Future Public Health Emergencies Research Articles

Guardian of society: Civil society in Nigeria's response to COVID-19 pandemic.

The rapid breakout and dissemination of the coronavirus disease 2019 (COVID-19) infection from the city of Wuhan, China, to the rest of the countries of the world in December 2019 triggered a situation that led the World Health Organization to report it as a global public health emergency. The pandemic resulted in abrupt and significant loss of lives, disruption of economies, loss of livelihoods, and severe hardship across the nations of the world. Nigeria encountered the COVID-19 reality following the discovery of the first case of the infection in the country on February 27, 2020, prompting the government to swing into action to contain its spread. However, the government's response to the pandemic benefited from the support of nonstate actors from the profit and nonprofit sectors. This study, thus, specifically examined the role of civil society organizations (CSOs) in Nigeria's response to the coronavirus crisis. Using data obtained through secondary sources and analysis of thematic and descriptive-interpretive methods, the study found that CSOs impressively contributed to the government's fight against COVID-19, particularly in view of their roles in creating awareness about the virus and rebutting disinformation regarding the disease, among others. Yet, CSOs encountered some problems while undertaking these roles, prominently the closure of the civic space, noninclusion of CSOs in government's pandemic response architecture, and loss of funding. The study recommends, among other things, that in the case of any future public health emergencies of COVID-19 magnitude, the Nigerian Government should make CSOs an integral part of its response structure, while concluding that the application of these measures would incentivize better contributions from CSOs.

Integrating Digital Health Solutions with Immunization Strategies: Improving Immunization Coverage and Monitoring in the Post-COVID-19 Era.

The COVID-19 pandemic underscored the critical importance of vaccination to global health security and highlighted the potential of digital health solutions to improve immunization strategies. This article explores integrating digital health technologies with immunization programs to improve coverage, monitoring, and public health outcomes. It examines the current landscape of digital tools used in immunization initiatives, such as mobile health apps, electronic health records, and data analytics platforms. Case studies from different regions demonstrate the effectiveness of these technologies in addressing challenges such as vaccine hesitancy, logistics, and real-time monitoring of vaccine distribution and adverse events. The paper also examines ethical considerations, data privacy issues, and the need for a robust digital infrastructure to support these innovations. By analyzing the successes and limitations of digital health interventions in immunization campaigns during and after the COVID-19 pandemic, we provide recommendations for future integration strategies to ensure resilient and responsive immunization systems. This research aims to guide policymakers, health professionals, and technologists in leveraging digital health to strengthen immunization efforts and prepare for future public health emergencies.

Challenges With School Meal Provisions in K-12 Public Schools: Findings From the National School COVID-19 Prevention Study.

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

Mortality Surveillance for the COVID-19 Pandemic: Review of the Centers for Disease Control and Prevention's Multiple System Strategy.

Mortality surveillance systems can have limitations, including reporting delays, incomplete reporting, missing data, and insufficient detail on important risk or sociodemographic factors that can impact the accuracy of estimates of current trends, disease severity, and related disparities across subpopulations. The Centers for Disease Control and Prevention used multiple data systems during the COVID-19 emergency response-line-level case‒death surveillance, aggregate death surveillance, and the National Vital Statistics System-to collectively provide more comprehensive and timely information on COVID-19‒associated mortality necessary for informed decisions. This article will review in detail the line-level, aggregate, and National Vital Statistics System surveillance systems and the purpose and use of each. This retrospective review of the hybrid surveillance systems strategy may serve as an example for adaptive informational approaches needed over the course of future public health emergencies. (Am J Public Health. Published online ahead of print July 25, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307743).

Nimble adaptations to sexual and reproductive health service provision to adolescents and young people in the early phase of the COVID-19 pandemic

Early in the COVID-19 pandemic, emerging evidence showed that the provision and use of a range of health services, including sexual and reproductive health (SRH) services, were affected. Otherwise, there was little evidence on whether and how they were adapted to maintain the access of different population groups, including adolescents. The study aims to provide an overview of adaptations to adolescent sexual and reproductive health (ASRH) services carried out during the early phases of the pandemic in low- and middle-income countries (LMICs). The Human Reproduction Program (HRP) at the World Health Organization (WHO) called upon WHO and United Nations Populations Fund (UNFPA) regional offices to reach out to organisations that provided ASRH services to submit analytic case studies using a short-form survey. The study team charted information from 36 case studies and performed a content analysis. Results show that the adaptations covered a wide array of SRH services that were provided to a diverse group of adolescents. Most adaptations focused on SRH education and access to contraception in comparison to other SRH services. Over half of the case studies included mental health services, most of which were not provided before the pandemic. The adaptations varied between being face-to-face, remote, digital, and non-digital. Most adaptations complemented a pre-existing service and were nimble, feasible, and acceptable to the targeted adolescents. Lessons learned from this study could be extrapolated into other humanitarian settings and rapid responses for future public health emergencies, provided that rigorous evaluation takes place.

