National Public Health Emergency Research Articles

Trends in telehealth: a content analysis of state-level legislation

ABSTRACT Telehealth services rapidly expanded with the COVID-19 national public health emergency. Following the end of the public health emergency telehealth practice may once again be limited by prior policy. The current content analysis assessed 299 legislative bills related to telehealth at the state-level in 2021 and 2022 to determine trends in telehealth laws in the United States. Analysis explored correlative relationships between metrics representing mental health needs on the state level.

Religion and Coronavirus Response in Kano State, Nigeria

Abstract In April 2020 there was an inordinate spike in COVID-19 related deaths in Kano State, northern Nigeria, due to a lack of adherence to the national public health emergency recommendations. This article aims to explain why this public health fiasco occurred. Utilizing secondary academic literature and news reports from local media, the article interrogates the manifestation of Islam in northern Nigeria and the resulting undermining of the country’s coronavirus mitigation response. The evidence from Kano State indicates that religious authorities failed to heed the suspension of congregational prayers as the relevant health agencies advised, due to a belief in the exceptionality of northern Nigeria as a theocratic substate in a secular federation. The article therefore highlights the challenges of communicating public health risk in a context where the authority of religious leaders, real or imagined, undercuts the power of state institutions.

Strengthening legal preparedness and response within the global health emergency framework: the role of the GHSA Legal Preparedness Action Package*

The COVID-19 pandemic exposed failings in preparedness and response across the world and a shortfall in global health security. The crisis also highlighted shortcomings in global and regional legal frameworks, including the International Health Regulations (2005) and relevant European Union law, as well as in national public health legislation and emergency plans. Lessons learned from the pandemic converge around strengthening preparedness and response capacities at all levels, with special attention to be paid to legal preparedness, a critical component of public health emergency preparedness. Improving legal capacities at country level is one of the strategic priorities set by the Global Health Security Agenda (GHSA), which established a new Legal Preparedness Action Package (LP AP) in order to elevate attention to and the importance of legal preparedness worldwide. Since 2021 the LP AP has been front and centre in international efforts to bridge the legal preparedness gap at national level. In bringing together technical experts in global health law and government health policy officials from a broad range of countries and partners, the LP AP seeks to set a foundation for legal preparedness by developing technical and capacity-building tools, legal guidelines, policy briefs, information and training. This article aims to illustrate and contextualize the work of the GHSA LP AP and raise awareness about the importance of its contribution to enhanced global health security. It also intends to highlight how its work promotes and develops synergies with parallel initiatives, processes and tools, facilitates regime interaction and harmonization of technical assistance and ultimately ensures consistency of action, methodology and approaches.

Tanzania's first Marburg Viral Disease outbreak response: Describing the roles of FELTP graduates and residents.

Viral Haemorrhagic Fever Outbreak presents a significant public health threat, requiring a timely, robust, and well-coordinated response. This paper aims to describe the roles of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) graduates and residents in responding to Tanzania's first Marburg Viral Disease (MVD) outbreak. We performed a secondary data analysis using a range of documents, such as rosters of deployed responders and the TFELTP graduate and resident database, to count and describe them. Additionally, we conducted an exploratory textual analysis of field deployment reports and outbreak situational reports to delineate the roles played by the residents and graduates within each response pillar. A total of 70 TFELTP graduates and residents from different regions were involved in supporting the response efforts. TFELTP graduates and residents actively participated in several interventions, including contact tracing and follow up, sensitising clinicians on surveillance tools such as standard case definitions, alert management, supporting the National and Kagera Regional Public Health Emergency Operations Centres, active case search, risk communication, and community engagement, coordination of logistics, passenger screening at points of entry, and conducting Infection Prevention and Control (IPC) assessments and orientations in 144 Health Facilities. The successes achieved and lessons learned from the MVD response lay a foundation for sustained investment in skilled workforce development. FELTP Training is a key strategy for enhancing global health security and strengthening outbreak response capabilities in Tanzania and beyond.

