COVID-19 Mitigation Policies Research Articles

What If…? Pandemic policy-decision-support to guide a cost-benefit-optimised, country-specific response.

After 18 months of responding to the COVID-19 pandemic, there is still no agreement on the optimal combination of mitigation strategies. The efficacy and collateral damage of pandemic policies are dependent on constantly evolving viral epidemiology as well as the volatile distribution of socioeconomic and cultural factors. This study proposes a data-driven approach to quantify the efficacy of the type, duration, and stringency of COVID-19 mitigation policies in terms of transmission control and economic loss, personalised to individual countries. We present What If…?, a deep learning pandemic-policy-decision-support algorithm simulating pandemic scenarios to guide and evaluate policy impact in real time. It leverages a uniquely diverse live global data-stream of socioeconomic, demographic, climatic, and epidemic trends on over a year of data (04/2020-06/2021) from 116 countries. The economic damage of the policies is also evaluated on the 29 higher income countries for which data is available. The efficacy and economic damage estimates are derived from two neural networks that infer respectively the daily R-value (RE) and unemployment rate (UER). Reinforcement learning then pits these models against each other to find the optimal policies minimising both RE and UER. The models made high accuracy predictions of RE and UER (average mean squared errors of 0.043 [CI95: 0.042-0.044] and 4.473% [CI95: 2.619-6.326] respectively), which allow the computation of country-specific policy efficacy in terms of cost and benefit. In the 29 countries where economic information was available, the reinforcement learning agent suggested a policy mix that is predicted to outperform those implemented in reality by over 10-fold for RE reduction (0.250 versus 0.025) and at 28-fold less cost in terms of UER (1.595% versus 0.057%). These results show that deep learning has the potential to guide evidence-based understanding and implementation of public health policies.

Political violence, risk aversion, and population health: Evidence from the US Capitol riot.

This study is the first to explore the impact of the January 6, 2021 Capitol riot on risk avoidance behavior and the spread of COVID-19. First, using anonymized smartphone data from SafeGraph, Inc., and an event-study approach, we document a substantial increase on January 6 in non-resident smartphone pings at the sites of the protest: the Ellipse, the National Mall, and the US Capitol Building. Then, using data from the same source and a synthetic control approach, we find that the Capitol riot led to an increase in stay-at-home behavior among District of Columbia residents, consistent with risk avoidance behavior and post-riot policies designed to limit large in-person gatherings. Finally, while we find no evidence that the Capitol riot substantially increased the spread of COVID-19 in the District of Columbia, we do find that counties with the highest inflows of out-of-town protesters experienced a 0.004 to 0.010 increase in the rate of daily cumulative COVID-19 case growth during the month following the event. These findings are exacerbated in counties without COVID-19 mitigation policies in place.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00148-022-00914-0.

Do disease prevalence and severity drive COVID-19 vaccine demand?

Large scale vaccination of population is widely accepted to be the key to recovery from the devastating economic and public health impacts of the COVID-19 pandemic. However, low uptake of vaccine has challenged vaccination efforts in many parts of the world. The paper explores the determinants of demand for COVID-19 vaccination – specifically, the prevalence dependence hypothesis – that identifies infection prevalence and mortality as the key drivers of individual preventive behavior against infectious diseases. Using daily disease tracking and vaccination data from 47 European countries the paper finds strong evidence that COVID-19 infection rate and mortality rate drive future vaccination uptake. Specifically, results from fixed effects models suggest that while lagged infection prevalence induce vaccination uptake by 0.18 to 0.24 percent, while the effect of lagged mortality is significantly larger, ranging between 1.10 to 1.53 percent. The results highlight the critical role of behavioral response to epidemiological outcomes and are of critical significance for COVID-19 mitigation policies, especially as they relate to achieving vaccine-induced herd immunity and economic reopening.

Do Fans Impact Sports Outcomes? A COVID-19 Natural Experiment∗.

