Initial Shutdown Research Articles

“Every Day I was Crying about Something”: Lingering Effects of the COVID-19 Pandemic on People Working in Juvenile Prisons

Staff working in prison settings experience high rates of job-related stress which was amplified during the COVID-19 pandemic. Twenty staff members from a juvenile prison were interviewed to determine the unique mental health symptoms and stressors several years after initial shutdown procedures. Anxiety, PTSD symptoms, and sleep disturbances were reported; sometimes resulting in staff avoiding interactions with youth. Some positive aspects were noted, but overall, results indicated a continued need for mental health support and policy changes for staff. As noted by one participant, “If you don’t have the direct care staff, you don’t have a facility.”

The Impact of COVID-19 on the Cypriot Stock Market Dynamics

This paper examines the effects of coronavirus disease 2019 (COVID-19) pandemic outbreak on the Cypriot Stock Exchange (CSE), which has encountered substantial turmoil. For this purpose, daily stock market returns were used over the period of September 3, 2019 - July 10, 2020, for the Cypriot economy. The study applied Granger causality models to explore whether the CSE is impacted by the crisis generated by novel coronavirus. Hsiao’s approach to Granger causality was employed to investigate the causalities among COVID-19 and stock market returns, as well as between pandemic measures and several commodities. The analyses uncover intricate dynamics and contributing factors, shedding light on the observed volatility. The findings demonstrate significant volatility throughout the pandemic, with notable shifts in market conditions. Nevertheless, the stock market showcased resilience and recovery during the initial shutdown period. These insights contribute to understanding the pandemic’s impact on the CSE, offering crucial guidance for investors, policymakers, and market participants.

Mothers, Household Bubbles, and Social Support During the First Wave of the COVID-19 Pandemic

Parents of young children experienced many stressors due to stay-at-home directives in the first wave of the COVID-19 pandemic. Bubbles were implemented by some governments, allowing households to connect with another household while minimizing contagion risk, but little is known about their effectiveness. We explored the social support experiences of Canadian mothers living in Nova Scotia during this first wave, focusing on whether they perceived household bubbles to be helpful in reducing parenting stress. In-depth interviews were completed with 18 mothers (aged 21–49) who had at least one child under the age of 12 during the first shutdown. Interviews focused on how they coped during the initial shutdown period, the immediate time after they paired up with another household, and what was happening for them currently (approximately eight to ten months later). Data were analyzed using qualitative description and content analysis through application of topic, descriptive, and analytical coding; memo writing; and matrix analysis. Deciding who to bubble with typically focused on direct support for parents or having playmates for children. Having a bubble arrangement reduced the pressure of the situation, and perceptions of future emergency backup support also reduced anxiety levels. Support from family members who lived far away, however, was still key for some families. Household bubbles play an important role in reducing stress levels during a pandemic through received and perceived support. As the COVID-19 pandemic evolves, policy directives and support interventions need to enhance social support for parents and peer interactions for young children.

Lessons Learned: A Disruption in Care Leads to Increased Rates of Proximal Amputations

BACKGROUND: In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss. PURPOSE: To understand the impact of COVID-19 on amputation rates. METHODS: A retrospective review of lower limb institution-wide amputations was conducted at Northwell Health from January 2020 to January 2021. The amputation rates during the COVID-19 shutdown period were compared to the pre-pandemic, post-shutdown, and reopening period. RESULTS: The pre-pandemic period had 179 amputations, of which 8.38% were proximal. 86 amputations were performed during shutdown, with a greater proportion being proximal (25.58%, p=0.0009). Following the shutdown period, amputations returned to baseline. The proportion of proximal amputations during post-shutdown was 18.5% and during reopening was 12.06%. Patients had 4.89 times higher odds of undergoing a proximal amputation during the shutdown period. CONCLUSIONS: The effect of COVID-19 on amputation rates demonstrates an increase in proximal amputation during the initial shutdown. This study suggests an indirect negative effect of COVID-19 hospital restrictions on surgeries during the initial shutdown period.