Rapid Online Data Collection and Reporting to Local Health Departments during the Pandemic: The COVID-19 Outbreak Public Evaluation (COPE) Initiative SARS-CoV-2 Case Surveys.

To develop and implement a pilot online data collection tool to help local health departments with their COVID-19 pandemic response efforts and inform health department actions. The COVID-19 Outbreak Public Evaluation (COPE) was an online survey and was distributed by participating sites to individuals who recently tested positive for SARS-CoV-2. Surveys recorded participant demographics and assessed recent infection risk behaviors (eg, mask use, air travel), vaccination status, sleep and exercise habits, social behaviors and beliefs, and physical and mental health. Seven health departments participated in the initiative, which took place during May 1 to September 30, 2022. Identical items were administered to demographically representative samples of adults nationally in the United States within a similar timeframe. A total of 38555 participants completed surveys. Responses from participants with recent SARS-CoV-2 infections were compared with respondents from the national surveys who did not have evidence or awareness of prior SARS-CoV-2 infections. To implement of a process that allows health departments to receive data from local cases and compare this information to national controls during the COVID-19 pandemic. Fifty-four biweekly reports were provided to public health departments between May and September 2022. Information and comparisons within the reports were updated in response to evolving public health priorities for the pandemic response. The initiative helped to guide public health response efforts during the COVID-19 pandemic. Moreover, the receptiveness by local health departments and participants provides evidence to support this data collection and reporting model as a component of the public health response to future emergencies. This project demonstrates the feasibility of a centralized, rapid, and adaptive data collection system for local health departments and provides evidence to advocate for data collection methods to help guide local health departments to respond in a timely and effective manner to future public health emergencies.

COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review.

Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.

Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study.

Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.

Retrospecting Digital Media Use, Negative Emotions, and Trust Gaps During the COVID-19 Pandemic in China: Cross-Sectional Web-Based Survey.

Retrospecting the trust gaps and their dynamics during the pandemic is crucial for understanding the root causes of postpandemic challenges and offers valuable insights into preparing for future public health emergencies. The COVID-19 pandemic eroded people's trust in strangers and acquaintances, while their trust in family members remained relatively stable. This resulted in 2 trust gaps, namely, the family members-strangers trust gap and the family members-acquaintances trust gap. Widening trust gaps impede social integration and undermine the effective management of public health crises. However, little is known about how digital media use shaped trust gaps during a pandemic. This study aims to investigate the relationships between digital media use, negative emotions, the family members-strangers trust gap, and the family members-acquaintances trust gap during the COVID-19 pandemic in China. We test the mediating role of negative emotions between digital media use and 2 trust gaps and compare the indirect effect of digital media use on 2 trust gaps through negative emotions. A cross-sectional web-based survey was conducted in China between January 31, 2020, and February 9, 2020. A total of 1568 adults participated in the survey. Questions related to digital media use, negative emotions, trust in family members, trust in acquaintances, and trust in strangers during the pandemic were asked. Regression analyses were performed to test the associations between the examined variables. We used a 95% bootstrap CI approach to estimate the mediation effects. Digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), which in turn were positively associated with the family members-strangers trust gap (B=0.15, SE 0.03; P<.001). Likewise, digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), while negative emotions were positively associated with the family members-acquaintances trust gap (B=0.08, SE 0.03; P=.01). Moreover, the indirect effect of digital media use on the family members-strangers trust gap (B=0.03, SE 0.01; 95% CI 0.01-0.04) was stronger than that on the family members-acquaintances trust gap (B=0.01, SE 0.01; 95% CI 0.003-0.027). The results demonstrate that negative emotions resulting from the frequent use of digital media are a key factor that accounts for the widening trust gaps. Considering the increasing reliance on digital media, the findings indicate that the appropriate use of digital media can prevent the overamplification of negative emotions and curb the enlargement of trust gaps. This may help restore social trust and prepare for future public health crises in the postpandemic era.

Health Care Workers' Reflections, Experiences, and Sequela throughout the COVID-19 Pandemic.

