COVID-19 Disruption Research Articles

Excess Cardiopulmonary Arrest and Mortality after COVID-19 Vaccination in King County, Washington

Introduction: Since the onset of widespread COVID-19 vaccination campaigns, there have been concerns about serious cardiovascular adverse events as a result of mass vaccination. This study aimed to estimate excess cardiopulmonary arrest mortality in King County, WA, and investigate any association with COVID-19 vaccination rates. Methods: An exploratory data analysis was performed. Comparative analyses were performed to evaluate the changes in total EMS attendances over time. Excess deaths were calculated using the 2015-2020 cardiopulmonary arrest mortality trend line. The relationship between excess cardiopulmonary arrest mortality and vaccination rates was analyzed using polynomial regression analysis. Results: Approximately 98% of the King County population received at least one dose of a COVID-19 vaccine by 2023. As of August 2nd, 2024, there have been approximately 589,247 confirmed COVID-19 cases in King County. In 2021- 2022, Total EMS attendances in King County sharply increased by 35.34% from 2020 and by 11% from pre-pandemic years. Cases of 'obvious death' upon EMS arrival increased by 19.89% in 2020, 36.57% in 2021, and 53.80% in 2022 compared to the 2017-2019 average. We found a 25.7% increase in total cardiopulmonary arrests and a 25.4% increase in cardiopulmonary arrest mortality from 2020 to 2023 in King County, WA. Excess fatal cardiopulmonary arrests were estimated to have increased by 1,236% from 2020 to 2023, rising from 11 excess deaths (95% CI: -12, 34) in 2020 to 147 excess deaths (95% CI: 123, 170) in 2023. A quadratic increase in excess cardiopulmonary arrest mortality was observed with higher COVID-19 vaccination rates. The general population of King County sharply declined by 0.94% (21,300) in 2021, deviating from the expected population size. Applying our model from these data to the entire United States yielded 49,240 excess fatal cardiopulmonary arrests from 2021-2023. Conclusions: We identified a significant ecological and temporal association between excess fatal cardiopulmonary arrests and the COVID-19 vaccination campaign. The increase in excess cardiopulmonary arrest deaths may also be attributed to COVID-19 infection and disruptions in emergency care during the pandemic. Urgent further research is needed to confirm our observations with attention to risk mitigation for incident events and improved survival with resuscitation.

Implementation of Digital-Based Adult Learning Education (ALE) at Community Learning Centre (CLC)

This study aims to answer the challenges of globalization of information and the position of advanced technology in adult learning education that accelerates the diffusion of science and technology in the work or social life and encourages adults to adapt to the times. This research uses mixed methods, with quantitative and qualitative approaches. The research was conducted at a community education institution, namely a CLC in Indonesia, with a total response of 120 adult learners from 43 CLCs. The results of the study are: 1) CLC has provided material according to the needs of the learning community with cooperative, participatory and collaborative learning; 2) CLC has facilitated its learning citizens to discuss and provide digital exercises and quizzes; 3) CLC has provided learning materials that are tailored to the needs of learning citizens; and 4) adult learners are considered satisfied with the learning and learning facilities in CLC. Digital-based adult learning education has been implemented in CLC in Indonesia. Despite COVID-19 disruptions, digitalization has brought positive changes to adult learning. It has diversified the learning process, requiring educators to be more creative. However, around 20% of the 43 CLCs continue conventional learning. Because institutions are not yet fully ready to equip IT equipment and most adult learners prefer face-to-face This research illustrates that teaching adults requires the right learning approach or strategy; boredom does not occur in learning. However, 20% of CLCs must still be ready to digitize adult learning education.

Investigating Longitudinal Trajectories of COVID-19 Disruption: Methodological Challenges and Recommendations.