Impact of the COVID-19 pandemic and generational heterogeneity on ecommerce shopping styles – A case study of Sacramento, California

The COVID pandemic has accelerated the growth of ecommerce and reshaped shopping patterns, which in turn impacts trip-making and vehicle miles traveled. The objectives of this study are to define shopping styles and quantify their prevalence in the population, investigate the impact of the pandemic on shopping style transition, understand the generational heterogeneity and other factors that influence shopping styles, and comment on the potential impact of the pandemic on long-term shopping behavior. Two months after the initial shutdown (May/June 2021), we collected ecommerce behavioral data from 313 Sacramento Region households using an online survey. A K-means clustering analysis of shopping behavior across eight commodity types identified five shopping styles, including ecommerce independent, ecommerce dependent, and three mixed modes in-between. We found that the share of ecommerce independent style shifted from 55% pre-pandemic to 27% during the pandemic. Overall, 30% kept the same style as pre-pandemic, 54% became more ecommerce dependent, and 16% became less ecommerce dependent, with the latter group more likely to view shopping an excuse to get out. Heterogeneity was found across generations. Pre-pandemic, Millennials and Gen Z were the most ecommerce dependent, but during the pandemic they made relatively small shifts toward increased ecommerce dependency. Baby Boomers and the Silent Generation were bimodal, either sticking to in-person shopping or shifting to ecommerce-dependency during the pandemic. Post-pandemic intentions varied across styles, with households who primarily adopt non-food ecommerce intending to reverse back to in-person shopping, while the highly ecommerce dependent intend to limit future in-store activities.

An Examination of Early Intervention Services for Children With Visual Impairments During the COVID-19 Pandemic.

Introduction: In the early spring of 2020, governments were beginning to react to the news of a global pandemic being caused by COVID-19. The purpose of this study was to examine the effect of COVID-19 on early intervention services for young children with visual impairments and their families. Methods: Parents of children with visual impairments aged birth to 3 years were asked a series of questions contained in a larger Access and Engagement survey that investigated the experiences of families of children and young adults with visual impairments aged birth to 21 years and professionals that provided educational services. Results: Three overall themes emerged from the data: (1) many changes occurred in the home, (2) early intervention services changed, and (3) planning for the transition to preschool was affected. Discussion: Overall, the changes in education due to the pandemic and initial shutdown resulted in much parental stress. Parents reported that they were stressed and sometimes overwhelmed by the sudden and dramatic changes in their daily lives and how best to help their children in continuing to learn and develop their skills while simultaneously working from home, being caregivers to the other children in the family, and serving as educators and sometimes informal therapists to their children. Many services moved to an online format and were provided remotely. Implications for Practitioners: Service providers should continue to provide services to families and children who have been affected by the COVID-19 pandemic and resulting shutdown while continuing to provide ways to support the social and emotional well-being of their families. Service providers and families should monitor their children's development and learning both now and in the future.

County jails' responses to COVID-19: Practices, procedures, and provisions of behavioral health services.

Michigan was one of the first states to feel the effects of the coronavirus disease 2019 (COVID-19) pandemic. This exploratory, mixed-methods study describes 20 county jails' responses to the pandemic across Michigan and presents a case study of one rural jail to examine changes in booking trends and behavioral health needs and services. Qualitatively, jails decreased their population at the outset of the pandemic via early releases, reconsideration of bond, and reductions in arrests. Quantitatively, the greatest prevalence of serious mental illness was found during the spring (initial shutdown period), which had the lowest weekly booking rates. Significant differences were found when comparing charge severity and charge type between study periods. Bookings occurring during the spring were significantly related to felony charges and drug/alcohol charges while individuals were less frequently booked because of violations. Past year recidivism significantly decreased from the winter to summer phase. Policy should mandate that jails screen for behavioral health problems and provide access to behavioral health services, while also expanding diversion opportunities during and after a pandemic. Innovations in continuity of care are critical for both behavioral and public health needs given the high risk for suicide, overdose, and viral spread after release from jail. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Telehealth Adoption and Perspectives Among Pediatric Otolaryngologists Following the COVID-19 Pandemic.

