National Pandemic Response Research Articles

Canada's approach to SARS-CoV-2 sero-surveillance: Lessons learned for routine surveillance and future pandemics.

In Canada's federated healthcare system, 13 provincial and territorial jurisdictions have independent responsibility to collect data to inform health policies. During the COVID-19 pandemic (2020-2023), national and regional sero-surveys mostly drew upon existing infrastructure to quickly test specimens and collect data but required cross-jurisdiction coordination and communication. There were 4 national and 7 regional general population SARS-CoV-2 sero-surveys. Survey methodologies varied by participant selection approaches, assay choices, and reporting structures. We analyzed Canadian pandemic sero-surveillance initiatives to identify key learnings to inform future pandemic planning. Over a million samples were tested for SARS-CoV-2 antibodies from 2020 to 2023 but siloed in 11 distinct datasets. Most national sero-surveys had insufficient sample size to estimate regional prevalence; differences in methodology hampered cross-regional comparisons of regional sero-surveys. Only four sero-surveys included questionnaires. Sero-surveys were not directly comparable due to different assays, sampling methodologies, and time-frames. Linkage to health records occurred in three provinces only. Dried blood spots permitted sample collection in remote populations and during stay-at-home orders. To provide timely, high-quality information for public health decision-making, routine sero-surveillance systems must be adaptable, flexible, and scalable. National capability planning should include consortiums for assay design and validation, defined mechanisms to improve test capacity, base documents for data linkage and material transfer across jurisdictions, and mechanisms for real-time communication of data. Lessons learned will inform incorporation of a robust sero-survey program into routine surveillance with strategic sampling and capacity to adapt and scale rapidly as a part of a comprehensive national pandemic response plan.

Understanding the impacts of the COVID-19 response measures on Deaf adults in Cape Town.

International literature has evidenced that Deaf people have been disadvantaged during the COVID-19 pandemic; however, there is currently little research published within the South African context. This study investigated the ways in which the COVID-19 pandemic and its consequent response measures impacted Deaf adults in Cape Town. Using a descriptive approach, semi-structured, qualitative interviews were held with 15 Deaf adults in Cape Town, South Africa. Participants were purposively selected through a local Deaf organisation. Data were analysed using thematic analysis. Data revealed the challenges experienced when accessing information, the impact of communication barriers on daily life, and how the response measures impacted access to healthcare. The findings of this study demonstrate how the needs of the Deaf community were overlooked and their voices disregarded during the planning of the national pandemic response, ultimately having detrimental consequences. Therefore, the authors argue for greater inclusion of Deaf representatives to ensure equal access to information and resources, especially during a crisis. This study contributes to the growing body of knowledge on the consequences of the COVID-19 pandemic in the field of disability and insights can inform both future research and interventions to promote equity and inclusion for Deaf people.

Planning with a gender lens: A gender analysis of pandemic preparedness plans from eight countries in Africa

BackgroundHealth planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa. MethodsMulti-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis. ResultsAll plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries. ConclusionsThe plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.

VA Big Data Science: A Model for Improved National Pandemic Response Present and Future.

The US Department of Veterans Affairs (VA) enterprise approach to research (VA Research) has built a data-sharing framework available to all research teams within VA. Combined with robust analytic systems and tools available for investigators, VA Research has produced actionable results during the COVID-19 pandemic. Big data science techniques applied to VA's health care data demonstrate that medical research can be performed quickly and judiciously during nationwide health care emergencies. We envision a common framework of data collection, management, and surveillance implemented in partnership with other health care agencies that would capture even broader, actionable, and timely observational data on populations, while providing opportunities for enhanced collaborative research across agencies. This model should be continued and expanded through the current COVID-19 and future pandemics. Extending the achievements of VA Research in the COVID-19 pandemic to date, we advocate national goals of open science by working toward a synergistic national framework of anonymized, synchronized, shared health data that would provide researchers with potent tools to combat future public health crises.