Relatively few studies have longitudinally investigated how COVID-19 has disrupted the lives and health of youth beyond the first year of the pandemic. This may be because longitudinal researchers face complex challenges in figuring out how to code time, account for changes in COVID-19 spread, and model longitudinal COVID-19-related trajectories across environmental contexts. This manuscript considers each of these three methodological issues by modeling trajectories of COVID-19 disruption in 1080 youth from 12 cultural groups in nine nations between March 2020-July 2022 using multilevel modeling. Our findings suggest that for studies that attempt to examine cross-cultural longitudinal trajectories during COVID-19, starting such trajectories on March 11, 2020, measuring disruption along 6-month time intervals, capturing COVID-19 spread using death rates and the COVID-19 Health and Containment Index scores, and using modeling methods that combine etic and emic approaches are each especially useful. In offering these suggestions, we hope to start methodological dialogues among longitudinal researchers that ultimately result in the proliferation of research on the longitudinal impacts of COVID-19 that the world so badly needs.

Epidemiological overlaps in COVID-19 and malaria within healthcare and community settings of Southern Ghana.

COVID-19 disruptions including lockdowns and prioritization of COVID-19 control programs in Africa in 2020-2022 contributed to reductions in malaria control activities including malaria diagnosis, treatment and resistance monitoring. This study investigated the malaria burden and distribution on the background of active transmission of SARS-CoV-2 in Southern Ghana; utilizing community health education and medical screening (CHEMS) approach to determine epidemiological overlaps in COVID-19 and malaria. Between October-December 2022, prospective cross-sectional surveys, with CHEMS were conducted in Greater Accra and Central regions, where 994 participants enrolled either at a hospital or community setting provided demographic and clinical data including history of clinical malaria infection and antimalarial treatment in the past 2 weeks. Of this study population, 953 provided nasal/throat swabs for COVID-19 RT-PCR testing, with a subset of 136 participants also providing finger-prick blood for malaria RDT testing. The study population comprised of 73.6% adults, with 54.6% COVID-19 vaccination rate. Overall, 18.1% of participants had a history of clinical malaria, which was associated (adjusted odds ratio > 1.50, p-value ≤0.022) with COVID-19 symptoms and positivity, study area and hospital setting, suggestive of overlaps in the epidemiological risk for malaria. On a background of widespread SARS-CoV-2 infections (12-37%), malaria parasitaemia was detected in 6%, with 2% being co-infections with SARS-CoV-2. Among the malaria positives, 9.5% had a history of antimalarial treatment, which suggested that their infections were recrudescent parasitaemia. The epidemiological and clinical overlap between malaria and COVID-19 within the hospital and community settings underscores the need for accurate case diagnosis to inform effective clinical treatments. Innovative surveillance programs, with community engagement are needed to maximize control interventions including treatment of asymptomatic malaria infections.

Assessing Indonesian Nutmeg Commodity Trade Competitiveness and Developing Sustainable Strategies in the Global Market

Nutmeg encounters challenges in productivity, quality, climate change, Covid-19 disruptions, and stagflation, requiring efforts to enhance competitiveness and meet global market demands. This study aims to analyze Indonesian nutmeg trade performance, assess competitive advantage, and formulate essential strategies to increase its competitiveness. Using comprehensive mixed quantitative and qualitative analysis, methods include export-import market share analysis, CAGR, import dependency ratio, import-to-export ratio, RCA, RSCA, RTA, and SWOT/QSPM analysis. The data obtained from in-depth interviews with key stakeholders was used for formulating strategies enhancing nutmeg’s competitiveness. The findings underscore Indonesia's significant dominance in the global nutmeg market, with a considerable 61.6% market share but its export growth rate for nutmeg was less than the import annual growth. The competitiveness indicators demonstrated a robust comparative advantage of Indonesian nutmeg trade in the global market, especially for products categorized as “nutmeg, neither crushed nor ground” and “nutmeg, crushed or ground”. Indonesian also has comparative advantage among other exporter countries. Crucial strategies of internal and external perspectives, such as expanding markets, improving nutmeg quality and productivity through improving farmer capacity, technological adoption, and good agricultural practices are necessary to take into account Indonesia’s nutmeg competitiveness in global markets.

