First Wave Of Pandemic Research Articles

The impact of the COVID-19 pandemic on stress and other psychological factors in pregnant women giving birth during the first wave of the pandemic

BackgroundThe onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant.MethodsPatients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother–child bonding were administered at T1 (delivery stay) and T2 (3–6 months postpartum).ResultsIn total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic.ConclusionObstetric patients` concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother–child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic.Clinical trial registration DRKS00022506

Multiple sclerosis and COVID-19: Assessing risk perception, patient behaviors and access to disease-modifying therapies

BackgroundFollowing the outbreak of COVID-19, global healthcare systems have had to rapidly adapt. People with multiple sclerosis (pwMS) were required to make decisions about their individual risk and consequent work and social behaviors. This study aimed to evaluate risk perception and patterns of shielding behavior amongst pwMS at the onset of the COVID-19 pandemic and the subsequent impact on patients’ employment and access to disease modifying therapies (DMTs). MethodsPostal surveys were sent to 1690 people within a UK population-based MS cohort during the first wave of the COVID-19 pandemic. Patients were surveyed on: (i) perceived vulnerability to COVID-19; (ii) isolation behavior; (iii) interruption to DMT; (iv) employment status; (v) level of satisfaction with their current working arrangement. ResultsResponses were received from 1000 pwMS. Two thirds of patients reported isolating at home during the first wave of the pandemic. This behavior was associated with increased age (p<0.0001), higher disability (p<0.0001) and use of high-efficacy DMTs (p = 0.02). The majority of patients reported feeling vulnerable (82%) with perceived vulnerability associated with higher EDSS (p<0.0001) and receiving a high-efficacy DMT (p = 0.04). Clinician-defined risk was associated with shielding behavior, with those at high-risk more likely to self-isolate/shield (p<0.0001). Patients on high-efficacy DMTs were more likely to have an interruption to their treatment (50%) during the first wave of the pandemic. Most pwMS experienced a change to their working environment, and most were satisfied with the adjustments. ConclusionThis study highlights the risk perception, social behavioral practices and changes to treatment experienced by pwMS during the first wave of the COVID-19 pandemic in a large, well-described UK cohort. The results may help inform management of pwMS during future pandemic waves.

Association Between the COVID-19 Pandemic and Insurance-Based Disparities in Mortality After Major Surgery Among US Adults

The COVID-19 pandemic caused significant disruptions in surgical care. Whether these disruptions disproportionately impacted economically disadvantaged individuals is unknown. To evaluate the association between the COVID-19 pandemic and mortality after major surgery among patients with Medicaid insurance or without insurance compared with patients with commercial insurance. This cross-sectional study used data from the Vizient Clinical Database for patients who underwent major surgery at hospitals in the US between January 1, 2018, and May 31, 2020. The hospital proportion of patients with COVID-19 during the first wave of COVID-19 cases between March 1 and May 31, 2020, stratified as low (≤5.0%), medium (5.1%-10.0%), high (10.1%-25.0%), and very high (>25.0%). The main outcome was inpatient mortality. The association between mortality after surgery and payer status as a function of the proportion of hospitalized patients with COVID-19 was evaluated with a quasi-experimental triple-difference approach using logistic regression. Among 2 950 147 adults undergoing inpatient surgery (1 550 752 female [52.6%]) at 677 hospitals, the primary payer was Medicare (1 427 791 [48.4%]), followed by commercial insurance (1 000 068 [33.9%]), Medicaid (321 600 [10.9%]), other payer (140 959 [4.8%]), and no insurance (59 729 [2.0%]). Mortality rates increased more for patients undergoing surgery during the first wave of the pandemic in hospitals with a high COVID-19 burden (adjusted odds ratio [AOR], 1.13; 95% CI, 1.03-1.24; P = .01) and a very high COVID-19 burden (AOR, 1.38; 95% CI, 1.24-1.53; P < .001) compared with patients in hospitals with a low COVID-19 burden. Overall, patients with Medicaid had 29% higher odds of death (AOR, 1.29; 95% CI, 1.22-1.36; P < .001) and patients without insurance had 75% higher odds of death (AOR, 1.75; 95% CI, 1.55-1.98; P < .001) compared with patients with commercial insurance. However, mortality rates for surgical patients with Medicaid insurance (AOR, 1.03; 95% CI, 0.82-1.30; P = .79) or without insurance (AOR, 0.85; 95% CI, 0.47-1.54; P = .60) did not increase more than for patients with commercial insurance in hospitals with a high COVID-19 burden compared with hospitals with a low COVID-19 burden. These findings were similar in hospitals with very high COVID-19 burdens. In this cross-sectional study, the first wave of the COVID-19 pandemic was associated with a higher risk of mortality after surgery in hospitals with more than 25.0% of patients with COVID-19. However, the pandemic was not associated with greater increases in mortality among patients with no insurance or patients with Medicaid compared with patients with commercial insurance in hospitals with a very high COVID-19 burden.