Contact-tracing of the COVID-19 spreading using digital technologies with artificial intelligence (literary review)

The emergence of COVID-19 almost coincided with the beginning of an active phase of the digitalization process in all areas, including the healthcare system. Moreover, COVID-19 unwittingly became the impetus that accelerated the adoption of digital technologies, and initiated new, often innovative solutions to combat both the virus and its devastating social and economic consequences.
 The purpose of the study: the current study conducts a literature review of existing scientific reports in the field of digital contact-tracing COVID-19 using artificial intelligence (AI) technologies, to discuss issues related to the security of personal data when using official mobile applications, to draw conclusions and make recommendations in the field of effective and ethical management of digital contact-tracing as one of the main tools for preventing the spread of the pandemic.
 Scientific reports contained in the scientific research databases of Ebsco Publishing and SpringerLink for the period March 2020 — April 2021 were analyzed.
 Digital contact-tracing solutions have found their important place among other anti-epidemic measures in many countries around the world. However, the same solutions, but already using AI, are still gaining popularity. National governments in numerous developed and developing countries understand the importance of national contact-tracing systems, which in turn has introduced such approaches in national pandemic response strategies.
 Conclusion: Digital contact-tracing technologies using AI can be an effective tool in the fight against COVID-19 and similar pandemics. However, such digital systems are still at a preliminary stage of their development and implementation, and it will take time before the results will be visible. Very few of the considered examples and models of digital tracing solutions using AI technologies have operational maturity at this stage.

Defence organizations in emergency networks: the early response to COVID-19 in Europe

PurposeThe purpose of this study is to analyse the crisis network response of European countries and the role played by defence organizations (DOs) during the early response phase of the pandemic, here set to encompass 75 days.Design/methodology/approachPublished materials – reports, news and communications – provided by authorities and DOs were used. Some of the authors actively participated in national pandemic response networks. An exploratory approach and qualitative content analysis were applied. The data were collected in national languages from 13 European countries, and they were coded and analysed using the actors, resources and activities (ARA) framework.FindingsThis study identified three main categories of activity structures in which the DOs interacted with civilian members of response networks, health-related services, logistics services and public support services. These networks among actors were found within formal response systems and emergent networks. The DOs engaged as actors that provided a range of services when civil authorities could not cope with the huge demand for specific services and when resources were scarce in the initial response phase.Originality/valueThis study contributes by filling an important research gap with regard to the civil-military relations associated with the use of DO resources in the civil response to the pandemic crisis in Europe, which is described as an untraditional response. The ARA network approach provides a framework for arranging ARA and extends the wider civil-military network to expand the formal networks of the early crisis response. The study lays knowledge about the co-operation between civilian and military actors in different contexts and provides a broader understanding of the roles that DOs played in the response operations.

Experiences of redeployed healthcare workers in the fight against COVID-19 in China: A qualitative study.

Public health responses were triggered while COVID-19 was spreading. China redeployed healthcare workers to serve the most vulnerable populations and communities in the initial epicentre-Wuhan. However, it is not known how redeployment processes impacted on healthcare workers in a pandemic crisis. To explore the experiences and needs of frontline healthcare workers who were redeployed to care for COVID-19 patients in Wuhan, China, and understand the long-term impacts of the redeployment experience on their work and life. A qualitative study was conducted with redeployed healthcare workers using semi-structured interviews and thematic analysis. This study is reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) guidelines. A total of 20 redeployed healthcare workers (13 nurses and seven physicians) participated, and four themes were generated: (1) Initial feelings and emotions of redeployment-Participants experienced worries and concerns, a sense of isolation and loneliness on their arrival to the epicentre. (2) 'It is like a war zone'-Healthcare workers faced a range of risks and challenges of caring for COVID-19 patients in Wuhan in the context of resource strain. (3) Uncertainty and coping strategies in patient care-Despite the hardships experienced, participants continued to deliver high-quality patient care including psychological care and palliative care, good communication and building mutual trusting relationships. (4) Reflection and far-reaching impacts of caring for COVID-19 patients-Participants felt motivated and encouraged as efforts were recognised by the government and wider society. Redeployed healthcare workers shared their unique needs and experiences of coping with redeployment and challenges they faced in the context of resource strain, which has significant implications for policy and future practice. The reality of a pandemic may reduce healthcare workers' willingness to work due to various reasons including inadequate preparedness of facilities and workplace safety. It is important to support frontline healthcare workers in order to maintain an adequate healthcare workforce in pandemic crises. Continuously evolving pandemic circumstances and uncertainty highlight the importance of an organized national pandemic response plan for subsequent waves of COVID-19 and future pandemics.