This paper studies the effect of fan attendance on home field advantage in top European soccer leagues. We exploit exogenous variation in the level of fan attendance driven by COVID-19 mitigation policies and find that the home field advantage, as measured by home minus away (expected) goals, is reduced by more than 50% across the English Premier League, German Bundesliga, Italian Serie A, and Spanish La Liga. This leads to a decrease in probability for a home win, indicating that these goals are pivotal with respect to match outcomes.

Economic fundamentals, policy responses, and state-level municipal bond sensitivity to COVID-19 prevalence

This paper conducts a state-by-state analysis of the financial impact of the COVID-19 pandemic on the U.S. municipal bond market. Using panel regressions and state-by-state regressions, we find that the prevalence rates of the COVID-19 virus negatively impacted the aggregate performance of municipal bonds. The study also explored whether the disparities in the economic fundamentals of U.S. states, as well as the COVID-19 mitigation policies employed by each state, can explain the sensitivity of the state’s municipal bond to its COVID-19 prevalence rates. States with more desirable economic fundamentals and robust COVID-19 mitigation policies appeared to have higher COVID-19 sensitivities than states that do not. This finding may be due to a baseline effect, in which the higher levels of economic activities in these states also make them more susceptible to the deleterious effects of the stronger mitigation policies enacted by them.

Regional poverty and infection disease: early exploratory evidence from the COVID-19 pandemic.

This paper examines the role of regional poverty on the COVID-19 pandemic in the USA. It also explores how the effects differ with the concentration of ethnic minorities. We find that poverty is a significant and consistent determinant of higher COVID-19 infections and fatalities. Prevalent poverty areas experienced higher infections due to economic structure that require hypermobility (high mobility and interpersonal interaction)—more physical human to human contact resulting in higher deaths from limited access to health services. These are also regions where minority groups are concentrated. Disproportionate infections and fatalities occurred within the black, Hispanic, and Asian population. Our evidence is robust to state fixed effects that capture local COVID-19 mitigation policies, multi-level hierarchical modeling, spatial autoregressive assessment, and large sets of county-level health, social, and economic factors. This paper contributes to the literature on health and economic disparities and their resulting consequences for infectious diseases.

Anxiety and trust in times of health crisis: How parents navigated health risks during the early phases of the COVID-19 pandemic in Denmark

In this article, we investigate how parents of children in primary school navigated risks in the context of COVID-19 mitigation policies during the early stages of the COVID-19 pandemic. In Denmark, this group found itself at the front line of the reopening after an early lockdown, as primary schools were among the first institutions to reopen. This situation was discussed by the parents amid much controversy, which prompted us to investigate the strategies of different groups of parents within their institutional contexts. Based on qualitative interviews with 30 key informants, supplemented by a qualitative survey completed by 31 parents, collected between April and July 2020, we find three main types of strategies for dealing with pandemic health risks: (1) those involving trust, especially in schools and in teachers; (2) those primarily characterised by prioritising other aspects, such as the work-life balance; (3) and those containing overt or covert resistance strategies. Our findings demonstrate the pivotal role of the perceived trustworthiness of institutions (mainly schools) and professionals (mainly teachers) at the frontline for shaping parental risk navigation strategies. As our sample included asylum seekers whose resistance – unlike that of other parents employing resistance strategies – was met by an intervention, our analysis also sheds light on how social exclusion manifests itself in the Danish welfare state context during a pandemic.

Implications of COVID-19 Mitigation Policies for National Well-Being: A Systems Perspective

The ongoing COVID-19 crisis and measures aimed at curbing the pandemic have a widespread impact on various aspects of well-being, such as housing, social connections, and others. Moreover, COVID-19 does not affect all population groups equally. This study analyzes the impact of major COVID-19 non-pharmaceutical interventions (NPIs) on a set of national well-being indicators from the most recent version of the OECD Well-Being Framework. Using causal loop diagrams (systems maps), we consider direct and indirect effects of these policies on various components of the national well-being system. Our results show that business closures directly and/or indirectly impact more national well-being components than any other policy. The most affected national well-being components by all policies are life satisfaction, perceived health, and prevalence of depressive symptoms. In addition, we specify how the impact of the anti-pandemic measures differs for various population strata, using the degree of income and employment loss as key stratifying variables. Our insights can be helpful to identify and promote measures that can alleviate the adverse effects of the COVID-19 crisis on the national well-being.