To assess use of and physician experiences with pediatric otolaryngology telehealth visits as impacted by the COVID-19 pandemic. Cross sectional survey. A 15-question survey was electronically distributed to 656 members of the American Society of Pediatric Otolaryngology in August 2021, addressing member demographics, experiential practice elements, and use pre-pandemic, during the initial shutdown period of March-May 2020, and current use at the time of survey inquiry. There were 124 respondents (response rate = 18.9%). Incident use pre-pandemic and during the shutdown were 21.0% (n = 26), and 92.7% (n = 115), respectively. Current use was 83.9% (n = 104) and the percentage of new current users (79.5%, n = 78) was significant (P < .0001,95% CI = 70.6%-86.4%). Estimated median telehealth visit rates pre-pandemic, during shutdown, and currently were 0 to 1, 4 to 5, and 2 to 3 per week, respectively (P < .0001). A difference in post-covid adoption rates was noted only for location (P = .008), with no differences for years out of training or practice type. Compared to in-person visits, physician satisfaction with telehealth visits was rated equivalent (49.0%) or worse/much worse (48.1%). The most common telehealth uses were follow-up visits (83.7%), pre-operative counseling (76.9%), and post-operative evaluation (69.2%). The need for a detailed exam (89.4%) and initial visits (32.7%) were reasons a telehealth visit was not offered. The COVID-19 pandemic appears to have precipitated a rapid increase in telehealth adoption among surveyed pediatric otolaryngologists, regardless of age or practice type. The most significant limitations remain the need for a detailed exam, perceived low patient technological literacy, and limitations to interpretive services. Technology-based optimization of these barriers could lead to increased use and physician satisfaction.

Maternal well-being and family adaptation during COVID-19 in fragile X syndrome.

Mothers of children with fragile X syndrome are at increased risk of experiencing anxiety and depression due to potential genetic risk and to stress associated with parenting a child with significant behavioral, emotional, and educational support needs. During the initial shutdown and subsequent restrictions of the COVID-19 pandemic, mothers of children with fragile X reported experiencing elevated levels of anxiety and depression relative to their usual levels of well-being. Many indicated that the negative consequences of exposure to COVID-19 and related stressors, as well as the impacts of the pandemic on their family, directly affected their anxiety and depression. Mothers reported on specific sources of distress as well as potential sources of resilience and positive adaptation that occurred during the first year of the COVID-19 pandemic.

Effects of COVID‐19 shutdowns on domestic violence in US cities

We empirically investigate the impact of COVID-19 shutdowns on domestic violence using incident-level data on both domestic-related calls for service and crime reports of domestic violence assaults from the 18 major US police departments for which both types of records are available. Although we confirm prior reports of an increase in domestic calls for service at the start of the pandemic, we find that the increase preceded mandatory shutdowns, and there was an incremental decline following the government imposition of restrictions. We also find no evidence that domestic violence crimes increased. Rather, police reports of domestic violence assaults declined significantly during the initial shutdown period. There was no significant change in intimate partner homicides during shutdown months and victimization survey reports of intimate partner violence were lower. Our results fail to support claims that shutdowns increased domestic violence and suggest caution before drawing inference or basing policy solely on data from calls to police.

The changing role of teachers of students with visual impairments in North America during the initial response to the COVID-19 pandemic

Schools abruptly closed throughout in response to the COVID-19 pandemic. Although legal requirements remained unchanged, service delivery models and how teachers of students with visual impairments supported their students changed. Teachers of students with visual impairments answered a series of questions about how district policies impacted their work, what materials they could not access and the subsequent impact on their students, and changes in their caseloads during the initial shutdown of schools. Four overall themes emerged from the data: (1) district policies often impeded the work of teachers of students with visual impairments; (2) teachers did not have the materials needed to ensure that their students could access instruction; (3) teachers were concerned that they could not locate some of their students; and (4) teachers experienced changes in their direct and consultative caseloads due to a variety of factors. The work of teachers of students with visual impairments was dramatically impacted by the COVID-19 pandemic. As the shutdown continued, district policies changed and often impeded their efforts to support students on their caseload. In addition, many teachers struggled to locate all of their students and lacked the basic supplies to ensure instruction was accessible. However, teachers of students with visual impairments were creative and provided instruction that incorporated online resources and readily available home materials, collaborated with colleagues, and engaged the community in order to support their students. The experiences of teachers and lessons learned during the pandemic can be used to advocate for policy that protects the rights of students with visual impairments to an education during future unanticipated events such as a pandemic or inclement weather.