Implementation of Emergency Preparedness and Response-Rapid Team Program in Niger

<i>Introduction:</i> The WHO’s prompt declaration of a Public Health Emergency of International Concern (PHEIC) shepherded an effective coordinated response to contain the epidemic. <i>Objective:</i> The aim of this study is to describe the experiences, challenges, and lessons learned during the Implementation of Emergency Preparedness and Response-Rapid Response Team (EPR-RRT) program. <i>Method:</i> The study used mixed methods approach quantitative and qualitative data from a literature review of WHO AFRO coordination mechanisms and the Niger Public Health Emergency Operational Centre (PHEOC). The study was conducted in the National Public Health Emergency Operational Centre (PHEOC) of Niger during 12 months from September 2022 to September 2023. <i>Results:</i> The implementation of this program began with the evaluation of Niger's capacities and capacity building of teams to prepare, detect and respond to public health emergencies within 24 hours of an alert. The team of multi-disciplinary and multi-sector experts was identified and selected and trained on series of modules training. The team is composed of a total of 50 experts from 6 ONE HEALTH sectoral ministries. The average age is 49.94 (±5.9) years with extremes ranging from 33 to 56 years. The sex ratio is 0.35. The team have acquired the experience of being deployed in 4 regions of the country, 6 districts as part of the response to 6 public health events. <i>Conclusion:</i> The rapid response team has made it possible not only to acquire the technical and operational skills, financial, human and logistical capacities to respond rapidly when a public health emergency occurs.

Information sharing across institutions: Practices and barriers during public health emergencies in Ethiopia

BackgroundRapid, integrated information exchange between stakeholders is critical for effective emergency preparedness and response. However, many low- and middle-income countries face barriers to seamless data sharing. While information accessibility is recognized as important for evidence-based decision-making and resource allocation in Ethiopia, factors influencing current health information sharing practices among stakeholders involved in public health emergency management programs are unclear. This study aims to examine multi-sectoral stakeholders' perspectives and experiences with health data sharing during emergencies in Ethiopia, to identify opportunities and challenges influencing practices to strengthen the national public health emergency response system. MethodsA mixed-methods study was conducted between June and August 2023, involving a survey of 169 stakeholders actively involved in PHEM programs in Ethiopia as well as 23 in-depth interviews with key informants in senior leadership or advisory roles. The data was analyzed using descriptive statistics in SPSS and thematic analysis of qualitative transcripts. ResultsDuring emergencies, it was observed that data sharing between different entities occurred. Quantitative findings showed the predominant types of health data shared between stakeholders during emergencies included hospital data (109, 64.5 %), clinical case information, and laboratory results. Challenges limiting effective coordination included issues like limited functionality of digital health systems (75, 44 %), incompatible data formats (13, 34 %), and financial constraints (83, 49 %) and and socio-cultural barriers constrain current practices in Ethiopia. Qualitative interviews identified five themes around risk communication and inclusive alert systems. Experts emphasized tailored, multichannel outreach but noted infrastructure gaps and digital divides currently limit poorer communities' engagement. ConclusionWhile collaborative health information exchange during emergencies is recognized as important, systemic, financial, and socio-cultural barriers constrain current practices in Ethiopia. Targeted strategies including capacity building, investment in integrated data infrastructure, economic optimization through innovative financing models, trust-based relationship development, and locally relevant communication channels informed by stakeholder perspectives can optimize information accessibility, coordination, quality, and equity of healthcare services during public health emergencies.

Rethinking the World Health Organization's leadership of global health governance and the global health surveillance systems.

Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO's ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts' perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO's global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO's governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS.

Despite public health emergency, OD deaths keep rising: Here are some solutions

In 2017, President Trump declared the opioid epidemic a national public health emergency (PHE), telling the nation that “we can be the generation that ends the opioid epidemic.”

Predictors of Prescription Opioid Misuse Based on Type of Healthcare Insurance

The misuse and abuse of prescription opioid (PO) medications has garnered the attention of lawmakers, healthcare professionals, and public health experts since the opioid epidemic was declared a national public health emergency in 2017. Our purpose in this study was to investigate the types of healthcare insurance that predict PO misuse. We also sought to inform stakeholders of potentially needed changes to the existing inconsistent drug utilization rules necessary to achieve parity among all types of healthcare insurance and minimize loopholes. We performed a secondary data analysis on the 2019 National Survey on Drug Use and Health data of noninstitutionalized U.S. citizens aged 12 years and older and used a binary logistic regression analysis to evaluate the data. Medicare beneficiaries were 1.79 times more likely and those who had private healthcare insurance through an employer or union were 1.68 times more likely (95% CI [ 1.025, 3.141] and [1.148, 2.463], respectively) than respondents with other healthcare insurances to use PO longer or in greater amounts than the prescription intended. Respondents who had Medicare were 2.226 times more likely than respondents with other healthcare insurance (95% CI [1.029, 4.989]) to misuse PO by taking the medications longer and for other reasons not specified. Our study demonstrates that the type of healthcare insurance is a predictor of PO misuse. Our research also emphasizes the need for stakeholders to use evidence-based research to ensure parity among insurances.