Exploring the unmet needs facing individuals with Alzheimer’s disease and related dementias during the COVID‐19 pandemic

BackgroundMany adults with ADRD rely on support from friends, family members, social service agencies, and their communities to meet their basic needs. It is unclear if COVID‐19 mitigation policies have made it more difficult for individuals with ADRD to receive this support. The objective of this study was to explore the types of unmet needs experienced by adults with ADRD in the United States during the COVID‐19 pandemic as well as the characteristics of adults with ADRD that are experiencing unmet needs.MethodWe performed a cross‐sectional analysis of the Medicare Current Beneficiary Survey (MCBS) summer and fall 2020 COVID‐19 supplemental surveys. The MCBS uses complex survey design to provide a nationally representative sample of Medicare beneficiaries. There were 20,800 survey participants in total and 4.07% have received a diagnosis with ADRD. Logistic regression was used to examine the characteristics of those reporting one or more unmet need.Result16.61% Medicare beneficiaries with ADRD reported having one or more unmet needs during the COVID‐19 pandemic (vs. 16.52% Medicare beneficiaries without ADRD, p=0.956). While beneficiaries with and without ADRD had no difference in unmet needs surrounding rent/mortgage, food, supplies, and medications, adults with ADRD had higher rates of unmet need for healthcare services (8.86% vs. 5.77%, p=0.008). Adults with ADRD were more likely to report having an unmet need between March‐June than between July‐November (18.10% vs. 7.84%, p<0.001). Among those with ADRD, individuals with depression (AOR=2.25, p=0.001) and multimorbidity (AOR=1.79, p=0.030) reported significantly higher unmet need, after controlling for age, sex, race/ethnicity, insurance, and geographic location. As compared with individuals without ADRD, individuals with co‐existing ADRD and depression (p<0.001) or co‐existing ADRD and multimorbidity (p<0.001) reported higher likelihood of having unmet needs.ConclusionMany adults with ADRD experienced unmet need during the first 4 months of the COVID‐19 pandemic. We also found that the ADRD patients with depression and complex health needs who require greatest number of healthcare services were more likely to voice unmet needs. The residual impact of unmet needs during the early pandemic months and on‐high risk subpopulations is currently unknown.

VP31.01: The impact of the COVID‐19 lockdowns on the global rates of preterm deliveries: a systematic review

On 11th March 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). As a result, many countries entered harsh lockdowns in order to restrict the spread of the virus. Several studies were conducted to assess the implication of the lockdowns on the rates of preterm birth, stillbirths and other maternal and perinatal outcomes, with inconsistent results. We have conducted a systematic review to report the current evidence of the Indirect impacts of COVID-19 on rates of preterm birth and perinatal mortality & morbidity. We conducted a systematic review following the PRISMA guidelines. We searched electronic databases MEDLINE, Embase, PubMed for potentially relevant published and preprint studies. Two independent reviewers conducted title/abstract screening, full text screening, and data extraction using a pre-specified form. Conflicts were resolved by consensus or consultation with a third reviewer. The primary outcome was the rate of preterm births following the introduction of the COVID-19 restrictions, compared to the rate before these restrictions. Secondary outcomes included stillbirth and neonatal death rates, neonatal birthweight, NICU admissions and rates of Caesarean deliveries. We have excluded studies assessing the direct effect of COVID-19. Our initial search has retrieved a total of 485 studies, of which 20 met inclusion criteria after screening. We didn't find a statistically significant change in the rates of preterm births (OR 0.95 [0.88-1.02]) or stillbirths (OR 0.91 [0.76-1.09]). COVID-19 mitigation policies vary between regions which may have led to the inconsistencies in the reported effects on preterm birth and perinatal mortality across studies. It is vital to interrogate these differences to identify risk factors for preterm birth that may be potentially modifiable at the patient (reduced exposure to infection/inflammation), clinician (decision making) and societal levels (public health measures) to enable new strategies to prevent preterm birth in non-pandemic times.