Health care workers (HCW) experienced significant stress during the COVID-19 pandemic. This qualitative study describes how they contextualized the experience several years later. In August 2023, 1832 HCW at an academic medical center completed a confidential electronic survey; 443 of them responded to an open-ended question about their experiences during the pandemic. The statements were analyzed qualitatively, using a grounded theory approach to allow themes to emerge from the data. Common themes included fear/anxiety (22%), burnout (15%), protecting family from risk (11%), lack of employer support (11%), fear of illness (8%), increased appreciation for life (8%), and exposure to death/illness (5%). HCW experienced substantial stress during the pandemic. Mental health services and structural changes in the health care system are needed to protect HCW during future public health emergencies.

Geography versus sociodemographics as predictors of changes in daily mobility across the USA during the COVID-19 pandemic: a two-stage regression analysis across 26 metropolitan areas

ObjectiveWe investigated whether a zip code’s location or demographics are most predictive of changes in daily mobility throughout the course of the COVID-19 pandemic.DesignWe used a population-level study to examine...

Efficacy and safety of COVID-19 vaccination in solid organ transplant recipients: A systematic review and network meta-analysis

The impact of COVID-19 vaccination on clinical outcomes in solid organ transplant (SOT) recipients remains unclear. This systematic review and network meta-analysis sought to assess the efficacy and safety of COVID-19 vaccination in SOT recipients. We searched 6 databases from inception to March 1, 2024 for randomized controlled trials (RCTs) and observational studies evaluating different COVID-19 vaccination strategies in SOT recipients. Based on patient-important outcomes, we performed frequentist random-effects pairwise meta-analyses and network meta-analyses, separating RCTs and nonrandomized evidence, and used the Grading of Recommendation, Assessment, Development, and Evaluation approach to assess our certainty in the evidence. We included 6 RCTs (N = 814) and 43 observational studies (N = 125 199). Overall, there is a paucity of randomized evidence evaluating COVID-19 vaccines in SOT recipients. The nonrandomized evidence evaluating COVID-19 vaccination strategies patient-important outcomes, including COVID-19 infection, mortality, hospitalization, ICU admission, and rejection, demonstrated low to very low certainty due to the included studies’ risk of bias. Throughout the COVID-19 pandemic, clinicians and SOT recipients worked with minimal, very low-quality evidence in relation to COVID-19 vaccines in this population. In the instance of future public health emergencies, clinicians and researchers should collaborate closely with patient partners to ensure there is sufficient evidence in the transplant population on patient-important outcomes.

Reduced Stress among COVID-Symptomatic Undergraduates: Act With Awareness, Nonjudgment, and Nonreactivity as Key Facets of Mindfulness

Objective: Associations between mindfulness and improved physical and psychological health have been established, but COVID-19 presents a novel context. This study examined the relationship between individual mindfulness facets and general stress among college students experiencing at least one symptom of acute COVID-19 infection in the context of the pandemic. Methods: Five hundred sixteen university students experiencing at least one CDC-identified COVID-19 symptom completed measures of general stress, mindfulness, and somatic symptoms in 2020-2021 during the COVID-19 pandemic following IRB approval and informed consent. Results: The act with awareness, nonjudgment, and nonreactivity facets of mindfulness were associated with general stress. In total, the model accounted for over half of the variance in general stress (R2 = 0.51, p &lt; 0.001). Conclusion: Mindfulness may be particularly important in explaining general stress among college students reporting a symptom of COVID-19. Mindfulness may benefit college students as the pandemic continues to unfold, and monitoring one’s physical health remains a primary mitigation strategy. These results may also inform understanding and responses to future public health emergencies in which monitoring somatic symptoms is encouraged by public health officials to contain the spread.

Travel bubble policies for low‐risk air transport recovery during pandemics

AbstractGlobal pandemics restrict long‐haul mobility and international trade. To restore air traffic, a policy named “travel bubble” was implemented during the recent COVID‐19 pandemic, which seeks to re‐establish air connections among specific countries by permitting unrestricted passenger travel without mandatory quarantine upon arrival. However, travel bubbles are prone to bursting for safety reasons, and how to develop an effective restoration plan through travel bubbles is under‐explored. Thus, it is vital to learn from COVID‐19 and develop a formal framework for implementing travel bubble therapy for future public health emergencies. This article conducts an analytical investigation of the air travel bubble problem from a network design standpoint. First, a link‐based network design problem is established with the goal of minimizing the total infection risk during air travel. Then, based on the relationship between origin‐destination pairs and international candidate links, the model is reformulated into a path‐based one. A Lagrangian relaxation‐based solution framework is proposed to determine the optimal restored international air routes and assign the traffic flow. Finally, computational experiments on both hypothetical data and real‐world cases are conducted to examine the algorithm's performance. The results demonstrate the effectiveness and efficiency of the proposed model and algorithm. In addition, compared to a benchmark strategy, it is found that the infection risk under the proposed travel bubble strategy can be reduced by up to 45.2%. More importantly, this work provides practical insights into developing pandemic‐induced air transport recovery schemes for both policymakers and aviation operations regulators.