Prediction of Foodborne Norovirus Outbreaks in Coastal Areas in China in 2008-2018.

Foodborne norovirus outbreak usually poses high risks in coastal areas in China. Owing to the influence of multiple climatic factors, it demonstrates typical seasonality and the hotspots gradually expanded northwards from 2008 to 2018. However, the complex mechanism of the onset of outbreaks makes accurate prediction difficult. Thus, it is in necessity to construct a predictive model for foodborne norovirus outbreaks in coastal areas based on environmental and geographical variables. A novel predictive nonlinear autoregressive model with exogenous inputs model was developed using 11 years of environmental and foodborne norovirus outbreak data collected from coastal areas in China. Five input variables (temperature, precipitation, elevation, latitude, and longitude) were screened through stepwise regression analysis. The predicted model developed in this study was able to reproduce 88.53% of outbreaks reported to the National Public Health Emergency Event Surveillance System (PHEESS) in the model development and 100% of outbreaks reported in the independent cross-validation since the system was first launched in China. In particular, foodborne norovirus outbreaks might occur when the probability is >0.6. The findings of this study suggest that foodborne norovirus outbreaks could be accurately predicted in coastal areas in China using the developed predictive model on a daily basis. The model output is most sensitive to temperature, followed by precipitation, and locations. The application of this predictive model is promising to improve local hygiene management levels, prevent foodborne norovirus outbreaks, and reduce the disease and economic costs in coastal areas in China.

Infection prevention and control policy implementation for CPE: a cross-sectional national survey of healthcare workers reveals knowledge gaps and suboptimal practices

In 2017, Ireland pioneered a unique response to the worsening epidemiology of carbapenemase-producing Enterobacterales (CPE), declaring a national public health emergency. Subsequently, CPE mitigation guidelines and policies were implemented in acute hospitals, focused on patient screening and outbreak management, often by healthcare workers (HCWs) with limited background in infection prevention and control (IPC). CPE risks from sinks and drains remain inadequately controlled. To compare CPE awareness, perceptions of the role of the environment in CPE transmission, and disposal practices of liquid waste from clinical handwashing sinks between IPC HCWs and non-IPC HCWs in Ireland. Between December 2022 and March 2023, HCWs employed in acute hospitals in Ireland between 2017 and 2022 were invited to participate anonymously in a 30-question digital survey. Responses (N=283) were received across several clinical disciplines. In total, 21.6% of respondents were working or had previously worked in IPC roles, 84.1% of whom reported no IPC-related learning needs. In comparison with non-IPC HCWs, more IPC HCWs perceived a risk of pathogen transmission from clean water plumbing (68.9% vs 39.2%; P<0.001) and waste/drainage plumbing (81.2% vs 43.7%; P<0.001). Among nursing and medical staff, only 5.6% of IPC HCWs used clinical handwashing sinks for disposal of liquid waste, compared with 60% of non-IPC HCWs (P<0.001). In comparison with non-IPC HCWs, a greater proportion of IPC HCWs reported that they had witnessed colleagues routinely discarding liquid waste (including nutritional products, antimicrobials and patient body fluids) via clinical handwashing sinks (88.9% vs 77.9%) CONCLUSIONS: Although there is general awareness of the role of the built environment in pathogen transmission, including CPE, familiarity with sink/water-related transmission is greater among IPC HCWs. There may be opportunities to improve disposal practices for liquid waste through education targeting non-IPC HCWs.

The impact of Public Health Emergency (PHE) on the news dissemination strength: Evidence from Chinese-Speaking Vloggers on YouTube.

News dissemination plays a vital role in supporting people to incorporate beneficial actions during public health emergencies, thereby significantly reducing the adverse influences of events. Based on big data from YouTube, this research study takes the declaration of COVID-19 National Public Health Emergency (PHE) as the event impact and employs a DiD model to investigate the effect of PHE on the news dissemination strength of relevant videos. The study findings indicate that the views, comments, and likes on relevant videos significantly increased during the COVID-19 public health emergency. Moreover, the public's response to PHE has been rapid, with the highest growth in comments and views on videos observed within the first week of the public health emergency, followed by a gradual decline and returning to normal levels within four weeks. In addition, during the COVID-19 public health emergency, in the context of different types of media, lifestyle bloggers, local media, and institutional media demonstrated higher growth in the news dissemination strength of relevant videos as compared to news & political bloggers, foreign media, and personal media, respectively. Further, the audience attracted by related news tends to display a certain level of stickiness, therefore this audience may subscribe to these channels during public health emergencies, which confirms the incentive mechanisms of social media platforms to foster relevant news dissemination during public health emergencies. The proposed findings provide essential insights into effective news dissemination in potential future public health events.