Cost-effectiveness of bioimpedance-guided fluid management in patients undergoing haemodialysis: the BISTRO RCT.

The BioImpedance Spectroscopy to maintain Renal Output randomised controlled trial investigated the effect of bioimpedance spectroscopy added to a standardised fluid management protocol on the risk of anuria and preservation of residual kidney function (primary trial outcomes) in incident haemodialysis patients. Despite the economic burden of kidney disease, the cost-effectiveness of using bioimpedance measurements to guide fluid management in haemodialysis is not known. To assess the cost-effectiveness of bioimpedance-guided fluid management against current fluid management without bioimpedance. Within-trial economic evaluation (cost-utility analysis) carried out alongside the open-label, multicentre BioImpedance Spectroscopy to maintain Renal Output randomised controlled trial. Thirty-four United Kingdom outpatient haemodialysis centres, both main and satellite units, and their associated inpatient hospitals. Four hundred and thirty-nine adult haemodialysis patients with > 500 ml urine/day or residual glomerular filtration rate > 3 ml/minute/1.73 m2. The study intervention was the incorporation of bioimpedance technology-derived information about body composition into the clinical assessment of fluid status in patients with residual kidney function undergoing haemodialysis. Bioimpedance measurements were used in conjunction with usual clinical judgement to set a target weight that would avoid excessive fluid depletion at the end of a dialysis session. The primary outcome measure of the BioImpedance Spectroscopy to maintain Renal Output economic evaluation was incremental cost per additional quality-adjusted life-year gained over 24 months following randomisation. In the main (base-case) analysis, this was calculated from the perspective of the National Health Service and Personal Social Services. Sensitivity analyses explored the impact of different scenarios, sources of resource use data and value sets. The bioimpedance-guided fluid management group was associated with £382 lower average cost per patient (95% CI -£3319 to £2556) and 0.043 more quality-adjusted life-years (95% CI -0.019 to 0.105) compared with the current fluid management group, with neither values being statistically significant. The probability of bioimpedance-guided fluid management being cost-effective was 76% and 83% at commonly cited willingness-to-pay threshold of £20,000 and £30,000 per quality-adjusted life-year gained, respectively. The results remained robust to a series of sensitivity analyses. The missing data level was high for some resource use categories collected through case report forms, due to COVID-19 disruptions and a significant dropout rate in the informing BioImpedance Spectroscopy to maintain Renal Output trial. Compared with current fluid management, bioimpedance-guided fluid management produced a marginal reduction in costs and a small improvement in quality-adjusted life-years. Results from both the base-case and sensitivity analyses suggested that use of bioimpedance is likely to be cost-effective. Future work exploring the association between primary outcomes and longer-term survival would be useful. Should an important link be established, and relevant evidence becomes available, it would be informative to determine whether and how this might affect longer-term costs and benefits associated with bioimpedance-guided fluid management. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number HTA 14/216/01 (NIHR136142).

Examining academics’ changing approaches to teaching in response to the pandemic disruption: a phenomenographic approach

ABSTRACT University curriculum systems are complex, and their modification requires coordinating multiple processes and broad consultation with teaching academics and leaders. Strong influences including policy changes and external disruptions can bring about rapid system-wide change, but these are not without stress and may not be sustainable. To appreciate how disruptions influence university teaching and learning over the longer term, we need to better understand how teachers respond. We examined the experiences of teaching academics during the disruption of COVID-19, using the relational 3P model as a guiding framework. Using phenomenographic analyses, we defined three key categories within which academics’ experiences varied: Teaching & Learning; Support, and their Role. Teachers’ perceptions of support and role were intertwined, forming a broader context than described by the relational 3P model. We suggest a modified model to better align with academics’ experiences during change, upon which supportive structures and processes can be designed.