Self-Reported COVID-19 Impact on Adolescents with Chronic Widespread Musculoskeletal Pain

Research on the impact of COVID-19 on adolescents with chronic pain has focused on outcomes within the initial 6 months of the pandemic and demonstrated some initial improvement in pain interference unless there was economic hardship. Little is known about how the pandemic's progression into a chronic life stressor has impacted this population. The purpose of the current study was to describe the self-reported physical and emotional impact of COVID-19 on adolescents with chronic widespread musculoskeletal pain (CWMP) approximately 6–18 months after the initial shut-down. Participants were 25 female patients and 1 gender fluid patient between 12-17 years (Mage =15.69, SD =1.55) at a tertiary outpatient pain management clinic who were recruited between August 2020 and February 2021. Participants completed the Pain and Symptom Assessment Tool (PSAT) online to determine eligibility. Participants who did not speak English and those with a comorbid chronic illness were excluded from the study. Eligible participants completed a self-report COVID-19 impact scale. All participants completed the COVID-19 impact scale in its entirety. Many indicated worsening physical symptoms related to the pandemic: pain (50%), fatigue (61.5%), physical activity (65.4%), and treatment engagement (50%). The majority of participants endorsed worsening of overall mood (92.3%), anxiety (88.5%), frustration (80.8%), and depressed mood (73.1%). Fewer participants endorsed worsening of sleep: sleep onset (50%), sleep duration (42.3%), and daytime napping (38.5%). Worsening school performance was endorsed by 46.2%. The majority of adolescents with CWMP reported worsening physical and emotional symptoms during the COVID-19 pandemic. The most common finding was worsening mood, which is in-line with the current behavioral health crisis in youth. Clinical implications include routine evaluation of physical and psychosocial symptoms of youth with chronic pain to provide appropriate psychological treatment referrals as the impact of the pandemic may change overtime. This research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number K23AR073934. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Abstract P3-04-04: Multi-institutional perspective on screening mammography and breast cancer stage at diagnosis during the COVID-19 pandemic

Abstract Background: During the SARS-CoV-2 pandemic in 2020, the use of routine screening mammography (SM) and diagnostic mammography (DM) was limited for several months in order to reduce patient exposure and redeploy medical personnel. Previous studies suggest such delays result in more late-stage breast cancer diagnoses. We hypothesized that this impact would vary between institutions depending on regional variations in shutdown periods and the ability and willingness of patients to resume screening. Methods: Patients diagnosed with invasive breast cancers from 2016-2020 were identified using the Beth Israel Deaconess Medical Center (BIDMC) and the Duke University Medical Center (DUMC) cancer registries. Rates of mammography were ascertained from billing data. Baseline patient characteristics, demographics, and clinical information were gathered and cross-referenced with the electronic medical record. Late-stage was defined as Anatomic Stage III-IV disease (AJCC 8th edition). Chi-squared analysis was used to examine monthly distributions in stage at presentation for diagnosis in 2016-2019 compared to in 2020 at each institution. Results: There were 5907 patients diagnosed with invasive breast cancer between 2016-2019 (1597 at BIDMC and 4310 at DUMC) and 1075 in 2020 (333 and 742, respectively). Mammography was limited from 3/16/20-6/8/20 at BIDMC and from 3/16/20-4/20/20 at DUMC. There were fewer SM at each institution during their respective shutdown periods in 2020 than in the same months in 2019: BIDMC 1713 versus 8566 (80% reduction) and at DUMC 1649 versus 5698 (71% reduction). Following the pandemic shutdown, SM volume increased in July-December 2020 compared to July-December 2019 (108% at BIDMC and 116% at DUMC). The proportion of patients diagnosed with late-stage disease at BIDMC was greater in 2020 than in 2016-2019, at 12.6% and 6.6%, respectively (p &amp;lt; 0.001); 86% of late-stage diagnoses and 68% of all diagnoses in 2020 at BIDMC occurred from July-December following the initial shutdown period. The proportion of patients diagnosed with late-stage disease at DUMC in these two cohorts were 14.3% in 2020 and 16.2%% in 2016-2019 (p = 0.1); 50% of late-stage diagnoses and 51% of all diagnoses in 2020 at DUMC occurred in the period following the initial shutdown from July-December. Conclusion: We identified variation between two large academic medical centers in the impact of the SARS-CoV-2 pandemic shutdown on the proportion of late-stage breast cancer diagnoses. These dissimilar outcomes may be the result of differences in referral patterns as well as regional differences in the approach to SM during the pandemic. In particular, a shorter closure time and substantial increase in SM volume following the initial shutdown period in the Southeast region may have prevented an increase in late-stage diagnoses. Further information and analysis may help suggest additional strategies to minimize adverse effects of reduced cancer screening in future public-health emergencies. Table 1.Proportion of SM in 2020 compared to 2019 and proportion of late disease per month in 2020BIDMC 2020JanFebMarAprMayJunJulAugSepOct NovDecSM, %96109480034104106112105113112Late Disease, n(%)0 (0)2 (10)1 (3)0 (0)0 (0)3 (21)1 (7)9 (21)10 (15)10 (19)5 (12)1 (8)DUMC 2020JanFebMarAprMayJunJulAugSepOctNovDecSM, %565860040123111109127116120119Late Disease, n(%)12 (11)13 (19)14 (19)4 (18)4 (12)6 (11)12 (13)10 (13)6 (10)12 (19)7 (13)5 (13) Citation Format: Sarah J Stephens, Maxwell R Lloyd, Julian C Hong, Tejas Mehta, Ted A James, Rachel Blitzblau, Abram Recht, Daphna Y Spiegel. Multi-institutional perspective on screening mammography and breast cancer stage at diagnosis during the COVID-19 pandemic [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-04-04.

Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic

The COVID-19 pandemic has affected every aspect of medical care, including surgical treatment. It is critical to understand the association of government policies and infection burden with surgical access across the United States. To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. Surgical procedure volume during the 2020 initial COVID-19-related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Data were analyzed from November 2020 through July 2021. 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. Incidence rate ratios (IRRs) were estimated from a Poisson regression comparing total procedure counts during the initial shutdown (March 15 to May 2, 2020) and subsequent COVID-19 surge (October 22, 2020-January 31, 2021) with corresponding 2019 dates. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. A total of 13 108 567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. This included 6 651 921 procedures in 2019 (3 516 569 procedures among women [52.9%]; 613 192 procedures among children [9.2%]; and 1 987 397 procedures among patients aged ≥65 years [29.9%]) and 5 973 573 procedures in 2020 (3 156 240 procedures among women [52.8%]; 482 637 procedures among children [8.1%]; and 1 806 074 procedures among patients aged ≥65 years [30.2%]). The total number of procedures during the initial shutdown period and its corresponding period in 2019 (ie, epidemiological weeks 12-18) decreased from 905 444 procedures in 2019 to 458 469 procedures in 2020, for an IRR of 0.52 (95% CI, 0.44 to 0.60; P < .001) with a decrease of 48.0%. There was a decrease in surgical procedure volume across all major categories compared with corresponding weeks in 2019. During the initial shutdown, otolaryngology (ENT) procedures (IRR, 0.30; 95% CI, 0.13 to 0.46; P < .001) and cataract procedures (IRR, 0.11; 95% CI, -0.11 to 0.32; P = .03) decreased the most among major categories. Organ transplants and cesarean deliveries did not differ from the 2019 baseline. After the initial shutdown, during the ensuing COVID-19 surge, surgical procedure volumes rebounded to 2019 levels (IRR, 0.97; 95% CI, 0.95 to 1.00; P = .10) except for ENT procedures (IRR, 0.70; 95% CI, 0.65 to 0.75; P < .001). There was a correlation between state volumes of patients with COVID-19 and surgical procedure volume during the initial shutdown (r = -0.00025; 95% CI, -0.0042 to -0.0009; P = .003), but there was no correlation during the COVID-19 surge (r = -0.00034; 95% CI, -0.0075 to 0.00007; P = .11). This study found that the initial shutdown period in March through April 2020, was associated with a decrease in surgical procedure volume to nearly half of baseline rates. After the reopening, the rate of surgical procedures rebounded to 2019 levels, and this trend was maintained throughout the peak burden of patients with COVID-19 in fall and winter; these findings suggest that after initial adaptation, health systems appeared to be able to self-regulate and function at prepandemic capacity.