7 Evaluating the Feasibility of a New Hybrid Teleneuropsychology Screening Service for Individuals with Opioid Use Disorders: Lessons Learned

Objective:Opioid use disorder (OUD) has been declared a national public health emergency leading to increased enrollment in medication assisted treatment (MAT) programs. Cognitive deficits are seen among those with OUD which can persist even with MAT. Moreover, cognitive deficits predict poor community and treatment outcomes. Neuropsychological evaluations can identify, diagnose, and provide treatment recommendations, and are associated with improved outcomes in non-substance use patient populations. Yet, patients with OUD rarely undergo neuropsychological assessment when participating in opioid use treatment. Teleneuropsychology (TNP) may increase access to care but has not been evaluated with people with substance use disorders (SUDs). This project used a mixed-method design to evaluate the feasibility and impact of a pilot hybrid TNP service with new patients with OUDs entering a MAT program.Participants and Methods:Participants were &gt;18 years old and new patients enrolling in MAT for OUD. Participants were excluded if they planned to move out of town within six months or were pending incarceration. Participants were identified by triage questions at MAT intake based on frequency of relevant co-occurring conditions indicating those with greatest need. Positively triaged individuals were referred to the TNP service which was conducted by a hybrid approach (i.e., patient presents to the clinic and is evaluated from a separate room using video-teleconferencing technology). We aimed to schedule participants within two-weeks of 30-days from intake to the MAT program. Consented participants completed questionnaires of feasibility and acceptability (e.g., satisfaction, usefulness) after undergoing a screening TNP evaluation and feedback of the results and recommendations. Participants also were invited to undergo a brief qualitative interview to further assess facilitators and barriers.Results:Of 57 individuals screened positive, 51 were referred, and 14 were reached to offer TNP. Ten (71.4%) agreed to the TNP evaluation and scheduled an appointment, though 50% had the first appointment scheduled within two weeks of 30-days after intake to MAT. Seven (70%) did not keep the first appointment (no show or cancellation) or were rescheduled due to clinic scheduling. Three were reached to reschedule. All three were unable to keep the appointment, but one did reschedule and keep the third appointment. Of the 4 who attended TNP, only 1 (25%) was within two weeks of 30-days after intake. Of those who attended the TNP appointment, 100% completed the protocol, 75% were satisfied with the evaluation overall, 75% found the evaluation useful, and 67% would recommend TNP to others (one participant did not respond to this question).Conclusions:Neuropsychological assessment may provide valuable information to improve treatment for those with OUDs. This pilot project revealed that individuals with OUDs can tolerate and are satisfied with a screening TNP evaluation and find the evaluation useful. The primary barrier was reaching referred patients. Treatment engagement among those with SUDs is a common challenge. Those with counselors who coordinated with the clinic schedulers were more likely to be reached and scheduled, suggesting support for regular case management. Other lessons learned and potential future steps are discussed.

The VA Research Enterprise: A Platform for National Partnerships Toward Evidence Building and Scientific Innovation.

Within a year of the start of the COVID-19 pandemic, the US Department of Veterans Affairs (VA) was managing about 300 COVID-19-related research projects across roughly 100 facilities, which has since grown to more than 900 projects. This robust set of activities arose from an existing enterprise strategy and aimed at identifying needs for supporting the clinical care mission, more rapidly leveraging resources, and coordinating research across the VA. The VA's efforts to implement an enterprise strategy before March 2020 positioned its research community to dynamically partner with other federal agencies, academic institutions, and industry in addressing a national public health emergency. The VA research enterprise involves a broad range of functions, scientific and clinical leaders, and organizational resources to enhance the health and care of veterans and the nation. The scope of research activities enables it to support its priorities while also partnering with others who share in mutual commitments to veteran health. Moving toward being the nation's learning health care system, the VA's leadership support, staff, patient volunteers, and partners were key contributors to a national response to COVID-19. Swift action and consistent communication helped address the complexities of the pandemic and strengthened the VA's ability to prepare and mobilize for emergencies and other potential disease outbreaks. Documenting strategies and practices can enhance future opportunities aimed at addressing the most challenging health care needs while also focusing on the primary mission to serve veterans. The COVID-19 pandemic contributed to critical knowledge and lessons that enabled the VA to advance enterprise goals, particularly in the context of its health care system. Sharing these unique processes and experiences will inform current and future partnerships among research, clinical, and public health communities oriented to serve veterans and the nation through scientific innovation.