COVID-19 mitigation policies and psychological distress in young adults

The COVID-19 pandemic has seen an unusually high proportion of the population suffering from mental health difficulties, but of particular concern is the disproportionate increase in psychological distress among younger adults. In this article, we exploit an explanatory sequential mixed-methods design to examine which aspects of the COVID-19 pandemic 18-25-year-olds found most challenging. We report analyses of American Voices Project (AVP) qualitative in-depth interview data, a MyVoice text-message open-ended survey, and Census Bureau Household Pulse Survey (HPS) data, all collected in 2020. Our interview and text-message results show that young adults were distressed about the effects of COVID-19 on the health of loved ones and older Americans. Young adults expressed concerns that the pandemic was not being treated sufficiently seriously by some politicians and the general public. The policy response was seen to be inadequate to the task of containing the disease, and some feared that the pandemic would never end. Statistical analyses of the HPS confirm that young adults’ scores on the HPS’s anxiety scale were significantly negatively associated with state-level policy responses. Overall, our results show that young adults found virus mitigation strategies challenging, but that a strong policy response was associated with reduced levels of psychological distress. Our results suggest that public health policy might have also operated as mental health policy during the COVID-19 pandemic.

Agent-Based Markov Modeling for Improved COVID-19 Mitigation Policies

The year 2020 saw the covid-19 virus lead to one of the worst global pandemics in history. As a result, governments around the world have been faced with the challenge of protecting public health while keeping the economy running to the greatest extent possible. Epidemiological models provide insight into the spread of these types of diseases and predict the effects of possible intervention policies. However, to date, even the most data-driven intervention policies rely on heuristics. In this paper, we study how reinforcement learning (RL) and Bayesian inference can be used to optimize mitigation policies that minimize economic impact without overwhelming hospital capacity. Our main contributions are (1) a novel agent-based pandemic simulator which, unlike traditional models, is able to model fine-grained interactions among people at specific locations in a community; (2) an RLbased methodology for optimizing fine-grained mitigation policies within this simulator; and (3) a Hidden Markov Model for predicting infected individuals based on partial observations regarding test results, presence of symptoms, and past physical contacts.&#x0D; This article is part of the special track on AI and COVID-19.

COVID-19 Mitigation Measures, Economic Impact and Factors in Recovery

The purpose of the paper is to analyse various factors influencing the speed of recovery and the return to the Old Normal, i.e., GDP levels of 2019 Q4. Most countries have imposed strong Covid-19 containment measures. The research paper reveals various implications of the Covid-19 mitigation policies on GDP growth, the budget deficit and the increase in the outstanding public debt. The analysis will show various correlations between the stringency of containment measures and the mobility of the population and the relationship with the decrease in GDP. It concludes that the size of the fiscal response is important, but does not guarantee immediate recovery. Besides monetary and fiscal policy, there are also other important elements, such as the strictness of the containment measures, the size of the tourism sector, the size of the outstanding pre-crisis debt level, and the quality of governance, which for many countries warrants a smaller decline in GDP. The paper concludes that countries with, on average, less stringent containment measures, with less accumulated pre-crisis public debt, a smaller tourism sector and more efficient governance, tend to have a smaller GDP slowdown and smaller budget deficits, and will recover sooner to pre-crisis levels.