Оценка привлекательности ресторанных рынков регионов Сибирского федерального округа

Many restaurant companies turn to territorial expansion to restore and develop the restaurant market after COVID-19 restrictions and disruptions in logistics. As a result, they need to select territories with the greatest business development prospects. As a rule, they choose geographical markets for expansion based on attractiveness assessments and market ratings provided by various research companies and institutes. However, these reports often lack rating attractiveness assessments for separate regions and the domestic restaurant market as a whole. Moreover, a review of scientific publications revealed no standard approach to market parameters in this sphere. The authors employed three different methods to assess the attractiveness of restaurant markets in the regions of the Siberian Federal District. Each method included single-factor or multi-factor parameters that determined the state of the restaurant market at a static moment in time. The methods were based on objective statistical data, which provided a fairly high degree of reliability. The comprehensive diagnosis yielded an attractiveness rating for various regions of the Siberian Federal District and their territorial expansion prospects for restaurant companies. The Krasnoyarsk Region demonstrated the best results byall methods. The republics of Khakassia, Tyva, and Altai appeared to be the least attractive areas for restaurant business expansion. The remaining six regions of Novosibirsk, Altai, Kemerovo, Irkutsk, Omsk, and Tomsk occupied the middle ranking.

Abstract C129: Adapting to disruption?: Changes in colorectal cancer screening modalities and disparities during the COVID-19 pandemic

Abstract Research Objective: At-home colorectal cancer screening methods, such as Fecal Immunochemical Tests (FIT), offered a safer, convenient alternative to in-clinic procedures like colonoscopies during the COVID-19 pandemic. Racial and ethnic minorities were more likely to use these tests prior to the pandemic, but it is unclear whether disparities in colorectal cancer screening changed because of the pandemic. We examined rates of colorectal cancer screening before and after shutdown periods across race/ethnicity, age, and income among health plan enrollees in the United States to inform screening catch-up strategies after COVID-19 disruptions. Study Design: We conducted a retrospective analysis of cancer screening claims from Optum Clinformatics Data Mart among enrollees from 2019-2021. Monthly screening volume was calculated for a three-year period, with January 2019-February 2020 as the pre-pandemic period, and July 2020-December 2021 as the post-pandemic period. We conducted an event study to calculate group-level monthly predicted probabilities of screening using a linear probability model with group interactions by month, controlling for demographic variables and comorbidities. Additionally, we used difference-in-difference (DD) regressions including group interacted with a post-pandemic dummy. The pandemic closure period months were excluded from our DD analysis. Eligible enrollees included those ages 40-75 with continuous enrollment 12 months prior to screening index month. Colorectal cancer screening claims included codes for colonoscopies and other endoscopic procedures as well as FIT and FOBT tests. Results: 2,576,760 health plan enrollees were included. Colonoscopy rates did not change significantly between the pre-COVID period and post-COVID period, however FIT test screening rates dropped from an average of 0.66% of age-eligible enrollees screened per month in the pre-pandemic period to 0.58%. Our difference-in-difference results suggested Hispanic-NH White disparities in FIT tests widened. For colonoscopy, Hispanic-NH White and Asian-White disparities widened, while Black-White disparities decreased. Conclusions: Despite the promise that in-home FIT testing would substitute for colonoscopy during the pandemic, we saw a much larger decline in FIT testing rates during the pandemic than for colonoscopy and increasing disparities. This study highlights the need for targeted strategies to address screening disparities exacerbated by the COVID-19 pandemic, particularly among Hispanic and NH-Asian populations. Citation Format: Cameron M. Kaplan, Willow Pastard, John Thacker, Todd Schneberk, Chun Nok Lam, Sarah Axeen, Jennifer Tsui. Adapting to disruption?: Changes in colorectal cancer screening modalities and disparities during the COVID-19 pandemic [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C129.