A survey of performance of public health risk assessment in emergencies of institutions for disease control and prevention at different levels in China

Objective: To understand the performance of public health risk assessment in emergencies of institutions for disease control and prevention at different levels in China, and provide suggestions for the improvement of public health risk assessment. Methods: A self-administered survey was conducted in professionals involved in public health risk assessment in emergencies from national institution, provincial institutions and some prefectural institutions for disease control and prevention (1-2 prefectural institutions were selected using convenience sampling in each province) between March and April in 2021. Results: A total of 79 institutions for disease control and prevention were investigated, including 1 national institution, 32 provincial institutions and 46 prefectural institutions. By April 2021, all the 79 institutions surveyed had conducted risk assessment of public health emergencies, in which 61 (77.2%) had established departments responsible for the public health risk assessment, i.e. emergency management office or communicable disease prevention and control office (section), and regular risk assessment mechanisms. The main sources of information for public health risk assessment were public health surveillance systems, including the National Notifiable Diseases Reporting System (100.0%) and Public Health Emergencies Management Information System (97.5%). Compared with the provincial institutions, the prefectural institutions were more likely to use specific disease surveillance systems (84.8% vs. 62.5%; χ2=5.09, P=0.024). The risk management recommendations made by 43 institutions for disease control and prevention (54.4%) after the risk assessment were accepted by the superior health administrative departments and used in epidemic prevention and control. Conclusions: Public health risk assessment in emergencies has been widely carried out by national, provincial and prefectural institutions for disease control and prevention in China. Specialized departments and mechanisms have been established, but the information sources are still confined to public health surveillance systems and the application of the risk assessment results still needs to be further improved.

Judicial Review of Hospitals' Legal Responsibility of Patients' Rights After the Covid-19 Pandemic

Normatively, the legal responsibilities of hospitals in fulfilling patient rights are stipulated in the Health Act, the Hospital Act, and the Medical Practice Act. During the Covid-19 pandemic, which was declared a health emergency, various statutory provisions were also enacted, such as Infectious Disease Outbreak Law, Health Quarantine Law, Presidential Decree Number 11 of 2020 concerning the Determination of the National Public Health Emergency of Corona Virus Disease 2019 (Covid-19) and Minister of Health Regulation Number 4 of 2018 concerning Hospital Obligations and Patient Obligations. In practice, the increasing number of Covid-19 cases in Indonesia has resulted in hospitals being unable to accommodate patients who need treatment, especially patients with severe and critical conditions who require ICU treatment rooms. This study aims to find out hospital’s legal responsibility after the Covid-19 pandemic, especially for the protection of patient’s medical record security under the scheme of telemedicine services. In terms of facilities and infrastructure, the government needs to provide support by increasing the number of emergency hospitals to accommodate patients. This study uses normative juridical research methods supported by empirical studies. The results show that despite limitations in providing excellent health services to patients, hospitals must still maintain the rights of patient’s medical record security and safety while undergoing hospitalization. Legal umbrella is neeeded to guarantee the rights of health workers and hospitals in providing services to patients during this pandemic, especially the protection of Occupational Health and labor social security norms.

Stochastic modeling of obesity status in United States adults using Markov Chains: A nationally representative analysis of population health data from 2017-2020.

