Future Pandemics Research Articles

Simulation of Epidemic Dynamics Using a Multi-Agent Model: Analysis of Social Distancing Strategies and Their Impacts on Public Health and Economy

Infectious disease epidemics have played a crucial role in shaping public health responses, particularly in global health crises. This study emerges as part of the efforts to prepare effective responses to potential future pandemics, leveraging lessons learned during the COVID-19 crisis. The research uses an adapted compartmental epidemiological model and a synthetic multi-agent community to investigate how social variables influence epidemic forecasts in socioeconomically vulnerable regions. Focusing on the simulation of epidemic dynamics in the socio-economically disadvantaged neighbourhood of Ilha Joana Bezerra in Recife, this study examines the impacts of social distancing strategies and other control measures, such as face masks and moderate social isolation. Through the adapted SEPAI3R3O model, which includes compartments for pre-symptomatic and asymptomatic states, this study provides a detailed analysis of disease dynamics in contexts characterised by high social vulnerability. The results underscore the importance of public health policies adapted to socio-economic factors, emphasising the need for continuous preparedness to manage future epidemic threats in vulnerable communities effectively.

Hesitation towards COVID-19 booster vaccination among dialysis patients: a cross-sectional study in Taizhou, China

PurposeThis research aimed to explore hesitation towards the COVID-19 booster vaccine among dialysis patients and study the association between COVID-19 pandemic-induced health behavior and vaccination hesitancy.MethodsA self-administered online questionnaire evaluating dialysis patients’ hesitation to take COVID-19 booster vaccination was conducted between March 24 and 22 April 2022 in Taizhou, China. The logistic regression method was applied to identify factors associated with vaccination hesitancy, and all data were analyzed using R software.ResultsOf the 365 study participants, 272 (74.5%) individuals hesitated to take the booster dose. Health behavior was found to be a significant factor for hesitation to take COVID-19 vaccines, with OR (95% CI) of 1.09 (1.02–1.17). Influenza vaccination history was also significantly associated with the hesitation (OR (95% CI) = 0.39 (0.21–0.74)). In addition, participants with higher education levels exhibited lower vaccine hesitancy compared to those with junior secondary or below, with ORs (95% CIs) of 0.49 (0.27–0.91) for senior secondary and 0.35 (0.14–0.89) for junior college or above, respectively.ConclusionThe proportion of hesitancy for taking the booster vaccination of the COVID-19 vaccine was high among dialysis patients. Health behaviors, influenza vaccination history, and education levels were risk factors in their vaccination hesitancy. These findings may aid efforts to help vaccinate people with underlying diseases against future pandemics.

B-152 Analysis of carbonyl compounds in exhaled breath for detection of COVID-19

Abstract Background COVID-19 pandemic has caused enormous loss of lives and economic disruption. The global crisis has resulted in more than 700 million infections and 7 million deaths worldwide. Rapid screening and detection of highly infectious respiratory diseases is a key for preventing and curbing future epidemic and pandemic. The objective of this work is to develop a novel breath analysis technique for detection of COVID-19 using chemoselective capture of carbonyl compounds in exhaled breath for analysis by gas chromatography-mass spectrometry (GC-MS). Respiratory viral infection causes oxidative stress and inflammation in its host body which leads to production of higher levels of some carbonyl compounds through oxidation of lipids and could be detected in exhaled breath. This breath analysis technique can be rapidly adapted for screening infectious respiratory diseases for future epidemic and potential pandemic. Methods A total of 237 subjects were enrolled in this study. Of these, 142 were COVID-19 positive and 95 were negative. One liter exhaled breath in Tedlar bags from both COVID-19 positive and negative subjects confirmed by reverse transcriptase polymerase chain reaction between April 2022 and September 2023. The collected one liter breath samples were completely evacuated through a cartridge packed with silica particles in 2-3 minutes. Silica particles were coated with a reactive aminooxy agent for capture of carbonyl compounds in the breath samples through oximation reactions. The captured carbonyl compounds were eluted by methanol and the eluted solutions were analyzed by GC-MS for calculation of each compound concentration in the exhaled breath samples. Biostatistics was used to identify significant carbonyl compounds (defined as p value < 0.05) as markers of CPOVID-19 infection. A machine learning algorithm was implemented with the captured carbonyl compounds as input features for differentiation of COVID-19 positive from negative subjects. Results A total of more than 30 carbonyl compounds were detected in exhaled breath samples of all subjects. 10 features including 3 individual carbonyl compounds and 7 compound ratios show significant differences (p value <0.05) between COVID-19 positive and negative groups. The developed machine learning and artificial intelligence (AI) algorithms successfully separated COVOD-19 positive from negative with an accuracy of 95.4%, sensitivity of 96.5%, specificity of 93.7%, and AUROC=0.974. Conclusions The analysis of carbonyl compounds in exhaled breath by GC-MS has great potential for non-invasive detection of COVID-19. The method could be rapidly adapted for detection of other respiratory infectious diseases with a small sample size and data set for training of the machine learning and AI algorithms.

Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises.

The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact. A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance. The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care. The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surgical prioritization, reasons for follow-up and trauma guidelines. The rationale for care during the unpredictable evolution of the COVID-19 pandemic may have the potential to be translated and replicated in future pandemics of similar significance.

Clinicopathological presentations of eyelid malignancy in COVID era versus pre-COVID era.

The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era. This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation. In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities. During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future.

Disaster management of COVID-19: A study of India

COVID-19 capsulated the whole world in a dangerous loop of death and crippled the transformative capacity of science and technology to save the mankind. Law, once monopolized by man, was soon hijacked by the law of nature and the only remedy available was to draw boundaries (in form of lockdown). Legislative measures, medical facilities, and vaccine drives altogether helped in timely control of COVID-19; however, the world statistical data is evident of the fact that few countries were able to manage COVID-19 very well in contrast to others. It is true that no country was prepared for COVID-19 and neither was India, however, India objectified the interpretation of its existing legislations purposefully to control the spread of COVID-19. The objective of this article is to narrate the best practices adopted by India which helped in timely control of COVID-19 and finally suggest guidelines to control such pandemics in future. Keywords: COVID-19, Disaster Management, Drugs, Lockdown, Vaccines.

Effects of essential caregiver policies on COVID-19 and non-COVID-19 deaths in nursing homes.

Federal authorities banned nursing home visitation in the early days of the coronavirus disease 2019 (COVID-19) pandemic. However, there was growing concern that physical isolation may have unintended harms on nursing home residents. Thus, nursing homes and policymakers faced a tradeoff between minimizing COVID-19 outbreaks and limiting the unintended harms. Between June 2020 and January 2021, 17 states implemented Essential Caregiver policies (ECPs) allowing nursing home visitation by designated family members or friends under controlled circumstances. Using the Nursing Home COVID-19 Public File and other relevant data, we analyze the effects of ECPs on deaths among nursing home residents. We exploit variation in the existence of ECPs across states and over time, finding that these policies effectively reduce both non-COVID-19 and COVID-19 deaths, resulting in a decrease in total deaths. These effects are larger for states that implemented policies mandatorily or without restrictions, indicating a dose-response relationship. These policies reduce non-COVID-19 deaths in facilities with higher quality or staffing levels, while reducing COVID-19 deaths in facilities with lower quality or staffing levels. Our findings support the use and expansion of ECPs to balance resident safety and the need for social interaction and informal care during future pandemics.

Analyzing the Dynamics of COVID-19 Transmission in Select Regions of the Philippines: A Modeling Approach to Assess the Impact of Various Tiers of Community Quarantines

The COVID-19 pandemic has significantly impacted communities worldwide, and effective management strategies are critical to reduce transmission rates and minimize the impact of the disease. In this study, we modeled and analyzed the COVID-19 transmission dynamics and derived relevant epidemiological values for three regions of the Philippines, namely, the National Capital Region (NCR), Davao City, and Baguio City, under different community quarantine implementations. The unique features and differences of these regions-of-interest were accounted for in simulating the disease spread and in estimating key epidemiological parameters fitted to the reported COVID-19 cases. Results support the robustness of the model formulated and provides insights into the effect of the government's implemented intervention protocols. With a forecasting feature, this modeling framework is beneficial for science-based decision support, policy making, and assessment for recent and future pandemics wherever regions-of-interest.

Mathematical modelling for pandemic preparedness in Canada: Learning from COVID-19.