Local TV News Coverage of Racial Disparities in COVID-19 During the First Wave of the Pandemic, March–June 2020

The COVID-19 pandemic has disproportionately impacted health and social outcomes for people of color in the United States. This study examined how local TV news stories attributed causes and solutions for COVID-19-related racial health and social disparities, and whether coverage of such disparities changed after George Floyd’s murder, during the first wave of the COVID-19 pandemic. We systematically validated keywords to extract relevant news content and conducted a content analysis of 169 discrete local TV news stories aired between March and June 2020 from 80 broadcast networks within 22 purposefully selected media markets. We found that social determinants of COVID-19 related racial disparities have been part of the discussion in local TV news, but racism as a public health crisis was rarely mentioned. Coverage of racial disparities focused far more attention on physical health outcomes than broader social impacts. Stories cited more structural factors than individual factors, as causes of these disparities. After the murder of George Floyd, stories were more likely to mention Black and Latinx people than other populations impacted by COVID-19. Only 9% of local news stories referenced racism, and stories referenced politicians more frequently than public health experts.

Social Responsibility and SDG 8 during the First Wave of the COVID-19 Pandemic: The Role of Chartered Accountants in Portugal

The fragility of the Portuguese economy, the weight of sectors that were especially vulnerable to the crisis caused by the pandemic, and the small size of enterprises meant that their economic and financial structure was not capable of supporting the effects of the economic crisis, jeopardizing the achievement of the SDG 8. This research explores the perception of chartered accountants about their role in supporting small and medium-sized enterprises during the first wave of the COVID-19 pandemic in Portugal, based on a literature review and on a questionnaire. The results show that 70% of professionals consider that their clients evaluated their work positively during the first wave of the pandemic. However, most chartered accountants did not charge their clients for their extra-work and expenses and 30% even decreased their monthly fees. Portuguese chartered accountants, confronted with the economic–financial problem caused by the pandemic, focused on saving most of their clients from collapse and safeguarding many jobs. This research highlights the public utility and social responsibility of chartered accountants’ work, in the pandemic context in Portugal, as well as their central role for the efficient application of Government economic policies to maintain economic growth and decent work (SDG 8).

Marital Status and Gender Differences as Key Determinants of COVID-19 Impact on Wellbeing, Job Satisfaction and Resilience in Health Care Workers and Staff Working in Academia in the UK During the First Wave of the Pandemic.

BackgroundThe COVID-19 pandemic is an unprecedented global public health crisis that continues to exert immense pressure on healthcare and related professional staff and services. The impact on staff wellbeing is likely to be influenced by a combination of modifiable and non-modifiable factors.ObjectivesThe aim of this study is to evaluate the effect of the COVID-19 pandemic on the self-reported wellbeing, resilience, and job satisfaction of National Health Service (NHS) and university staff working in the field of healthcare and medical research.MethodsWe conducted a cross sectional survey of NHS and UK university staff throughout the COVID-19 pandemic between May-November 2020. The anonymous and voluntary survey was disseminated through social media platforms, and via e-mail to members of professional and medical bodies. The data was analyzed using descriptive and regression (R) statistics.ResultsThe enjoyment of work and satisfaction outside of work was significantly negatively impacted by the COVID-19 pandemic for all of staff groups independent of other variables. Furthermore, married women reporting significantly lower wellbeing than married men (P = 0.028). Additionally, the wellbeing of single females was significantly lower than both married women and men (P = 0.017 and P < 0.0001, respectively). Gender differences were also found in satisfaction outside of work, with women reporting higher satisfaction than men before the COVID-19 pandemic (P = 0.0002).ConclusionOur study confirms that the enjoyment of work and general satisfaction of staff members has been significantly affected by the first wave of the COVID-19 pandemic. Interestingly, being married appears to be a protective factor for wellbeing and resilience but the effect may be reversed for life satisfaction outside work. Our survey highlights the critical need for further research to examine gender differences using a wider range of methods.