The prevalence of obesity among United States adults has increased from 34.9% in 2013-2014 to 42.8% in 2017-2018. Developing methods to model the increase of obesity over-time is a necessity to know how to accurately quantify its cost and to develop solutions to combat this national public health emergency. A cross-sectional cohort study using the publicly available National Health and Nutrition Examination Survey (NHANES 2017-2020) was conducted in individuals who completed the weight questionnaire and had accurate data for both weight at the time of survey and weight 10years ago. To model the dynamics of obesity, a Markov transition state matrix was created, which allowed for the analysis of weight transitions over time. Bootstrap simulation was incorporated to account for uncertainty and generate multiple simulated datasets, providing a more robust estimation of the prevalence and trends in obesity within the cohort. Of the 6146 individuals who met the inclusion criteria, 3024 (49%) individuals were male and 3122 (51%) were female. There were 2252 (37%) White individuals, 1257 (20%) Hispanic individuals, 1636 (37%) Black individuals, and 739 (12%) Asian individuals. The average BMI was 30.16 (SD=7.15), the average weight was 83.67 kilos (SD=22.04), and the average weight change was a 3.27kg (SD=14.97) increase in body weight. A total of 2411 (39%) individuals lost weight, and 3735 (61%) individuals gained weight. 87 (1%) individuals were underweight (BMI <18.5), 2058 (33%) were normal weight (18.5≤BMI <25), 1376 (22%) were overweight (25≤BMI <30) and 2625 (43%) were in the obese category (BMI >30). United States adults are at risk of transitioning from normal weight to the overweight or obese category. Markov modeling combined with bootstrap simulations can accurately model long-term weight status.

The moderating influence of perceived government information transparency on COVID-19 pandemic information adoption on social media systems.

Social media systems are instrumental in the dissemination of timely COVID-19 pandemic information to the general population and contribute to the fight against the pandemic and waves of disinformation during the COVID-19 pandemic. This study uses the information adoption model (IAM) as the theoretical framework to examine the moderating influence of perceived government information transparency on the adoption of COVID-19 pandemic information on social media systems from the Ghanaian perspective. Government information transparency regarding the pandemic is crucial since any lack of transparency can negatively affect the global response to the pandemic by destroying trust (in government and public health authorities/institutions), intensifying fears, and causing destructive behaviors. It applies a convenient sampling technique to collect the responses from 516 participants by using self-administrated questionnaires. The data analysis was computed and analyzed with SPSS-22. The following statistical tests were conducted to test the hypotheses: descriptive statistics, scale reliability test, Pearson bivariate correlation, multiple linear regressions, hierarchical regression, and slope analysis. The results indicate that information quality, information credibility, and information usefulness are significant drivers of COVID-19 pandemic information adoption on social media systems. Furthermore, the perceived government information transparency positively moderates the influence of information quality, information credibility, and information usefulness on the adoption of COVID-19 pandemic information on social media systems. The theoretical and managerial implications of these findings suggest the utilization of social media systems as an effective tool to support the continued fight against the current COVID-19 pandemic and its future role in national and global public health emergencies.

Interim Recommendations for Use of Bivalent mRNA COVID-19 Vaccines for Persons Aged ≥6 Months — United States, April 2023

Throughout the national public health emergency declared in response to the COVID-19 pandemic, CDC, guided by the Advisory Committee on Immunization Practices (ACIP), has offered evidence-based recommendations for the use of COVID-19 vaccines in U.S. populations after each regulatory action by the Food and Drug Administration (FDA). During August 2022-April 2023, FDA amended its Emergency Use Authorizations (EUAs) to authorize the use of a single, age-appropriate, bivalent COVID-19 vaccine dose (i.e., containing components from the ancestral and Omicron BA.4/BA.5 strains in equal amounts) for all persons aged ≥6 years, use of bivalent COVID-19 vaccine doses for children aged 6 months-5 years, and additional bivalent doses for immunocompromised persons and adults aged ≥65 years (1). ACIP voted in September 2022 on the use of the bivalent vaccine, and CDC made recommendations after the September vote and subsequently, through April 2023, with input from ACIP. This transition to a single bivalent COVID-19 vaccine dose for most persons, with additional doses for persons at increased risk for severe disease, facilitates implementation of simpler, more flexible recommendations. Three COVID-19 vaccines are currently available for use in the United States and recommended by ACIP: 1) the bivalent mRNA Pfizer-BioNTech COVID-19 vaccine, 2) the bivalent mRNA Moderna COVID-19 vaccine, and 3) the monovalent adjuvanted, protein subunit-based Novavax COVID-19 vaccine.* As of August 31, 2022, monovalent mRNA vaccines based on the ancestral SARS-CoV-2 strain are no longer authorized for use in the United States (1).

Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic

The COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US. To examine mental health service use among US adults from January through December 2020. This cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021. Per-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group. The study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (β, -6.44; 95% CI, -8.33 to -4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; β, -5.28; 95% CI, -7.50 to -3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; β, -1.81; 95% CI, -2.75 to -0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; β, -6.78; 95% CI, -8.51 to -5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; β, -2.00; 95% CI, -3.98 to -0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; β, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; β, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period. In this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.