It’s all about resources: Narcissistic CEOs and entrepreneurial orientation during disruptions

Research regarding the influence of personality traits, such as narcissism, on entrepreneurial orientation (EO) is burgeoning, yet the role of affective and cognitive mechanisms is under-examined. Drawing from research on conservation of resources (COR) theory, entrepreneurial cognition and emotion, we examine the narcissism-EO relationship nexus. Specifically, we analyse the mediating role of the resource-induced coping heuristic (RICH) and the moderating influence of fear on the relationship between narcissism and EO. Longitudinal data from CEO-entrepreneurs of SMEs in six countries were collected during the COVID-19 disruptions. Results suggest that the RICH fully mediates the relationship between narcissism and EO. Fear of COVID-19 (FC-19) positively influenced EO and strengthened the narcissism-RICH relationship. Further, pandemic-related disruptions negatively influenced EO and attenuated the positive influence of FC-19 on EO. These findings offer insight into the drivers of entrepreneurial behaviour during times of disruption.

CROI 2024 BHIVA working group summary.

The Conference on Retroviruses and Opportunistic Infections (CROI) is usually the most significant HIV conference of the year in terms of basic and clinical scientific output. CROI 2024 in Denver, USA, felt very much back to 'business as usual' following COVID-19 disruptions that had impacted preceding years, but also felt more global and outward- facing. The British HIV Association supports a working group to attend CROI annually and deliver feedback in the UK. This article summarizes the highlights from that meeting.

헬스케어 공급망 리스크 주요 이슈 분석: 뉴스기사를 중심으로

This study investigates the major risk issues and their causes in healthcare supply chains, using network analysis and qualitative analysis of news media publications, and then proposes response and operational strategies for managing healthcare supply chain risks. We divided our study into two time periods for a comparative analysis of key risk issues in different degrees of environmental uncertainty. The year 2020 marked the emergence of the COVID-19 pandemic. The first period of our analysis is four years covering 2016-2019, prior to COVID-19 disruptions. The second period is also four years during 2020-2023 when the full force of COVID-19 disruptions affected healthcare supply chains. The keywords used to collect news media publications were “healthcare,” “healthcare industry,” “healthcare services,” “hospital,” “health center,” and “medicine.” The results of the study indicated that the major risks experienced in healthcare supply chains were due to the following factors: the type of patients who needed healthcare services, care services provided (lab tests, treatment, prescriptions, etc.), care service methods used (surgery, utilization of medical devices), and examination and diagnostics (clinical kits, etc.). While these factors were identified as possible causes of risk in the healthcare supply chains involving procurement of supplies and raw materials, these risks tend to intensify in the increased disruption period (year 2020-2023). Managing these risk issues in the disruptive periods contributes significantly not only to the performance of healthcare organizations but also to the well-being of the society at large. This study offers theoretical implications in that it analyzes the causes of risks in the healthcare supply chains and provides a basis for a comparative analysis of the relationships of risk factors in healthcare supply chains during a normal environment and a very disruptive environment. From a practical perspective, this study suggests effective countermeasures for managing healthcare supply chain risks with examples that can be used as a guideline by healthcare executives, managers, and policy-makers of healthcare services.

COVID-19 Disruptions and Choice: Student Movement and Academic Outcomes in Indiana During the Pandemic

ABSTRACT Faced with, nearly all U.S. schools transitioned to remote instruction in March 2020. The following year, the majority of public schools remained closed, but most Catholic schools offered in-person learning. In Indiana, many parents had additional opportunity to switch to a private school for in-person instruction. We examine student and school administrative data to consider movement between sectors and achievement outcomes for students moving to Catholic schools compared to matched peers in their previous public schools. Students who moved to in-person instruction in a Catholic school during this time fared better academically than those remaining in their previous public school.