“Not a Political Virus”: Manufacturing Consent by Czech Public Service Media in the Pandemic

The article presents an analysis of the news broadcast on Czech public television during the first wave of the COVID-19 pandemic in March 2020. Based on the concept of post-politics, the analysis illustrates how Czech Television created consensus, naturalized the measures adopted by the government, and transformed a potentially political space into one that privileged instrumental and technical solutions. The author argues that the later emergence of protest movements in Czechia may also be related to the first wave of the pandemic being presented in a consensual, post-political form in public service media. This activity prevented society from recognizing the socially unequal impact of the pandemic and the measures aimed at reducing its impact. Dealing with the question of how to represent a world that went through a rapid change, because of a pandemic, the article ends with a plea for agonistic media pluralism.

Imaging strategies used in emergency departments for the diagnostic workup of COVID-19 patients during the first wave of the pandemic: a cost-effectiveness analysis

ObjectivesEmergency departments (EDs) were on the front line for the diagnostic workup of patients with COVID-19–like symptoms during the first wave. Chest imaging was the key to rapidly identifying COVID-19 before administering RT-PCR, which was time-consuming. The objective of our study was to compare the costs and organizational benefits of triage strategies in ED during the first wave of the COVID-19 pandemic. MethodsWe conducted a retrospective study in five EDs in France, involving 3712 consecutive patients consulting with COVID-like symptoms between 9 March 2020 and 8 April 2020, to assess the cost effectiveness of imaging strategies (chest radiography, chest computed tomography (CT) scan in the presence of respiratory symptoms, systematic ultra–low-dose (ULD) chest CT, and no systematic imaging) on ED length of stay (LOS) in the ED and on hospital costs. The incremental cost-effectiveness ratio was calculated as the difference in costs divided by the difference in LOS. ResultsCompared with chest radiography, workup with systematic ULD chest CT was the more cost-effective strategy (average LOS of 6.89 hours; average cost of €3646), allowing for an almost 4-hour decrease in LOS in the ED at a cost increase of €98 per patient. Chest radiography (extendedly dominated) and RT-PCR with no systematic imaging were the least effective strategies, with an average LOS of 10.8 hours. The strategy of chest CT in the presence of respiratory symptoms was more effective than the systematic ULD chest CT strategy, with the former providing a gain of 37 minutes at an extra cost of €718. DiscussionSystematic ULD chest CT for patients with COVID-like symptoms in the ED is a cost-effective strategy and should be considered to improve the management of patients in the ED during the pandemic, given the need to triage patients.

Was it Doomsday? First Wave of the COVID-19 Pandemic Impact on the Polish Cultural Industry

Abstract Research purpose. The COVID-19 pandemic has become a theme of the research on the functioning of the economy and particular industries. The same concerns were raised regarding the issue of the cultural industry. Therefore, the content of this paper was dictated by the recognition of the impact of the first wave of the Covid-19 pandemic on the activities of the cultural industry in Poland. The formulated research question reads: “How did the beginning of the Covid-19 pandemic impact the economic standing of the Polish cultural industry?” Design / Methodology / Approach. The conducted literature review, whose purpose was to recognise the threads of the scientific discourse on the pandemic and cultural industry together with the cultural issues of business activity in a broad sense, was based on the use of the VOSviewer software, based on the data obtained from the Web of Science Core Collection. This concerned publications from January 1, 2020, to April 4, 2022. The part of the paper that leads to answering the research question uses the inductive method. It is based on the analysis of the quantitative data and information obtained from Statistics Poland (GłównyUrządStatystyczny), research reports as well as media releases. Findings. It was determined that in the first year of the pandemic, the number of cultural events, as well as the number of their participants, drastically decreased. There was also a change in the structure and value of expenditures of the citizens of Poland. This caused a drastic fall in revenues from the activity conducted by cultural institutions at the beginning of 2020. The situation improved after the disbursement of the government aid. However, even one year after the first lockdown, the increased debt of the art industry can be pointed out. Originality / Value / Practical implications. Determining in a broad way the impact of the first wave of the pandemic on the cultural industry in Poland concerning the economic standing is a novel approach. The previous studies focused on the situation of particular types of cultural institutions and possibly on the people associated with them. Due to its specificity, the conducted research also makes it possible to identify potential research problems relating to this industry. On the one hand, these potential studies are in line with the research threads represented in world literature. On the other hand, they concerned the specificity of the Polish cultural industry.