The COVID-19 pandemic underlined the need for pandemic planning but also brought into focus the use of mathematical modelling to support public health decisions. The types of models needed (compartment, agent-based, importation) are described. Best practices regarding biological realism (including the need for multidisciplinary expert advisors to modellers), model complexity, consideration of uncertainty and communications to decision-makers and the public are outlined. A narrative review was developed from the experiences of COVID-19 by members of the Public Health Agency of Canada External Modelling Network for Infectious Diseases (PHAC EMN-ID), a national community of practice on mathematical modelling of infectious diseases for public health. Modelling can best support pandemic preparedness in two ways: 1) by modelling to support decisions on resource needs for likely future pandemics by estimating numbers of infections, hospitalized cases and cases needing intensive care, associated with epidemics of "hypothetical-yet-plausible" pandemic pathogens in Canada; and 2) by having ready-to-go modelling methods that can be readily adapted to the features of an emerging pandemic pathogen and used for long-range forecasting of the epidemic in Canada, as well as to explore scenarios to support public health decisions on the use of interventions. There is a need for modelling expertise within public health organizations in Canada, linked to modellers in academia in a community of practice, within which relationships built outside of times of crisis can be applied to enhance modelling during public health emergencies. Key challenges to modelling for pandemic preparedness include the availability of linked public health, hospital and genomic data in Canada.

“We Don't Have a Lot of Answers”: An Investigation of COVID Long‐Haulers' Information Needs & Practices

ABSTRACTThe information behaviors of people who have COVID‐19 have been well studied, however, there is a gap regarding those who experience long COVID. We conducted an exploratory mixed‐methods study to examine the information needs and practices of these COVID ‘long‐haulers’ with the intention of suggesting new health communication strategies to help people in similar health crises or future pandemics from an information standpoint. Several themes have emerged from our preliminary findings: how participants tend to define long COVID, their long COVID‐related information seeking and their difficulty with finding such information, and their experiences with discrimination and stigma. Throughout data collection, we have experienced issues with suspicious respondents (such as potential bots), though we were able to implement new criteria to determine legitimacy. Data collection and analysis is still ongoing and we expect to report additional findings in the near future.

Exploring intercity travel decision-making in a developing country: Insights from COVID-19 impacts in Iran

This study examines the impact of COVID-19 on intercity travel mode choices in Mazandaran province, Iran, addressing critical gaps in understanding how pandemics affect travel behavior in developing countries. The research focuses on how socio-economic factors, perceived health risks, and travel time influence individuals’ choice of transportation modes during the pandemic. Using a stated preference survey method with 669 participants, the study assessed how concerns about virus transmission and adherence to health protocols shape travel decisions. Discrete choice modeling was employed to predict travel mode shares between public transport and personal vehicles. The findings reveal that COVID-19 risk perception, socio-economic factors, and travel time significantly impact travel behavior. Specifically, heightened perceived risk of infection resulted in a 25% reduction in public transportation use, with individuals increasingly opting for personal vehicles. Additionally, strict adherence to health protocols, such as mask-wearing and vehicle cleaning, improved safety perception, leading to a 40% increase in confidence in public transport. The study also found that socio-economic factors like age, income, and education significantly shaped travel preferences. These insights provide valuable guidance for public health policymakers and transportation authorities to enhance the safety and management of intercity travel during ongoing and future pandemics.

Pandemic Action Plan: Phase 3-Lessons Learned from Implementation. "What Did We Learn?"

The COVID-19 pandemic created critical challenges for hospitals and health care providers. Suddenly clinics were forced to close; elective procedures were delayed; scheduled visits were canceled; emergency rooms were overcrowded; hospital beds, equipment, and personal protective equipment (PPE) were in short supply; and staff were faced with rapidly changing circumstances, care protocols, trauma, and personal risk. To better address challenges of the ongoing COVID-19 pandemic and prepare for future pandemics, the National Telemedicine Technology Assessment Resource Center (TTAC) was asked to develop a Pandemic Response Action Plan that would allow its users to address critical issues with available telemedicine and related technologies. The project was constructed in 3 phases. Phase 1-Develop a Pandemic Response Action Plan and a Pandemic Response Action Plan Policy and Regulatory Summary, which identifies the regulatory challenges as well as policy recommendations. Phase 2-Publish the Action Plan and the Policy and Regulatory Summary. Phase 3-Look at health care providers who used the approaches, tools, and technology in the Pandemic Action Plan and document the results. This document represents Phase 3. This document is Phase 3. In this report we look back at health care providers who used the approaches in the Phase 1 Pandemic Response Action Plan as published in Phase 2. In this document we report on the challenges and results of implementing parts of the Pandemic Action Plan. It records the findings, conclusions, and recommendations resulting from the experience of health care providers and the professional experiences of the team and their organizations in implementing parts or all of the plan. Methods: The same multidisciplinary team that constructed Phase 1 and Phase 2 were engaged to develop this Phase 3 report. The members of the team represent leadership expertise and key stakeholders in health care delivery during a pandemic (administration, infection control, physicians, nurses, public health, contingency planning, disaster response, and information technology) as well as a facilitator. For Phase 3, the group used structured brainstorming to define the findings, issues, and results of their own organizations' digital health response to the pandemic. In addition, eight health care providers (hospitals) identified by the Telemedicine Resource Centers' (TRCs) organizations, who used the Pandemic response Plan (created in Phases 1 and 2), were interviewed. All interviews were conducted by the same facilitator with leaders (CEO, and leaders of the telemedicine programs) in each of the eight programs, using a standard questionnaire created by the team. Current literature references are included in this report to illustrate when findings are known to have broader applicability. Conclusions: The impact of the COVID-19 Pandemic was severe and identified multiple critical challenges and weaknesses. Applying the approaches, tools, and technology outlined in the Pandemic Response Action Plan proved to be effective in addressing critical provider challenges. However, implementing these tools during a crisis was difficult unless the organization had experience with the tools and necessary workflows in advance. Implementing these tools as part of standard workflows and everyday operations increased the capabilities and resilience of these organizations in the provision of care during this and for future pandemics.