Features of databases that supported searching for rapid evidence synthesis during COVID-19: implications for future public health emergencies

BackgroundAs evidence related to the COVID-19 pandemic surged, databases, platforms, and repositories evolved with features and functions to assist users in promptly finding the most relevant evidence. In response, research synthesis teams adopted novel searching strategies to sift through the vast amount of evidence to synthesize and disseminate the most up-to-date evidence. This paper explores the key database features that facilitated systematic searching for rapid evidence synthesis during the COVID-19 pandemic to inform knowledge management infrastructure during future global health emergencies.MethodsThis paper outlines the features and functions of previously existing and newly created evidence sources routinely searched as part of the NCCMT’s Rapid Evidence Service methods, including databases, platforms, and repositories. Specific functions of each evidence source were assessed as they pertain to searching in the context of a public health emergency, including the topics of indexed citations, the level of evidence of indexed citations, and specific usability features of each evidence source.ResultsThirteen evidence sources were assessed, of which four were newly created and nine were either pre-existing or adapted from previously existing resources. Evidence sources varied in topics indexed, level of evidence indexed, and specific searching functions.ConclusionThis paper offers insights into which features enabled systematic searching for the completion of rapid reviews to inform decision makers within 5–10 days. These findings provide guidance for knowledge management strategies and evidence infrastructures during future public health emergencies.

Entry-Level Occupational Therapy Student Volunteer Activities During COVID-19 and Beliefs about Practitioner Roles in Crisis Management

Background: Due to the global novel coronavirus disease 2019 (COVID-19) pandemic, many students in entry-level occupational therapy programs faced changes to their daily roles, habits, and routines. To understand beliefs about OT practitioner roles in a public health crisis, a cross-sectional study was designed to understand occupational therapy students (OTS) and occupational therapy assistant students (OTAS) volunteer activities during the COVID-19 pandemic. Methods: A survey was developed and distributed in April 2020, and closed after five weeks. Quantitative data was analyzed in Statistical Package for Social Sciences (Version 27) and open response data was categorized in Microsoft Excel. Results: Respondents included students from entry-level OT/OTA accredited programs such as occupational therapy doctorate, entry level master’s, bachelor’s to master’s and occupational therapy assistant (n=853, 2.8% of OTS/OTAS population). Nearly all respondents endorsed that OT practitioners have at least one role during a crisis (n=851, 99.8%) and after a crisis (n=848, 99.4%) like COVID-19. A minority of students volunteered in response to COVID-19 (n=60, 7.0%). Volunteer activities addressed clinical work, food insecurity, loneliness, social justice, healthcare workers, COVID-19 transmission, and personal protective equipment. Inspirations for volunteering included altruism, justice, personal responsibility, changes to routines, calls to action, and fulfilling obligations. Discussion: It is hoped that this study serves as a springboard for future research related to the OTS/OTAS response to COVID-19. Educators can prepare students for future public health emergencies by exposing them to information regarding OT’s role in disaster management.

A scoping review of behavioural science approaches and frameworks for health protection and emergency response

Aims: Rapid intervention development, implementation, and evaluation are required for emergency public health contexts, such as the recent COVID-19 pandemic. A novel Agile Co-production and Evaluation (ACE) framework has been developed to assist this endeavour in future public health emergencies. This scoping review aimed to map available behavioural science resources that can be used to develop and evaluate public health guidance, messaging, and interventions in emergency contexts onto components of ACE: rapid development and implementation, co-production with patients or the public including seldom heard voices from diverse communities, and inclusion of evaluation. Methods: A scoping review methodology was used. Searches were run on MEDLINE, EMBASE, PsycINFO, and Google, with search terms covering emergency response and behavioural science. Articles published since 2014 and which discussed a framework or guidance for using behavioural science in response to a public health emergency were included. A narrative synthesis was conducted. Results: Seventeen records were included in the synthesis. The records covered a range of emergency contexts, the most frequent of which were COVID-19 ( n = 7) and non-specific emergencies ( n = 4). One record evaluated existing approaches, 6 proposed new approaches, and 10 described existing approaches. Commonly used approaches included the Behavioural Change Wheel; Capability, Opportunity, and Motivation Behaviour model; and social identity theory. Three records discuss co-production with the target audience and consideration of diverse populations. Four records incorporate rapid testing, evaluation, or validation methods. Six records state that their approaches are designed to be implemented rapidly. No records cover all components of ACE. Conclusion: We recommend that future research explores how to create guidance involving rapid implementation, co-production with patients or the public including seldom heard voices from diverse communities, and evaluation.