Survey of awareness, attitudes, and compliance with COVID-19 measures among Vermont residents.

The objective of this research was to examine residents’ awareness, attitudes, and compliance with COVID-19 public health guidelines in Vermont, which emerged as an early leader in national pandemic response. Our methods included conducting an online survey of adult Vermont residents between January and April 2021. We analyzed demographics associated with awareness and compliance, and identified features associated with non-compliance. Our results show that of the 2,208 adult Vermont residents who completed the survey, 90% were extremely aware of the state’s COVID-19 guidelines, and 95% reported knowing exactly what to do to follow recommended actions. Political affiliation emerged as a primary factor related to attitudes and compliance. Self-identified Republicans were less likely to agree that public health measures keep people safe or help businesses stay open, and were less likely to follow masking, quarantine, social distancing, and vaccine guidance than Independents, Progressives, and Democrats. The large differences in COVID-19 infection and death rates across the country, and recent shift toward a "pandemic of the unvaccinated," underscore the need for identifying public health strategies that work in some areas in order to adapt and apply them to areas that have struggled with controlling the virus. Consistent with national surveys, our results show that resistance to public health guidance is a partisan challenge even in states with high compliance. Identifying populations that are less supportive or hesitant to follow guidelines while understanding factors that motivate compliance can help inform strategies for developing targeted programs to encourage collective action on pandemic response. Developing communication strategies that reach people who do not believe COVID-19 guidelines keep them safe is necessary to reach universal compliance.

Experiences and well-being of healthcare professionals working in the field of ultrasound in obstetrics and gynaecology as the SARS-CoV-2 pandemic were evolving: a cross-sectional survey study

ObjectiveAssess experience of healthcare professionals (HCPs) working with ultrasound in obstetrics and gynaecology during the evolving SARS-CoV-2 pandemic, given the new and unprecedented challenges involving viral exposure, personal protective equipment...

Community socioeconomic deprivation and SARS-CoV-2 infection risk: findings from Portugal.

BackgroundSocioeconomic differences have been observed in the risk of acquiring infectious diseases, but evidence regarding SARS-CoV-2 remains sparse. Hence, this study aimed to investigate the association between SARS-CoV-2 infection risk and socioeconomic deprivation, exploring whether this association varied according to different phases of the national pandemic response.MethodsA cross-sectional study was conducted. Data routinely collected for patients with a laboratorial result recorded in SINAVE®, between 2 March and 14 June 2020, were analysed. Socioeconomic deprivation was assessed using quintiles of the European Deprivation Index (Q1-least deprived to Q5-most deprived). Response phases were defined as before, during and after the national State of Emergency. Associations were estimated using multilevel analyses.ResultsThe study included 223 333 individuals (14.7% were SARS-CoV-2 positive cases). SARS-CoV-2 infection prevalence ratio increased with deprivation [PR(Q1)=Ref; PR(Q2)=1.37 (95% CI 1.19–1.58), PR(Q3)=1.48 (95% CI 1.26–1.73), PR(Q4)=1.73 (95% CI 1.47–2.04), PR(Q5)=2.24 (95% CI 1.83–2.75)]. This was observed during the State of Emergency [PR(Q5)=2.09 (95% CI 1.67–2.62)] and more pronounced after the State of Emergency [PR(Q5)= 3.43 (95% CI 2.66–4.44)].ConclusionThe effect of socioeconomic deprivation in the SARS-CoV-2 infection risk emerged after the implementation of the first State of Emergency in Portugal, and became more pronounced as social distancing policies eased. Decision-makers should consider these results when deliberating future mitigation measures.