Health care providers' perceptions of burnout and moral distress during the COVID-19 pandemic: A qualitative study from Saskatchewan, Canada.

This study sought to describe feelings and perceptions of burnout and moral distress experienced by health care providers in the Canadian province of Saskatchewan during the COVID-19 pandemic. This study was part of a larger mixed methods project, and we here report on the qualitative results relating to burnout and moral distress experienced by medical doctors, registered nurses and respiratory therapists. We used an exploratory, qualitative descriptive design involving one-one-one interviews with 24 health care providers. Interview data were analysed using a reflexive thematic analysis approach. We identified three overarching themes each for health care provider burnout and moral distress. Interviews revealed that providers experienced burnout through (i) increased expectations and (ii) unfavourable work environments, which led most of them to recognise (iii) a need to step back. Regarding moral distress, key themes were: (i) a sense of compromised care, (ii) feelings of bumping heads with authorities and patient families, and (iii) seeing patients make difficult decisions. Our study found that medical doctors, registered nurses and respiratory therapists working during the COVID-19 pandemic experienced and continue to experience significant burnout and moral distress. This was often driven by both institution- and system-level factors. There is a need for sustained investment to build and support a motivated health care workforce to prepare for future pandemics and health emergencies.

Rural community pharmacists' willingness to receive, administer, and recommend COVID-19 vaccines after the First U.S. vaccine rollout

IntroductionVaccines remain the cornerstone for prevention of COVID-19. Particularly in rural areas, community pharmacists are among the most accessible healthcare professionals. Their advocacy for immunization can help overcome patients' vaccine hesitancy and close the disparity gap between rural and urban regions. This study explored factors influencing the willingness to recommend and administer COVID-19 vaccines among rural community pharmacists after the first U.S. vaccine rollout. MethodsA convenience sample of rural community pharmacists completed a selfadministered, validated paper/online survey (n = 86, 23.4% response rate). Measures included COVID-19 vaccination status, perceived benefits of offering COVID-19 immunization services at the pharmacy, and willingness to recommend and administer COVID-19 vaccines. Descriptive, bivariate, and multivariate statistics were used to analyze potential nonresponse bias, survey responses, and associations between variables as appropriate. Alpha was set at 0.05. ResultsThe proportion of pharmacists who were vaccinated against COVID-19 was 79.1%. Over 75% of participants were in favor of recommending COVID-19 immunizations to eligible family members and patients and almost 85% agreed that they would administer COVID-19 vaccines to their patients. Most pharmacists perceived COVID-19 immunization services to be beneficial, such as attracting more patients into the pharmacy (81.2%), increasing pharmacy revenue (75.3%), and enhancing relationships with local clinics/public health agencies (74.1%). COVID-19 vaccination status and the perceived benefit of offering immunization services at the pharmacy were significantly associated with pharmacists' willingness to recommend and administer COVID-19 vaccines. ConclusionThe relatively high rates of COVID-19 vaccination uptake and the strong willingness of rural community pharmacists to recommend and administer COVID-19 vaccines, after the first national vaccine rollout, were encouraging. The findings underscore the importance of engaging rural community pharmacists in efforts to prepare for and respond to future pandemics and public health crises.

Effects of visit restriction in the COVID-19 pandemic: Experiences and perceptions of intensive care nurses.