Optimal shutdown strategies for COVID-19 with economic and mortality costs: British Columbia as a case study.

Decision makers with the responsibility of managing policy for the COVID-19 epidemic have faced difficult choices in balancing the competing claims of saving lives and the high economic cost of shutdowns. In this paper, we formulate a model with both epidemiological and economic content to assist this decision-making process. We consider two ways to handle the balance between economic costs and deaths. First, we use the statistical value of life, which in Canada is about C$7 million, to optimize over a single variable, which is the sum of the economic cost and the value of lives lost. Our second method is to calculate the Pareto optimal front when we look at the two variables—deaths and economic costs. In both cases we find that, for most parameter values, the optimal policy is to adopt an initial shutdown level which reduces the reproduction number of the epidemic to close to 1. This level is then reduced once a vaccination programme is underway. Our model also indicates that an oscillating policy of strict and mild shutdowns is less effective than a policy which maintains a moderate shutdown level.

The impact of COVID-19 on breast cancer stage at diagnosis.

528 Background: During the SARS-CoV-2 pandemic, routine screening mammography (SM) was stopped and diagnostic mammography (DM) was limited for several months across the United States in order to reduce patient exposure and redeploy medical personnel. We hypothesized that this delay would result in patients presenting with later-stage disease following the initial shutdown. Methods: Patients diagnosed with invasive breast cancers from 2016-2020 were identified using the Beth Israel Deaconess Medical Center Cancer Registry. Baseline patient characteristics, demographics, and clinical information were gathered and cross-referenced with our electronic medical record. Late-stage disease was defined as initial anatomic stage III-IV disease in the AJCC 8th edition staging system. The control cohort consisted of patients diagnosed from 2016-2019; patients diagnosed in 2020 were the test cohort. Chi-squared analysis was used to compare monthly distributions in stage at diagnosis between the control and test cohorts. Multivariate analysis was performed using a logistic regression model. Results: There were 1597 patients diagnosed with invasive breast cancer between 2016-2019 and 333 in 2020. Median age at diagnosis was 60 years; 99% were female, and 69.1% were white. Mammography was limited from 3/16/20-6/8/20, with 90% reduction in volume during this time. The number of screening studies performed in March, April, May, and June of 2020 were 987, 1, 4, and 721 compared to 2042, 2141, 2241, and 2142 in 2019. The volume of new diagnoses per month decreased substantially during the shutdown (see table). The proportion of patients diagnosed with late-stage disease was 6.6% in the control cohort compared to 12.6% in the 2020 test cohort (p &lt; 0.001); 92.9% of late-stage diagnoses in 2020 occurred from June to December following the shutdown period. On multivariate analysis, year of diagnosis (2020 vs 2016-2019; OR = 4.25 95% CI 0.035-0.095, p &lt; 0.001), lower income (&lt;200% of the federal poverty level; OR = 2.73 95% CI 0.016-0.099, p = 0.006) and increased Charlson Comorbidity Index (OR = 12.01 95% CI 0.037-0.052, p &lt; 0.001) were associated with later stage at diagnosis. Conclusions: Patients were more likely to be diagnosed with late-stage breast cancer following the global shutdown due to the SARS-CoV-2 pandemic. Patients with lower income and medical comorbidities were disproportionately affected. These data raise significant concerns regarding the impact of SARS-CoV-2 on cancer diagnoses and long-term outcomes, especially in vulnerable patient populations.[Table: see text]

Financial Decisions and Reopening a Practice During the COVID-19 Pandemic: A Survey of California Plastic Surgeons.