Delving into the Architecture of International B2B Relationship Marketing During the COVID-19 Pandemic: From Business Convergence to Partnership Effectiveness

ABSTRACT Purpose The study seeks to address the influence of different facets of business-to-business (B2B) relationship marketing on internationalization effectiveness, by taking into account the turbulent environment generated by the COVID-19 pandemic. The focus falls on the factors that generate, frame, catalyze, sustain and strengthen international business relationships between managers from organizations with converging interests. Methodology B2B relationship marketing in the international arena is analyzed by means of various angles such as business convergence, business context, interpersonal compatibility, business credibility and network interconnections as availed by the “new normal” triggered by the COVID-19 pandemic. A questionnaire-based survey with 158 business owners and managers from European industrial companies was carried out during November 2023 to investigate the configuration and dynamics of B2B relationship marketing in the unprecedented and systemic COVID-19 crisis. Data was analyzed via structural equation modeling using SmartPLS 4. Findings The findings showed that while business convergence remains a strong influencer of all the other relational dimensions, the restrictions and limitations engendered by the pandemic have also altered international B2B relationship marketing to such an extent that the only significant factor for internationalization effectiveness relies on business networking. Research and practical implications The study has both theoretical and practical implications, bringing forward a topical perspective on international B2B relationships during COVID-19 disruptions and their impact on the effectiveness of international operations. Originality The study advances a phenomenological view of the unprecedented changes and their influences on the overseas operations of SMEs in a particular field. It complements and adds to the literature by stressing a more articulated relationship-centric architecture, which probed relevance during the pandemic.

Malaysian Government's Unified Approach to Address National Food Security

In Malaysia, following the COVID-19 disruption of food supply, the Cabinet Committee of National Food Security Policy was set up in 2020 as a whole-of-government effort to bring together strategies and action plans for food security at the national level. This study looks at how the policies of different ministries and central agencies match up with the progressive direction set by the committee. Even though there are varying focuses on the policies between the government bodies, a collective synergy emerges from their efforts. A document analysis of these key policies shows the government's commitment to ensuring enough food for everyone.

Specialty economies of scope in English hospitals: Cost Arguments for colocation

ObjectiveCurrent policy responses to COVID-19 disruption and care backlogs suggest potential changes to the location and structure of hospital healthcare supply. However, few studies investigating the cost effects of hospital reorganisation consider changes in the mix of outputs or test for the existence of economies of scope in hospital healthcare. Attempts to create dedicated hubs to address healthcare demand backlogs could have unintended adverse cost effects where these are provided outside existing hospital arrangements. To evaluate this, we investigate the existence and size of economies of scope in English hospital healthcare. DataWe use cost and activity data from the English NHS, linked to aggregated staff wage information and information taken from hospital financial statements. Cost and activity data was obtained from NHS England's Costing Publications. Wage data was extracted from the NHS's Electronic Staff Record via the NHS England Workforce Statistics Team, and published hospital financial accounts were aggregated and linked together at the organisation level. ResultsGeneral Surgery exhibited positive economies of scope when provided alongside other healthcare, as to a lesser extent did General Medicine and Obstetric/Gynaecology healthcare. There was little evidence for economies of scope in Diagnostic and Pathology services, Orthopaedics, or Emergency Care. Few (2/28) output cross-products (cost complementarities) were statistically significant, but Baumol's wider definition of scope economies demonstrates that scope economies are present in some specialties. ConclusionPolicymakers seeking to maximise the amount of healthcare provided and minimise the costs of doing so may wish to consider retaining General Surgery, General Medicine and Obstetric/Gynaecology healthcare supply alongside the provision of other clinical specialties. There is limited evidence that reconfiguring supply by centralizing other specialty groups into fewer providers would increase costs.