The epidemiology of distress: prevalence and associated factors of symptoms of depression, anxiety, and loneliness at the end of the first wave of COVID-19 in Qatar

IntroductionThere is paucity of epidemiological studies from the Arab world and most of the focus of available international data is on the early months of the pandemic.ObjectivesWe conducted the first cross-sectional national phone survey of adults in Qatar during the end of the first wave of the pandemic (December 2020 -January 2021) to estimate the prevalence and determinants of depression and/or anxiety.MethodsWe used the Physician Health Questionnaire-9 and Generalized Anxiety Disorder-7 with cut-off scores of ≥10; the revised UCLA loneliness scale; and questions related to COVID-19 status, death of family or friend, quarantine, health and changes in living arrangements. Bivariate and logistic regression models estimated associations between thirteen variables and combined depression-anxiety (score of 20 or higher).Results The two-week prevalence of depression was 6.5% (95%CI: 5.1-8.4), of anxiety 5.1% (95%CI: 3.8-6.9), but only 2.5% sought mental health professional help since the pandemic started. When including loneliness (OR=1.57, p (&lt;0.001) in the model, the following variables were statistically significantly associated with depression-anxiety: female gender (OR=1.90, p=0.037), Qatari nationality (OR=2.37, p=0.018), Arab ethnicity (OR=3.14, p=0.007), and COVID-19 death of family or friend (OR=3.06, p=0.003). Without adjusting for loneliness, younger age (18-29 versus 40+ years of age: OR=2.9, p=0.004) and chronic health conditions (OR=2.0, p=0.029) were significantly associated with depression-anxiety.ConclusionsPrevalence of depression and/or anxiety during the end of the first wave of COVID-19 pandemic in Qatar was similar to pre-pandemic estimates. Mental health service should focus on young adults, women, the bereaved, lonely and those with chronic health problems.DisclosureNo significant relationships.

Exchange Rates in Emerging Markets in the First Wave of the Covid-19 Pandemic

ABSTRACT We analyze the impact of the Covid-19 pandemic on emerging market real exchange rates using a Behavioral Equilibrium Exchange Rate approach augmented by pandemic variables. We show that behavioral factors related to Covid-19 played a significant role in explaining the behavior of emerging market real exchange rates during the first wave of the pandemic. The real exchange rates were driven by the number of new Covid-19 deaths rather than by the number of new infections. These results are robust for different country samples.

The Experience of COVID-19 Visitor Restrictions among Families of People Living in Long-Term Residential Care Facilities during the First Wave of the Pandemic in Ireland.

Public health responses to COVID-19 in long-term residential care facilities (LTRCFs) have restricted family engagement with residents. These restrictions impact on quality of care and the psychosocial and emotional well-being of family caregivers. Following a national cross-sectional web-based survey, respondents were invited to provide personal reflections on visitor restrictions. This study aims to describe the consequences of these restrictions for individuals living in LTRCF and their families during the first wave of the COVID-19 pandemic. Data from open-ended questions contained within the survey were analyzed using Braun and Clarke’s (2006) method of thematic analysis. Four themes were identified: 1. Altered Communication and Connection; 2. Emotional and Psychological Impact; 3. Protecting and Caring Role of Staff; 4. Family Role. Throughout the narrative accounts, it is evident that the visitor restrictions impacted on the emotional and mental well-being of families. Some respondents expressed frustration that they could not assist staff in essential care provision, reducing meaning and purpose in their own lives. COVID-19 LTRCF visitor restrictions made little distinction between those providing essential personal care and those who visit for social reasons. A partnership approach to care provision is important and should encompass strategies to maintain the psychosocial and emotional well-being of families and their relatives during times of self-isolating or restrictive measures.