Differential impact of mitigation policies and socioeconomic status on COVID-19 prevalence and social distancing in the United States

BackgroundThe spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers to practicing social distancing. We aimed to quantify the differential impact of stay-at-home policy on COVID-19 transmission and residents’ mobility across neighborhoods of different levels of socioeconomic disadvantage.MethodsThis was a comparative interrupted time-series analysis at the county level. We included 2087 counties from 38 states which both implemented and lifted the state-wide stay-at-home order. Every county was assigned to one of four equally-sized groups based on its levels of disadvantage, represented by the Area Deprivation Index. Prevalence of COVID-19 was calculated by dividing the daily number of cumulative confirmed COVID-19 cases by the number of residents from the 2010 Census. We used the Social Distancing Index (SDI), derived from the COVID-19 Impact Analysis Platform, to measure the mobility. For the evaluation of implementation, the observation started from Mar 1st 2020 to 1 day before lifting; and, for lifting, it ranged from 1 day after implementation to Jul 5th 2020. We calculated a comparative change of daily trends in COVID-19 prevalence and Social Distancing Index between counties with three highest disadvantage levels and those with the least level before and after the implementation and lifting of the stay-at-home order, separately.ResultsOn both stay-at-home implementation and lifting dates, COVID-19 prevalence was much higher among counties with the highest or lowest disadvantage level, while mobility decreased as the disadvantage level increased. Mobility of the most disadvantaged counties was least impacted by stay-at-home implementation and relaxation compared to counties with the most resources; however, disadvantaged counties experienced the largest relative increase in COVID-19 infection after both stay-at-home implementation and relaxation.ConclusionsNeighborhoods with varying levels of socioeconomic disadvantage reacted differently to the implementation and relaxation of COVID-19 mitigation policies. Policymakers should consider investing more resources in disadvantaged counties as the pandemic may not stop until most neighborhoods have it under control.

Impact of COVID-19 Mitigation Efforts on Adults With Serious Mental Illness: A Patient-Centered Perspective.

In response to COVID-19 mitigation policies, mental health and social service agencies have had to rapidly change their operations, creating challenges for patients with serious mental illness (SMI). This study aimed to explore the experiences of adults with SMI navigating these altered systems during the pandemic. In-depth interviews were conducted with 20 hospitalized adults with SMI in the fall of 2020; they were coded using thematic analysis. Most participants found the new systems effective at meeting their essential needs. However, several reported significant unmet needs, including inability to access mental health care and public benefits. These participants lacked identification documents, housing, and/or a personal device. Although none of the participants used telemedicine before COVID-19, most reported no or minimal problems with telemental health. Those reporting difficulties did not have personal devices, were receiving audio-only services, or viewed telemedicine as less personal or too distracting.

COVID-19, individual wellbeing and multi-dimensional poverty in the state of South Australia.

Research efforts in the initial months of the COVID-19 pandemic focused on the actual and potential impacts on societies, economies, sectors, and governments. Less attention was paid to the experiences of individuals and less still to the impact of COVID-19 on an individual's wellbeing. This research addresses this gap by utilising a holistic wellbeing framework to examine the impact of COVID-19 on the overall wellbeing of individuals in the Australian state of South Australia through an online survey. The research framework for the survey comprises six dimensions: psychological and emotional health, physical health, living standards, family and community vitality, governance, and ecological diversity and resilience. The results show that most respondents (71%) were able to maintain overall wellbeing during the pandemic. However, more than a half of the respondents could not maintain wellbeing in psychological and emotional health. Further examination of the drivers of inability to maintain overall wellbeing reveals that low-income individuals, younger respondents (aged 18-24) and women suffer disproportionate hardships. Defining poverty in terms of multi-dimensional deprivations in wellbeing enables a nuanced analysis of the unequal impacts of COVID-19 mitigation policies that can be used to improve policymaking.

Assessing the nationwide impact of COVID-19 mitigation policies on the transmission rate of SARS-CoV-2 in Brazil