A retrospective survey study of paramedic students\u2019 exposure to SARS-CoV-2, participation in the COVID-19 pandemic response, and health-related quality of life

BackgroundHealthcare workers have reported increased anxiety while working in hospitals during the COVID-19 pandemic, and the role of healthcare students in a health crisis has been discussed among clinicians and researchers. The simultaneous international shortage of personal protection equipment (PPE) during the first wave of the pandemic potentially exposed healthcare workers and students to the virus during their work and clinical training. Our aim was therefore to evaluate the extent to which paramedic students in Oslo, Norway, were exposed to the SARS-CoV-2 virus and were involved in voluntary and/or paid healthcare-related work. An evaluation was also made of the students’ COVID-19-related symptoms and of their health-related quality of life (HRQoL) during the first wave of the pandemic.MethodsParamedic students (n = 155) at Oslo Metropolitan University, Norway, were invited to complete an online survey five months after the first cases of COVID-19 were detected. The university was situated in the epicenter of the pandemic in Norway. The responses were analyzed using descriptive statistics, independent sample t-tests, and linear regression analysis.ResultsOf the 109 respondents (70.3%), 40 worked in patient-related healthcare work. Of those, seven (17.5%) students experienced insufficient supplies of PPE, six (15.0%) participated in aerosol-generating procedures without adequate PPE, and nine (22.5%) experienced insufficient time to don PPE. Seventy-five (70.1%) students experienced no COVID-19-related symptoms, and no students tested positive for COVID-19. HRQoL was scored 0.92 (sd 0.12), which was significantly higher than for the general population before the pandemic (p = 0.002). Students continued with their education and participated in a variety of pandemic-related emergency tasks during the first wave of the pandemic.ConclusionsParamedic students were valuable contributors to the national pandemic response. Despite potential exposure to SARS-CoV-2 in unpredictable emergency settings with limited supplies of personal protection equipment, no students tested positive for COVID-19. Their health-related quality of life remained high. Students’ participation and utilization in similar health crises should be considered in future health crises.

Decreasing proportion of extended-spectrum beta-lactamase among E. coli infections during the COVID-19 pandemic in France

We investigated the impact of the COVID-19 and national pandemic response on the epidemiology of Extended Spectrum Beta-Lactamase producing E. coli (ESBL-E.coli) in France. Individual microbiology records from clinical laboratories were analyzed between 1 January 2019 to 31 December 2020. The ESBL-E.coli rates from clinical samples of patients in primary care and nursing home residents were compared before and after the general lockdown in March 2020, according to demographic and geographical characteristics. Interrupted time series analyses were performed to detect measurable changes in the trend of ESBL-E.coli rates. Records covering 793,954 E. coli isolates from 1022 clinical laboratories were analyzed. In primary care, 3.1% of E. coli isolates from clinical samples were producing ESBL before March 2020 and 2.9% since May 2020 (p<0.001). The proportion of ESBL-E.coli decreased significantly among urine cultures, females, age categories 5-19, 40-64, >65 year-old, and in the North, West, East and South-East regions. In nursing home, the ESBL-E.coli rate was 9.3% (monthly rate min-max: 6.5-10.5%) before March 2020 and 8.3% (7.2-9.1%) since May 2020 (p<0.001). The reduction rate accelerated from -0.04%/month to -0.22%/month from May 2020 (p<0.001). Investigation of factors that led to the decreased proportion of ESBL-E.coli during the COVID-19 pandemic is urgently needed.

Philippine private sector response, strategies, and state-business relations toward economic recovery and growth post-COVID-19

AbstractThe Philippines was among the fastest-growing economies averaging within the 6.5 percent GDP growth in the past five years. However, the COVID-19 crisis brought major disruptions to the Philippine economy as growth, employment, and overall productivity fell into recession levels along with the declaration of a nationwide lockdown. As the pandemic resulted in a series of business closures, supply chain breakdowns, and massive job cuts, the private sector was forced to confront the challenges brought by the pandemic including its threat to business continuity and survival. This article presents the private sector's assessment of the pandemic's impact on the Philippine economy along with their views on the national pandemic response and the extent of public-private collaborations in countering the effects of COVID-19. Following the insights and experiences shared by industry leaders and other corporate executives, this article also discusses pivots in corporate strategy along with a significant shift in corporate mindset toward new ways of doing business and fulfilling their responsibilities in society.