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study

BackgroundDuring the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths. ObjectiveTo determine whether hospital differences in pre-pandemic and during pandemic nursing resources—average patient-to-registered nurse (RN) staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition—explain differences in risk-adjusted Covid-19 mortality; and to estimate how many deaths may have been prevented if nurses were better resourced prior to and during the pandemic. MethodsThis is a cross-sectional study of 87,936 Medicare beneficiaries (65–99 years old) hospitalized with Covid-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition) in the pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality using adjusted logistic regression models. ResultsThe mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with Covid-19 died during the hospitalization (n = 20,243); 31.5 % died within 30-days of admission (n = 27,719). Patients admitted with Covid-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were statistically significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12–1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09–1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with Covid-19 could have been avoided. ConclusionsPatients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.

Rethinking Infection Control: Nursing Home Administrator Experiences during the COVID-19 Pandemic

ObjectiveTo examine nursing home administrator perspectives of infection control practices in nursing homes at the height of the COVID-19 pandemic and characterize lessons learned. DesignDescriptive qualitative study. Setting and ParticipantsAdministrators from 40 nursing homes across 8 diverse health care markets in the United States. MethodsSemistructured interviews were conducted via telephone or Zoom with nursing home administrators. Interviews were repeated at 3-month intervals, for a total of 4 interviews per participant between July 2020 and December 2021 (n = 156). Qualitative analysis of interview transcripts used modified grounded theory and thematic analysis to identify overarching themes. ResultsThree major themes emerged reflecting administrator experiences managing infection control practices and nursing home operations at the height of the COVID-19 pandemic. First, administrators reported that the more stringent infection control protocols implemented to manage and mitigate COVID-19 at their facilities increased awareness and understanding of the importance of infection control; second, administrators reported incorporating higher standards of infection control practices into facility-level policies, emergency preparedness plans, and staff training; and third, administrators said they and their executive leadership were reevaluating and upgrading their facilities’ physical structures and operational processes for better infection control infrastructure in preparation for future pandemics or other public health crises. Conclusions and ImplicationsInsights from this study's findings suggest important next steps for restructuring and improving nursing home infection control protocols and practices in preparation for future pandemics and public health emergencies. Nursing homes need comprehensive, standardized infection control training and upgrading of physical structures to improve ventilation and facilitate isolation practices when needed. Furthermore, nursing home emergency preparedness plans need better integration with local, state, and federal agencies to ensure effective communication, proper resource tracking and allocation, and coordinated, rapid response during future public health crises.

What aspects of the pandemic had the greatest impact on adolescent mental health: duration of lockdown or subjective experience?

BackgroundThe COVID-19 pandemic negatively impacted global mental health, with adolescents experiencing disproportionate effects. Limited research has explored the impact of different pandemic restrictions on adolescent mental health, and only a few studies have examined the longer-term impacts of the pandemic on adolescent mental health. These investigations are crucial for informing public health policies, particularly the integration of mental health care in future public health emergencies.MethodsThis study aimed to investigate the impact of lockdown duration and the impact of adolescents’ subjective experiences of the pandemic on their wellbeing, internalising symptoms, and externalising symptoms. Australian adolescents (N = 1,001, mean age = 14.2 years) completed a baseline survey in 2021, shortly after pandemic lockdowns were lifted (Time 1), and a follow-up survey approximately 12 months later (Time 2). Predictors of interest were the total duration of COVID-19 lockdowns across 2020–2021, and adolescents’ subjective experiences of the pandemic on their social connections, learning, technology use and family relationships. A range of covariates were included in analyses to examine subgroup differences.ResultsLinear mixed-effects models indicated that total duration of the lockdown was not associated with any of the outcomes at Time 1 or Time 2 (all ps > 0.017). Negative subjective experience of the pandemic on learning was associated with greater externalising symptoms at both Time 1 (t = 5.17, df = 980, p <.001) and Time 2 (t = 2.72, df = 708, p =.007). Negative subjective experience of the pandemic on social connection was associated with greater internalising symptoms at Time 2 only (t = 3.20, df = 709, p =.001). Negative subjective experience of the pandemic on family relationships or technology use was not associated with any of the outcomes at Time 1 or Time 2 (all ps > 0.017).ConclusionsAdolescents’ negative subjective experience of the pandemic on learning and social connections was associated with greater internalising and externalising symptoms after the lockdown had been lifted. Duration of lockdowns was not associated with any of the primary outcomes. During future public health emergencies, mental health interventions should be tailored to assist adolescents to adapt to new learning environments, and to build and maintain social connections.