Détresse et résilience des étudiants en médecine de Paris-Saclay lors de la première vague de la pandémie de COVID-19

ObjectivesIn France, during the first wave of the COVID-19 pandemic, all care workers have been mobilized. Despite this, the strong demand for care has put the health system under great strain. To overcome this overload of world, 86 medical students of Paris-Saclay University came to help some hospital services. They replaced caregivers, nurses or stretcher bearers under “degraded care” conditions. At the university level, the closure of the faculty due to generalized lockdown disrupted the training of these future doctors who were in second, third or fourth year of training (pre-clinical). This exploratory study proposes to collect the impact of the experience of these students during the first wave of the pandemic in order to better understand the difficulties they encountered, as well as the resources they exploited during this period. Materials and methodsUsing a mixed approach, both quantitative on the one hand and qualitative on the other hand, medical students from Paris-Saclay were interviewed through a retrospective questionnaire distributed in December 2020. The quantitative part of the questionnaire assessed their psychological distress (6-item Kessler scale) and their resilience (Brief Resilience Scale). The qualitative part of the questionnaire included various open questions concerning the motivations to participate, the difficulties encountered, the impact of the situation on their interpersonal relationships or their university course. ResultsA total of 46 responses from medical students from the University of Paris-Saclay were collected. This constitutes a response rate of 55%. Half of them were second or third year medical students. They were assigned to emergency departments, resuscitation or units dedicated to the care of patients with COVID-19. The average psychological distress score is 7.13. The average resilience score is 3.14. From these results, several categories of students were analyzed according to the elements found in their answers to the open questions. Almost all the students reported wanting to contribute to the collective effort and help hospital services. For some students, it was also a way of making themselves useful while escaping lockdown. The students were exposed to difficult working conditions, the distress of families and the deaths of numerous patients. Their involvement also had an impact on their relationships with their families: they could feel more isolated, or be afraid of infecting them. Their university work was very disrupted by their investment in the hospital: fatigue, concentration problems, lack of motivation could lead them to a form of dropping out of university. ConclusionsThe results of this study are part of the context of a particular health crisis. They show medical students exposed to significant psychosocial risks in a period of stress. It seems important to identify what leads some students to develop good resilience capacities. The COVID-19 pandemic acts as an indicator of difficulties that were already present but that it is exacerbating: the link between the faculty, the student and the hospital, mentoring, supervision, support, university workload, hospital working conditions, psycho-pedagogical support for students and support for most struggling students… These results invite us to rethink the educational engineering of medical studies so that they make it possible, even in a health crisis, to ensure the quality of training and the quality of life of medical students.

Predictive Models for Forecasting Public Health Scenarios: Practical Experiences Applied during the First Wave of the COVID-19 Pandemic.

Background: Forecasting the behavior of epidemic outbreaks is vital in public health. This makes it possible to anticipate the planning and organization of the health system, as well as possible restrictive or preventive measures. During the COVID-19 pandemic, this need for prediction has been crucial. This paper attempts to characterize the alternative models that were applied in the first wave of this pandemic context, trying to shed light that could help to understand them for future practical applications. Methods: A systematic literature search was performed in standardized bibliographic repertoires, using keywords and Boolean operators to refine the findings, and selecting articles according to the main PRISMA 2020 statement recommendations. Results: After identifying models used throughout the first wave of this pandemic (between March and June 2020), we begin by examining standard data-driven epidemiological models, including studies applying models such as SIR (Susceptible-Infected-Recovered), SQUIDER, SEIR, time-dependent SIR, and other alternatives. For data-driven methods, we identify experiences using autoregressive integrated moving average (ARIMA), evolutionary genetic programming machine learning, short-term memory (LSTM), and global epidemic and mobility models. Conclusions: The COVID-19 pandemic has led to intensive and evolving use of alternative infectious disease prediction models. At this point it is not easy to decide which prediction method is the best in a generic way. Moreover, although models such as the LSTM emerge as remarkably versatile and useful, the practical applicability of the alternatives depends on the specific context of the underlying variable and on the information of the target to be prioritized. In addition, the robustness of the assessment is conditioned by heterogeneity in the quality of information sources and differences in the characteristics of disease control interventions. Further comprehensive comparison of the performance of models in comparable situations, assessing their predictive validity, is needed. This will help determine the most reliable and practical methods for application in future outbreaks and eventual pandemics.