Assessing the Performance of Australian Federalism in Responding to the Pandemic

This article provides a comprehensive evaluation of the federalism-implicated aspects of Australia’s response to the COVID-19 pandemic. The article’s research question is: to what extent was Australia’s federal structure responsible for the relative successes and failures of the national pandemic response? The method chosen to answer this question is largely theoretical, supplemented by aspects of institutional and policy analysis. That is to say, the inquiry identifies what were widely considered to be important policies, and considers the extent to which the formulation and implementation of those policies was furthered or hindered by the institutions and relations forming Australia’s federal structure. Five policy areas are considered, namely: the National Cabinet; social distancing and related policies; international travel and quarantine; interstate travel; and cities and local government. The conclusions reached are that a number of policy responses achieved federalism’s objectives of enhancing local decision-making power, increasing state and federal cooperation, and cabining policy failure. While Australia’s was not an unmitigated success story, on the whole the pandemic galvanized and reinvigorated Australia’s federal structure and institutions.

Setting the boundaries of COVID-19 lockdown relaxation measures

PurposeThe purpose of this paper is to develop a simple deterministic model that quantifies previously adopted preventive measures driven by the trend of the reported number of deaths in both Italy and India. In addition, the authors forecast the spread based on some selected quantified preventive measures. The optimal exiting policy is derived using the inverse dynamics of the model. Furthermore, the model developed by the authors is dependent on the daily number of deaths; as such, it is sensitive to the death rate but remains insensitive to trends in deaths.Design/methodology/approachIn the wake of COVID-19, policymakers and health professionals realized the limitations and shortcomings of current healthcare systems and pandemic response policies. The need to revise global and national pandemic response mechanisms has been thrust into the public spotlight. To this end, the authors devise an approach to identify the most suitable governmental non-pharmaceutical intervention (NPI) policies, previously adopted in a community, country or region that serve as the foundation for most pandemic strategies.FindingsLeveraging Italy, the authors compare the aftermath by considering three scenarios: (a) recently adopted preventive measures, (b) strictest preventive measures previously adopted, and (c) the optimal exiting policy. In comparison to the second scenario, the authors estimate about twice the number of recoveries and deaths within five months under the first scenario and about 80 times more under the optimal scenario. Whereas in India, the authors applied one scenario of recently adopted preventative measures to showcase the rapid turnaround of their model. According to the new timeline, almost 90% of all deaths in India could have been prevented if the policies implemented in April 2021 were put in place three months prior, i.e. in January 2021.Originality/valueThe novelty of the proposed approach is in the use of inverse dynamics of a simple deterministic model that allows capturing the trend of contact rate as a function of adopted NPIs, regardless of pandemic type.

Increasing aggression during the COVID-19 lockdowns

BackgroundTo combat the spread of COVID-19, many communities implemented restrictions on personal movement, often referred to as “lockdowns.” We hypothesized that continued lockdowns might be associated with increased feelings of aggression.MethodsOver the first six months of the COVID-19 pandemic, the Buss-Perry Aggression Questionnaire (BPAQ) was administered to a total of 5,928 adults distributed proportionally from across the United States during independent online cross-sectional surveys collected each month. Data across the 6-month period were compared between those under lockdown versus those not under such restrictions.ResultsBPAQ Total Aggression scores showed a significant main effect for both month and lockdown status as well as a significant interaction effect, with increasing scores evident for those reporting that they were under lockdown relative to those reporting no restrictions. This same pattern was evident for all four subscales of the BPAQ, including Physical Aggression, Verbal Aggression, Anger, and Hostility.LimitationsRandom sampling of the entire population was not possible, so generalization of the results should be made with caution. Additionally, data were collected cross-sectionally and cannot be considered to reflect longitudinal change within individuals. Finally, the cross-sectional survey design means that it is impossible to infer that the lockdowns caused the increase in aggression.ConclusionsLockdowns were associated with elevated levels of aggression that were higher in later months of the national pandemic response.

Lessons Learned From the COVID-19 Pandemic: Occupational Therapy on the Front Line.