On March 11, 2020, the World Health Organization declared COVID-19 as a global pandemic. As a response, the United States shut down public gatherings and businesses in an effort to quarantine. This included the stopping of elective operations, which greatly affected plastic surgeons and their practices during the initial shutdown. We aim to study the early impact of COVID-19 on the financial implications and practice patterns of plastic surgeons in the state of California during the initial shutdown of elective surgery and provide guidelines for effective management during future crises. A 20-question survey was sent using Qualtrics XM software to 851 surgeon members of the California Society of Plastic Surgeons. The survey was open from May 13, 2020, to May 29, 2020. Standard statistical analysis was completed to compare private practice and nonprivate practice plastic surgeons. We had a total of 140 respondents to our survey for a 16.5% response rate. The majority (77.1%) of the respondents were in a private practice setting. Private practice plastic surgeons reported a higher financial impact with a 79% reduction in financial income compared with nonprivate practice plastic surgeons at a 37% reduction (P < 0.0001). Additionally, private practice plastic surgeons demonstrated a higher reduction in case volume and were more likely to lay off or furlough staff, close their practice, and apply for loans (P < 0.001). Our survey study showed that private practice plastic surgeons in the state of California faced the most financial hardship during the early shutdown of the COVID-19 pandemic. It serves as a valuable snapshot in our economic history and depicts the heavy financial impact of the stopping of elective surgery. Since the reopening of practices, new guidelines have been implemented to maintain safe elective surgery while the pandemic continues. Further follow-up studies on both the state and national level need to be completed to see the continued financial effects on private and nonprivate plastic surgery practices since the reopening and resumption of elective surgery.

Effects of COVID-19 Shutdowns on Domestic Violence in US Cities

We empirically investigate the impact of COVID-19 shutdowns on domestic violence using incident-level data on both domestic-related calls for service and crime reports of domestic violence assaults from the 18 major US police departments for which both types of records are available. Although we confirm prior reports of an increase in domestic calls for service at the start of the pandemic, we find that the increase preceded mandatory shutdowns, and there was an incremental decline following the government imposition of restrictions. We find no evidence that domestic violence crimes increased. Rather, domestic violence assaults declined significantly during the initial shutdown period and there was no significant change in intimate partner homicides in these months. Nationwide intimate partner violence rates in the National Crime Victimization Survey, including crimes not reported to police, were also lower during shutdown months. Our results fail to support claims that shutdowns increased domestic violence and suggest caution before drawing inference or basing policy on calls data alone.

Effects of the COVID-19 Pandemic on Domestic Violence in Los Angeles

Around the world, policymakers and news reports have warned that domestic violence (DV) could increase as a result of the COVID-19 pandemic and the attendant restrictions on individual mobility and commercial activity. However, both anecdotal accounts and academic research have found inconsistent effects of the pandemic on DV across measures and cities. We use high-frequency, real-time data from Los Angeles on 911 calls, crime incidents, arrests, and calls to a DV hotline to study the effects of COVID-19 shutdowns on DV. We find conflicting effects within that single city and even across measures from the same source. We also find varying effects between the initial shutdown period and the one following the initial re-opening. DV calls to police and to the hotline increased during the initial shutdown, but DV crimes decreased, as did arrests for those crimes. The period following re-opening showed a continued decrease in DV crimes and arrests, as well as decreases in calls to the police and to the hotline. Our results highlight the heterogeneous effects of the pandemic across DV measures and caution against relying on a single data type or source.

Stringent response leads to continued cell division and a temporal restart of DNA replication after initial shutdown in Vibrio cholerae.

Vibrio cholerae is an aquatic bacterium with the potential to infect humans and cause the cholera disease. While most bacteria have single chromosomes, the V. cholerae genome is encoded on two replicons of different size. This study focuses on the DNA replication and cell division of this bi-chromosomal bacterium during the stringent response induced by starvation stress. V. cholerae cells were found to initially shut DNA replication initiation down upon stringent response induction by the serine analog serine hydroxamate. Surprisingly, cells temporarily restart their DNA replication before finally reaching a state with fully replicated single chromosome sets. This division-replication pattern is very different to that of the related single chromosome model bacterium Escherichia coli. Within the replication restart phase, both chromosomes of V. cholerae maintained their known order of replication timing to achieve termination synchrony. Using flow cytometry combined with mathematical modeling, we established that a phase of cellular regrowth be the reason for the observed restart of DNA replication after the initial shutdown. Our study shows that although the stringent response induction itself is widely conserved, bacteria developed different ways of how to react to the sensed nutrient limitation, potentially reflecting their individual lifestyle requirements.