COVID-19 is now identified in almost all countries in the world, with poorer regions being particularly more disadvantaged to efficiently mitigate the impacts of the pandemic. In the absence of efficient therapeutics or large-scale vaccination, control strategies are currently based on non-pharmaceutical interventions, comprising changes in population behavior and governmental interventions, among which the prohibition of mass gatherings, closure of non-essential establishments, quarantine and movement restrictions. In this work we analyzed the effects of 707 governmental interventions published up to May 22, 2020, and population adherence thereof, on the dynamics of COVID-19 cases across all 27 Brazilian states, with emphasis on state capitals and remaining inland cities. A generalized SEIR (Susceptible, Exposed, Infected and Removed) model with a time-varying transmission rate (TR), that considers transmission by asymptomatic individuals, is presented. We analyze the effect of both the extent of enforced measures across Brazilian states and population movement on the changes in the TR and effective reproduction number. The social mobility reduction index, a measure of population movement, together with the stringency index, adapted to incorporate the degree of restrictions imposed by governmental regulations, were used in conjunction to quantify and compare the effects of varying degrees of policy strictness across Brazilian states. Our results show that population adherence to social distance recommendations plays an important role for the effectiveness of interventions and represents a major challenge to the control of COVID-19 in low- and middle-income countries.

Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420).

PURPOSECOVID-19 has affected cancer care worldwide. Clinical trials are an important alternative for the treatment of oncologic patients, especially in Latin America, where trials can be the only opportunity for some of them to access novel and, sometimes, standard treatments.METHODSThis was a cross-sectional study, in which a 22-question survey regarding the impact of the COVID-19 pandemic on oncology clinical trials was sent to 350 representatives of research programs in selected Latin American institutions, members of the Latin American Cooperative Oncology Group.RESULTSThere were 90 research centers participating in the survey, with 70 of them from Brazil. The majority were partly private or fully private (n = 77; 85.6%) and had confirmed COVID-19 cases at the institution (n = 57; 63.3%). Accruals were suspended at least for some studies in 80% (n = 72) of the responses, mostly because of sponsors' decision. Clinical trials' routine was affected by medical visits cancelation, reduction of patients' attendance, reduction of other specialties' availability, and/or alterations on follow-up processes. Formal COVID-19 mitigation policies were adopted in 96.7% of the centers, including remote monitoring and remote site initiation visits, telemedicine visits, reduction of research team workdays or home office, special consent procedures, shipment of oral drugs directly to patients' home, and increase in outpatient diagnostic studies. Importantly, some of these changes were suggested to be part of future oncology clinical trials' routine, particularly the ones regarding remote methods, such as telemedicine.CONCLUSIONTo our knowledge, this was the first survey to evaluate the impact of COVID-19 on Latin American oncology clinical trials. The results are consistent with surveys from other world regions. These findings may endorse improvements in clinical trials' processes and management in the postpandemic period.

Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements

ObjectivesCOVID-19 may spread rapidly in densely populated urban informal settlements. Kenya swiftly implemented mitigation policies; we assess the economic, social and health-related harm disproportionately impacting women.DesignA prospective longitudinal cohort study...

Flattening the curve in jails and prisons: Factors underlying support for COVID-19 mitigation policies.

Jails and prisons have become hotbeds of COVID-19 outbreaks Various policies, such as improving access to medical care for inmates, providing soap and hand sanitizer to improve hygiene, and releasing some inmates to facilitate social distancing, have been proposed as ways to mitigate the spread of the virus in these facilities Across 2 studies, we examined the factors underlying support for policies aimed at reducing the spread of COVID-19 in jails (n = 132) and prisons (n = 125) and yielded 3 key findings Factors found in prior research to be associated with desire for punitive responses-namely, negative attitudes toward offenders and, to a lesser extent, lack of trust in the criminal justice system-were found to underlie lack of support for all types of COVID-19 mitigation policies Concern related to COVID-19-namely, perceptions of personal risk of contracting the virus-was related to increased support for policies to curb the spread of the virus among inmates Social media consumption and reliance on social media for news regarding COVID-19 demonstrated inconsistent relationships with support for policies These findings suggest that factors related to support for harsh treatment of offenders and concerns related to the present situation both contribute to support for criminal justice policy during a crisis situation like a pandemic The recommended policies offer hope for reducing the negative impact of COVID-19 among justice-involved people We offer suggestions on tailoring messaging to improve public support for these policies (PsycInfo Database Record (c) 2020 APA, all rights reserved)