Has a change in established care pathways during the first wave of the COVID-19 pandemic led to an excess death rate in the fragility fracture population? A longitudinal cohort study of 1846 patients

ObjectiveDuring the first wave of the COVID-19 pandemic, changes to established care pathways and discharge thresholds for patients with fragility fractures were made. This was to increase hospital bed capacity...

The Impact of the First Wave of the COVID-19 Pandemic on Healthcare Workers: An Italian Retrospective Study.

Healthcare workers (HCWs) played an essential role in managing the COVID-19 pandemic. The Italian Workers’ Compensation Authority (INAIL) and the Italian National Institute of Health (ISS) developed a retrospective study to analyze and understand trends and characteristics of infections among HCWs during the first wave of the pandemic. Between May and September 2020, Italian Regions retrospectively collected anonymous data regarding HCWs infected from the beginning of the pandemic until 30 April 2020 from their administrative sources through a questionnaire asking for socio-demographic and occupational information about the characteristics of contagion and disease outcome. Almost 16,000 valid questionnaires were received. Logistic regression was performed to ascertain the effect of age, gender, geographical macro area, profession, and pre-existing health conditions on the likelihood of HCWs developing more severe forms of COVID-19 (at least hospitalization with mild symptoms). All predictor variables were statistically significant. HCWs at higher risk of developing a more severe disease were males (OR: 1.90; 95% CI: 1.44–2.51), older than 60 years of age (OR: 6.00; 95% CI: 3.30–10.91), doctors (OR: 4.22; 95% CI: 2.22–9.02), working in Lombardy (OR: 55.24; 95% CI: 34.96–87.29) and with pre-existing health conditions (OR: 1.90; 95% CI: 1.43–2.51). This study analyses the main reasons for the overload put on the National Health Service by the first wave of the pandemic and the risk of infection for HCWs by age, gender, occupational profile and pre-existing health conditions. Improved knowledge, availability of personal protective equipment (PPE) and a tight vaccination campaign for HCWs strongly changed the trend of infections among HCWs, with substantial elimination of serious and fatal cases.

Politics and corona lockdown regulations in 35 highly advanced democracies: The first wave

This article gives an initial overview of the explanatory power of established approaches in comparative political science of various lockdown strategies in connection with the COVID-19 pandemic in 35 democracies. In a macro-comparative statistical analysis of the first wave of the pandemic, I test partisan and veto player theories. I distinguish two phases of the first wave of the COVID-19 pandemic, which show distinct patterns of political impacts. In the first phase of implementing lockdown strategies, central governments were relatively uncontested and partisan theory has strong explanatory power. In the second phase of lifting lockdowns, party differences lose relevance, but veto players have a strong influence during this time. The analysis shows that political science theories are useful for analysing political processes not only under normal conditions but also in extreme social crises. Moreover, it provides deeper insights into the democratic decision-making process of advanced democracies in exceptional situations.

Uncooperative society, uncooperative politics or both? Trust, polarization, populism and COVID-19 deaths across European regions.

Why have some territories performed better than others in the fight against COVID‐19? This paper uses a novel dataset on excess mortality, trust and political polarization for 165 European regions to explore the role of social and political divisions in the remarkable regional differences in excess mortality during the first wave of the COVID‐19 pandemic. First, we investigate whether regions characterized by a low social and political trust witnessed a higher excess mortality. Second, we argue that it is not only levels, but also polarization in trust among citizens – in particular, between government supporters and non‐supporters – that matters for understanding why people in some regions have adopted more pro‐healthy behaviour. Third, we explore the partisan make‐up of regional parliaments and the relationship between political division – or what we refer to as ‘uncooperative politics’. We hypothesize that the ideological positioning – in particular those that lean more populist – and ideological polarization among political parties is also linked to higher mortality. Accounting for a host of potential confounders, we find robust support that regions with lower levels of both social and political trust are associated with higher excess mortality, along with citizen polarization in institutional trust in some models. On the ideological make‐up of regional parliaments, we find that, ceteris paribus, those that lean more ‘tan’ on the ‘GAL‐TAN’ spectrum yielded higher excess mortality. Moreover, although we find limited evidence of elite polarization driving excess deaths on the left‐right or GAL‐TAN spectrums, partisan differences on the attitudes towards the European Union demonstrated significantly higher deaths, which we argue proxies for (anti)populism. Overall, we find that both lower citizen‐level trust and populist elite‐level ideological characteristics of regional parliaments are associated with higher excess mortality in European regions during the first wave of the pandemic.