The pandemic caused by coronavirus disease 2019 (COVID-19) highlighted the insufficient public health policies and lack of a national pandemic response strategy. Rehabilitation departments faced barriers to providing care in the traditional manner and needed to consider protection of patients and staff, staffing and personal protective equipment shortages, and uncertainty about best practices to address a novel health condition. This article highlights the strategies implemented by acute care occupational therapy leaders to support their staff; facilitate efficient care provision; and pivot with constantly changing policies, procedures, and research during the COVID-19 crisis. Occupational therapy's distinct value in caring for this population and role in responding to the pandemic are shared to provide a guidepost for future health care crises.

Contact tracing apps for self-quarantine in South Korea: rethinking datafication and dataveillance in the COVID-19 age

PurposeThe first case of coronavirus disease 2019 (COVID-19) was documented in China, and the virus was soon to be introduced to its neighboring country – South Korea. South Korea, one of the earliest countries to initiate a national pandemic response to COVID-19 with fairly substantial measures at the individual, societal and governmental level, is an interesting example of a rapid response by the Global South. The current study examines contact tracing mobile applications (hereafter, contact tracing apps) for those who were subject to self-quarantine through the lenses of dataveillance and datafication. This paper analyzes online/digital data from those who were mandatorily self-quarantined by the Korean government largely due to returning from overseas travel.Design/methodology/approachThis study uses an Internet ethnography approach to collect and analyze data. To extract data for this study, self-quarantined Korean individuals' blog entries were collected and verified with a combination of crawling and manual checking. Content analysis was performed with the codes and themes that emerged. In the COVID-19 pandemic era, this method is particularly useful to gain access to those who are affected by the situation. This approach advances the author’s understandings of COVID-19 contact tracing mobile apps and the experiences of self-quarantined people who use them.FindingsThe paper shows Korean citizens' understandings and views of using the COVID-19 self-tracing application in South Korea through examining their experiences. The research argues that the application functions as a datafication tool that collects the self-quarantined people's information and performs dataveillance on the self-quarantined people. This research further offers insights for various agreements/disagreements at different actors (i.e. the self-quarantined, their families, contact tracers/government officials) in the process of contact tracing for COVID-19.Originality/valueThis study also provides insights into the implications of information and technology as they affect datafication and dataveillance conducted on the public. This study investigates an ongoing debate of COVID-19's contact tracing method concerning privacy and builds upon an emerging body of literature on datafication, dataveillance, social control and digital sociology.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0377

Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves

ObjectivesWe investigated the impact of COVID-19 and national pandemic response on primary care antibiotic prescribing in London. MethodsIndividual prescribing records between 2015 and 2020 for 2 million residents in north west London were analysed. Prescribing records were linked to SARS-CoV-2 test results. Prescribing volumes, in total, and stratified by patient characteristics, antibiotic class and AWaRe classification, were investigated. Interrupted time series analysis was performed to detect measurable change in the trend of prescribing volume since the national lockdown in March 2020, immediately before the first COVID-19 peak in London. ResultsRecords covering 366 059 patients, 730 001 antibiotic items and 848 201 SARS-CoV-2 tests between January and November 2020 were analysed. Before March 2020, there was a background downward trend (decreasing by 584 items/month) in primary care antibiotic prescribing. This reduction rate accelerated to 3504 items/month from March 2020. This rate of decrease was sustained beyond the initial peak, continuing into winter and the second peak. Despite an overall reduction in prescribing volume, co-amoxiclav, a broad-spectrum “Access” antibiotic, prescribing rose by 70.1% in patients aged 50 and older from February to April. Commonly prescribed antibiotics within 14 days of a positive SARS-CoV-2 test were amoxicillin (863/2474, 34.9%) and doxycycline (678/2474, 27.4%). This aligned with national guidelines on management of community pneumonia of unclear cause. The proportion of “Watch” antibiotics used decreased during the peak in COVID-19. DiscussionA sustained reduction in community antibiotic prescribing has been observed since the first lockdown. Investigation of community-onset infectious diseases and potential unintended consequences of reduced prescribing is urgently needed.

The critical importance of community health workers as first responders to COVID-19 in USA.

COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts.