family-centered care (FCC) is especially a concern and challenge in PEMCC. This article addresses the tension between offering FCC and effective disaster treatment/triage. It offers a list of practical suggestions for incorporating FCC principles into each of the following healthcare settings during a disaster, including a PEMCC event: EMS transport, emergency departments, pediatric ICUs, general pediatric wards, and alternative sites. Disaster and PEMCC responses must incorporate FCC principles to the extent possible in a variety of healthcare settings. Family-Centered Care in EMS Care of Children. Practical suggestions have been developed for EMS professionals planning for and responding to mass casualty/pandemic events that involve children. These include encouraging families, local pediatricians, and local groups (champions) to engage in every stage of planning and preparation for disasters. FCC in Emergency Departments and ICUs in a Mass Event. Overcrowding, panic, security concerns, staff stress, and separation of families during triage make practicing FCC an imperative and demanding task. The fundamental precepts of FCC, such as attention to the as a of and of the health of the critical to the of disaster The following are some recommendations for emergency department professionals as they plan and to the needs of children and their families in a mass event: possible, EMS and emergency should a to with the child during the triage and This may providing care for parents in addition to children. The local triage and tools should for a and should a of including at least date of and should be obtained as and as possible, and if necessary to the National for and Children an by the government to with families in a mass Mental health professionals in triage and emergency of children should be available on the In the pediatric and of a liaison such as a child or nursing to and general information of to families could reduce on the and skilled medical to the acute needs of critically or patients. FCC in should include a for children with families and proper for children. The Task Force also recommends planning for FCC during PEMCC at alternative and a medical strategies to establishing of when families are and and families, including those with and in PEMCC (p. The specific is ethical issues unique to children in disasters to their and It that children should be not in proportion to existing resources, to their proportion of the general population or those affected by the event. While the ethical principles of triage the for and the lack of a validated pediatric scoring system on expert opinion. The article the to individuals between and of capacity for children should be based on their proportion of the population, or in proportion to those or likely to be affected by the mass critical care event, rather than in proportion to existing standards are to be resources should be allocated on the basis of medical need, medical benefit, and the conservation of resources. the of a validated pediatric the recommends the use of expert opinion. lists are to the Resources should not be allocated based on the complete or on or to in this is essential. The of PEMCC in the developing (p. care in developing is as well as the that can be for offering mass critical care in developed during disasters. in scarce resource and routinely make difficult allocation This article and recommendations for providing the most good with resources through with existing healthcare and using available resources to The of pediatric critical care should include "the of the child with a or in without for the and including emergency, and intensive to disasters in developing have to take into the available resources and (i.e., to provide special needs care that as a of immediate lifesaving The response in these needs to be to the stage of development of the health services and resources. In the must be on care, and basic emergency care, in care should without care resources. in preparing for a pandemic in a developing from public health and and developing strategies for community and mitigation strategies. care strategies must on using the United Health guidelines and for of and of and assistance is provided to during through provided by the Health of 2007 and the Regional emergency response capabilities and their through the Regional with international such as for government (Canada), Department for and will the deployment of scarce resources. are many issues to PEMCC that are such as of triage and decision making and research priorities that need to be addressed. institutions need to make use of these recommendations as guidelines to their readiness and in preparation for PEMCC. The Pediatric Emergency Mass Critical Care Task Force the American Academy of Pediatrics and Disaster for their review and to this

On April 22,2020 a crowd gathered at the Fujikata Racetrack in Tsu City, Mie Prefecture, Japan With the anxiety of the COVID-19 pandemic swirling about them, citizens ventured from their homes donning facemasks Once at the racetrack they formed a "socially distant" line and waited for the gates to open Residents were not waiting to see a race Rather, they had come to do their grocery shopping While nearby city markets and green grocers were still open for business, these citizens had come in hopes of snagging a bargain and also supporting their community This was not your typical farmers' market the produce was gathered from unfulfilled school lunch orders With schoolyards shuttered due to the pandemic, the fresh ingredients ordered months ago had nowhere to go, and rather than let the food go to waste, the community and local government intervened Even with the schools closed, school lunch helped to unite a community

To generate concrete, youth-derived recommendations for government, policymakers, and service planners to support public health planning for the next pandemic or public health emergency. Using a virtual, modified Delphi, Youth Delphi Expert Panel Members rated recommendation items over three rounds, with the option to create their own recommendations items. 'Consensus' was defined a priori if ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rated items at a 6 or 7 (on a 7-point Likert scale). Items that did not achieve consensus were dropped. Content analysis was used for qualitative responses in Rounds 1 and 2. Youth were engaged as members of an expert advisory committee throughout the design, implementation, and interpretation of findings. A total of n = 40 youth participated in Round 1 with good retention (> 95%) in subsequent rounds. Youth endorsed eleven recommendations to support public health planning for future pandemics or public health emergencies. Youth prioritized easily accessible and understandable information about pandemics; equitably and efficiently distributed vaccines; increased awareness of timely and accessible mental health and substance use services in schools, workplaces, and communities; and greater investment in free or inexpensive MHSU services. For Canada to move forward in a relevant, efficient, and ethically sound manner, decisions must be guided by the population that these decisions affect. These recommendations can be used to guide Canada's strategies and policies to prepare for future public health emergencies and pandemics, prioritizing the needs of youth, families/caregivers, and communities.

Background: Although significant scholarly assessments have been made regarding the conditions for restricting fundamental rights under extraordinary circumstances and the impact of public health emergencies on the separation of powers, the literature has not yet been able to fully rely on the systematization of the extensive recent constitutional court jurisprudence—particularly in the Central and Eastern European (CEE) region. In recent years, constitutional courts (or supreme courts with constitutional review powers) have addressed many aspects of the COVID-19 pandemic. A thorough examination of this case law can contribute both theoretically and practically to the legal framework governing public health emergencies, the limitations of fundamental rights, the evolution of the separation of powers, and the reinterpretation of the constitutional effects of the global pandemic. Nevertheless, scholars have repeatedly noted the difficulty in accessing relevant materials, which has hindered further research in this field. Methods: The ConstCovid project aims to close this gap by offering systematic access to global constitutional case law related to COVID-19, thereby expanding the potential for comparative research. Several specific examples from the CEE region will be used to demonstrate the regional usefulness of the ConstCovid database. Based on this case law, the regional tendencies and shortcomings of constitutional practice during public health emergencies will be identified. Utilising the ConstCovid database, this study contributes to the broader understanding of the constitutional ramifications of the COVID-19 pandemic and explores its potential implications for managing future public health emergencies in CCE. Results and conclusions: This contribution draws some conclusions from the analysed constitutional case law stemming from ConstCovid, which may be valuable for preparing potential unwanted future public health emergencies. First, it examines strands of case law that applied general constitutional standards to the extraordinary circumstances. Second, it illustrates that these ways of argumentation were combined inconsistently with the elaboration of new frameworks of constitutional interpretation, resulting in meaningful uncertainty across the region. Third, the analysis highlights the absence of constitutional remedies specifically established to address public health challenges.

The present study aimed to (1) examine the changes in sleep habits and dietary intake among school-aged children after the school re-opening from a 3-month closure (without school lunch) due to the COVID-19 pandemic, and (2) examine whether the changes differ between those with different temporal patterns of sleep and eating during school closure, namely, 'Very early', 'Early', 'Late' and 'Very late'. The latter patterns were characterised by later timings of wake up, breakfast and lunch. Questionnaires were answered twice by 4084 children (aged 8-15 years), themselves and/or their parents: first in June 2020 (for assessing lifestyle during school closure) and second, from July 2020 to February 2021 (for assessing lifestyle after school opening). After school re-opening, the participants' wake-up time became an hour earlier (95% CI 1⋅0, 1⋅1) and sleep duration got 0⋅94 h shorter (95% CI 0⋅91, 0⋅97) than during school closure. An increase in dietary intake was observed for thiamine, vitamin B6, potassium, fruits and dairy products, and a decrease was observed for sugars (as foods) and confectioneries and sweetened beverages, despite small effect sizes (Cohen's d: 0⋅20-0⋅30). Significant changes in wake-up time, sleep duration and sweetened beverage intake were observed among children with the latter temporal patterns. Thus, children wake up earlier and sleep for shorter durations after school re-opening than during school closure; however, changes in dietary intake were generally insignificant. Dietary intake among school-aged children in Japan during school closure (without school lunch) might not be worse than that during school days with universal school lunch.

Peer programs, which pair individuals of similar age or life experience, can address complex psychosocial needs, loneliness, and social isolation among diverse older adults. However, these services were heavily disrupted by the COVID-19 pandemic. This study examined which pandemic-era innovations were sustained across six peer programs and identified core features of peer programs relevant to future public health emergency preparedness. In this mixed-methods study, we first thematically analyzed 67 qualitative interviews (August, 2023-April, 2024) with diverse stakeholders, including older adult participants (n = 24), peer specialists (n = 12), program leaders across six peer programs (n = 12), and experts in aging, public health, and peer programs (n = 19) using a rapid assessment process. Qualitative findings were compared with quantitative trajectories of loneliness and depression among peer program participants over 6-month intervals (May 2020-April 2024). Peer programs have been involved in ongoing efforts to help older adults recover from prolonged loneliness and isolation related to pandemic restrictions. Two pandemic-era innovations were sustained: (1) hybrid communication (in-person, virtual, and telephone) that expanded reach, and (2) new partnerships with health and city services. However, "peer drift," where peers roles can become diluted as they are asked to do more, emerged as a challenge, complicating the consistency and effectiveness of programs. Core features of peer programs identified as relevant to future public health emergency preparedness included: (1) fostering trust with marginalized communities, (2) flexibility in responding to urgent public health needs, and (3) complementary expertise to clinical teams. Quantitative data demonstrated diverse trajectories of loneliness and depression for participants over multiple years of the public health emergency, with interviews indicating how peers helped older adults navigate these challenges. Peer programs have continued to leverage hybrid communication and expanded health and city partnerships to meet the needs of socially isolated older adults. Results further suggest their potential to be integrated into future public health emergency responses.

The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families’ needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity.

BackgroundStrict confinement measures during the COVID-19 pandemic, such as school closures and lockdowns, had a profound impact on vulnerable populations, particularly young people with disabilities and their families. Unfortunately, the long-term effects of these confinement measures remain unexplored.AimsTo better understand the immediate and long-term impacts of the confinement measures of COVID-19 pandemic on young people with cerebral palsy and their family in the province of Quebec.MethodA mixed-method study was conducted. 18 legal guardians completed a purpose-developed survey about the overall impact of COVID-19 on their children. In-depth interviews were undertaken with 9 legal guardians. The data from both the survey and the semi-structured interviews were analysed using thematic analysis, enabling integration between the two methods.ResultsThree themes emerged from the qualitative data analysis: (1) Stress and psychological needs; (2) coordination of daily family routines; (3) child development. The pervasive fear of contracting COVID-19 had a significant negative impact on the psychological well-being of young people and their legal guardians. Family routines were disrupted leading to increased mental burden and challenges between work and caregiving. The COVID-19 also had a negative impact on the overall development of young people, despite having access to telerehabilitation to mitigate these challenges.ConclusionsPolicymakers must thoroughly grasp these findings to effectively address the needs of young people with cerebral palsy and their legal guardians in future public health crises. Additionally, healthcare professionals must remain attentive to both the immediate and long-term impacts, taking proactive steps to safeguard the developmental well-being of these young people.

This paper explores changes to school food standards from 2010, free school meal provision during the COVID‐19 pandemic across the UK and potential implications for children's diets. To obtain information on UK school food policies and free school meal provision methods we reviewed several sources including news articles, policy documents and journal articles. School food is an important part of the UK's health agenda and commitment to improving children's diets. Each UK nation has food‐based standards implemented, however, only Scotland and Wales also have nutrient‐based standards. School food standards in each nation have been updated in the last decade. Universal free school meals are available for children in the first 3 years of primary school in England and the first 5 years of primary school in Scotland, with plans announced for implementation of free school meals for all primary schoolchildren in Scotland and Wales. There is a lack of consistent monitoring of school food across the UK nations, and a lack of reporting compliance to the standards. Each nation differed in its response and management of free school meals during COVID‐related school closures. Further, there are issues surrounding the monitoring of the methods to provide free school meal support during school closures. The role of school food has been highlighted during COVID‐19, and with this, there have been calls for a review of free school meal eligibility criteria. The need for improved and consistent monitoring of school food across the UK remains, as does the need to evaluate the impact of school food on children's diets.

Association of Frequency of School Meal Consumption and Student Dietary Intake During COVID-Related School Closures

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others.

The COVID-19 pandemic resulted in widespread school closures, reducing access to school meals for millions of students previously participating in the US Department of Agriculture (USDA) National School Lunch Program (NSLP). School-prepared meals are, on average, more nutritious than home-prepared meals. In the absence of recent data measuring changes in children’s diets during the pandemic, this article aims to provide conservative, back-of-the-envelope estimates of the nutritional impacts of the pandemic for school-aged children in the United States. We used administrative data from the USDA on the number of NSLP lunches served in 2019 and 2020 and nationally representative data from the USDA School Nutrition and Meal Cost Study on the quality of school-prepared and home-prepared lunches. We estimate changes in lunchtime calories and nutrients consumed by NSLP participants from March to November 2020, compared to the same months in 2019. We estimate that an NSLP participant receiving no school meals would increase their caloric consumption by 640 calories per week and reduce their consumption of nutrients such as calcium and vitamin D. Because 27 to 78 million fewer lunches were served per week in March–November 2020 compared to the previous year, nationally, students may have consumed 3 to 10 billion additional calories per week. As students return to school, it is vital to increase school meal participation and update nutrition policies to address potentially widening nutrition disparities.

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