Motivational Network Intervention to Reduce Substance Use and Increase Supportive Connections for Emerging Adults in a Supportive Housing Program

Abstract: Background. For transition-aged youth experiencing homelessness (TAYEH) moving to transitional housing, a motivational network intervention (MNI) may help modify high-risk networks, thereby reducing substance use and strengthening prosocial connections. Methods. Thirty-six TAYEH received a four-session MNI integrated into usual housing case management or usual case management. Intervention acceptability, feasibility, and motivational interviewing fidelity were evaluated. Results. Nearly all participants would recommend the MNI to others, formed goals, and believed the program improved their lives. Case managers delivered the program with fidelity. However, sample size and number of sessions delivered fell short of targets due to COVID-19 disruptions and other factors and limited our ability to examine preliminary effects on substance use and network outcomes in a fully powered trial. Conclusion. Case managers can successfully deliver the MNI, but its use may not be feasible unless adaptations are made to accommodate the instability this population faces when they enter housing.

Exploring Systems Thinking and Systemic Design: Insights from a Summer School Experiment Addressing Urban Health Crises

This paper relates urban healthcare crises to the global challenges of overshoot and collapse and suggests systems thinking as an innovative approach towards addressing these amalgamated crisis situations. We begin by reviewing what systems are and how they are structured and behave, highlighting how systems thinking can identify high-leverage interventions and systemic design to achieve effective change. Subsequently, we illustrate how these system concepts were applied in an international, multidisciplinary summer school between European and Southeast Asian partners in collaboration with the World Health Organization’s (WHO) Technical Science for Health Network (Téchne). Examining how ventilation, temperature, humidity, and daylighting control strategies enhance Infection Prevention and Control (IPC), the initiative developed ideas and designs for a multiple disease treatment center that would provide isolation units and create a safe care environment for patients, families, and communities. The design process was informed through consultation with three physically and socio-economically diverse neighborhoods across the Bangkok Metropolitan Region to gain a richer understanding of the varied experiences and approaches in managing the COVID-19 disruption. Leveraging WHO guidelines, students adopted a systemic design approach to develop innovative solutions that could withstand natural hazards and used local materials and natural ventilation to prevent airborne infection and control indoor temperature. In conclusion, we propose a novel working model linking specific stages of systemic thinking and systemic design into a generalized, iterative urban and healthcare design framework that will be further refined as part of specific electives at the KU Leuven Faculty of Architecture and joint summer schools in 2023, 2024 and beyond.

COVID-19 Disruptions to Social Care Delivery: A Qualitative Study in Two Large, Safety-Net Primary Care Clinics

BackgroundSocial care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs.ObjectiveTo describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting.DesignWe used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration.SettingTwo safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs.ParticipantsSix physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews.ResultsFour major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences.ConclusionsThe COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.

Criticality assessment and cascading effects: impacts of COVID-19 disruptions in public transport on marginalized groups in Dortmund, Germany, São Paulo, Brazil, and Cape Town, South Africa

The COVID-19 pandemic has underscored the interconnectedness of critical infrastructure systems and their profound impact on marginalized communities. This study investigates the cascading effects of reduced mobility and infrastructure disruptions caused by COVID-19 response strategies on marginalized households across three diverse urban settings: Dortmund, São Paulo, and Cape Town. Employing a criticality assessment, we examine disruptions in healthcare, food and nutrition, social work, education, and childcare sectors, highlighting interdependencies and their implications for marginalized communities. Our findings reveal that disruptions in one sector, such as public transportation, can trigger adverse consequences across interconnected systems, amplifying vulnerabilities and exacerbating social inequalities. Furthermore, limited digital accessibility compounds these challenges, particularly for marginalized groups who may lack access to necessary technologies or digital literacy skills. Addressing these disparities in digital access is crucial for ensuring equitable access to essential services and support networks, especially in times of crisis. The study underscores the importance of mobility and accessibility in addressing systemic vulnerabilities and advocates for comprehensive resilience strategies that prioritize the needs of marginalized communities. Recommendations for policymakers, urban planners, and community stakeholders are provided to enhance infrastructure resilience and mitigate the indirect effects of disruptions on marginalized groups. The study contributes to a deeper understanding of cascading effects within critical infrastructure networks and informs future research and policy initiatives aimed at building resilient communities in an interconnected world.