Increased COVID-19 mortality rate in rare disease patients: a retrospective cohort study in participants of the Genomics England 100,000 Genomes project

BackgroundSeveral common conditions have been widely recognised as risk factors for COVID-19 related death, but risks borne by people with rare diseases are largely unknown. Therefore, we aim to estimate the difference of risk for people with rare diseases comparing to the unaffected.MethodTo estimate the correlation between rare diseases and COVID-19 related death, we performed a retrospective cohort study in Genomics England 100k Genomes participants, who tested positive for Sars-Cov-2 during the first wave (16-03-2020 until 31-July-2020) of COVID-19 pandemic in the UK (n = 283). COVID-19 related mortality rates were calculated in two groups: rare disease patients (n = 158) and unaffected relatives (n = 125). Fisher’s exact test and logistic regression was used for univariable and multivariable analysis, respectively.ResultsPeople with rare diseases had increased risk of COVID19-related deaths compared to the unaffected relatives (OR [95% CI] = 3.47 [1.21– 12.2]). Although, the effect was insignificant after adjusting for age and number of comorbidities (OR [95% CI] = 1.94 [0.65–5.80]). Neurology and neurodevelopmental diseases was significantly associated with COVID19-related death in both univariable (OR [95% CI] = 4.07 [1.61–10.38]) and multivariable analysis (OR [95% CI] = 4.22 [1.60–11.08]).ConclusionsOur results showed that rare disease patients, especially ones affected by neurology and neurodevelopmental disorders, in the Genomics England cohort had increased risk of COVID-19 related death during the first wave of the pandemic in UK. The high risk is likely associated with rare diseases themselves, while we cannot rule out possible mediators due to the small sample size. We would like to raise the awareness that rare disease patients may face increased risk for COVID-19 related death. Proper considerations for rare disease patients should be taken when relevant policies (e.g., returning to workplace) are made.

Increased ambulance on-scene times but unaffected response times during the first wave of the COVID-19 pandemic in Southern Denmark

BackgroundDuring the first wave of the COVID-19 pandemic, a lockdown was imposed on the Danish society. Reports from other countries that were hit by the COVID-19 pandemic before Denmark instilled fear of flooding of the emergency departments. To mitigate this flooding, increased competencies were conveyed to the paramedics in the ambulances aiming to allow for a release of a higher number of patients prehospitally.The increased competencies in the prehospital personnel were expected to increase the on-scene time and thus the total workload of the ambulances potentially resulting in delays in the acute care. We sought to elucidate the effects of the pandemic on the workload of the prehospital system during the first wave.MethodsThis was a retrospective study using operational data from the regional emergency medical dispatch centre in the Region of Southern Denmark. We collected the number of ambulance runs, the response times, the on-scene times, and the mission outcome of all ambulance runs with lights and sirens in the Region of Southern Denmark during the first wave of the pandemic. We compared the numbers with a similar period in the year before.ResultsCompared with the year before the pandemic we observed a 10.3% reduction in call volume and a corresponding reduction in the total number of missions with lights and sirens. We found an increase in on-scene times in both missions with patients conveyed to hospital (20.6 min vs. 18.7 min) and missions with non-conveyed patients (37.4 min versus 30.7 min). The response times were unaffected.ConclusionThe increased on-scene times of the ambulances may largely be attributed to time utilised to exert the increased competencies concerning treat-and-release of patients.. Despite an increased on-scene time of the ambulances, we believe that the combination of a reduction in the number of total missions and the existing capacity in the ambulance service in the Region of Southern Denmark nullified the prolongation of ambulance response times that was seen in other countries during the pandemic. This capacity allowed for time spent performing in-depth examinations of patients with the potential to be released at the scene.