The visit restrictions imposed as a result of COVID-19 precluded the entrance of the patient's family into the confines of the intensive care unit. This study evaluated the experiences of intensive care nurses (ICNs) regarding COVID-19 visit restrictions and their opinions on these restrictions. From May 2023 to July 2023, semi-structured interviews with 15 ICNs from intensive care units in a tertiary public hospital in Türkiye were conducted. Data were analysed using qualitative content analysis with an inductive approach. Reporting of the study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. The analysis revealed two main themes, 'widespread negative impacts of visit restrictions' and 'adaptive strategies to the visitation ban', and seven sub-themes supporting the main themes. Nurses perceived that the visit restrictions imposed during the COVID-19 pandemic had a severe negative effect on patients, their relatives, themselves and the care environment. They also did not support visit restriction in future pandemics. The COVID-19 visitation policy weakened the involvement of family members in patient care and created serious challenges in the intensive care setting. The study revealed an urgent need for patient-centred, family-sensitive and consistently applied protocols in future pandemics. In future pandemics, strategies such as the benefit-benefit ratio of the visit, the provision and use of adequate personal protective equipment, and vaccination requirements should be considered in visiting decisions of patients hospitalized because of infection. Participation of nurses responsible for patient care in decisions regarding visitor practices should be supported.

Primary healthcare nurses’ experiences in managing chronic diseases during COVID-19 in the North West province

Background: The World Health Organization, stated that the coronavirus disease 2019 (COVID-19) pandemic not only affected the socioeconomic well-being of millions but also had adverse effects on public health, particularly in the management of chronic diseases at the primary healthcare (PHC) level. What remained unknown was the experiences of professional nurses(PNs) working in PHC regarding this issue.Aim: The study aimed to explore and describe the lived experiences of PHC nurses in managing chronic diseases during the COVID-19 pandemic.Setting: The study was conducted in the North West province, South Africa.Methods: A qualitative descriptive phenomenological design was employed to collect and analyse data. Face-to-face interviews were conducted and audio recorded with 16 PNs from five high-volume PHC facilities selected purposively.Results: The study’s findings reveal four themes: suboptimal care for patients with chronic disease, a lack of resources, mental health challenges experienced by PHC nurses, and stigma and discrimination from both family and community members.Conclusion: The neglect of PHC and its frontline healthcare staff has impeded the mental health of PHC workers and the management of chronic diseases thus any progress made in reducing the burden of chronic diseases is likely to have regressed during the COVID-19 pandemic.Contribution: Policymakers should prioritise strengthening PHC by implementing integrated disease management policies, ensuring ethical clinical standards, providing supportive supervision, fair resource allocation and capacity building for PHC staff. In addition, addressing stigma and discrimination, and raising awareness among families and communities is crucial for future pandemics to effectively manage both chronic and infectious diseases.

A case study of the Philippines' COVID-19 after action review.

This Brief Report recounts the process undertaken to conduct the COVID-19 AAR in the Philippines and the subsequent Pandemic Preparedness, Response and Resilience Plan writing workshop that took place in June and July 2023, respectively. It suggests that other countries may find similar benefits in employing the methodology to reflect on their COVID-19 responses and devise strategies to institutionalize best practices and identify critical areas for improvement in order to be better prepared for future pandemics or health emergencies.

Assessing Urban Slums in Post-COVID-19 to Achieving Sustainable Development Goal 1: Nigeria’s Stakeholders Perspective Using Qualitative Approach

Studies showed that upgrading urban slums could bridge income inequality, create better opportunities, and mitigate/prevent virus spread in slums environment. There is a paucity of research concerning regenerating urban slums to achieve Goal 1 in Nigeria with reference to the post-COVID-19. Therefore, this research explored the impact of COVID-19 on slums in Nigerian cities and recommend measures to transform slums into sustainable cities and bridge income inequality to improve achieving Goal 1. The research used an interview type of qualitative research design and covered five major cities across Nigeria. The researchers engaged thirty interviewees (selected construction practitioners, NGOs, medical experts, and government agencies). The study adopted a thematic method to analyse the collated data. Findings show an increased poverty level across the five slum cities covered during and immediately after the pandemic. The significant impacts are high exposure to contagious and non-contagious infections, increased food insecurity, homelessness, unemployment, increased crime rates, and worse overcrowding during the lockdown. The study recommended measures to regenerate urban slums. The findings would stir policymakers to promote urban slum upgrading. Findings will support and provide insight into the active transformations of slums for the benefit of humanity and mitigate climate disruptions in future pandemics.

Unraveling COVID-19 Diagnostics: A Roadmap for Future Pandemic

Unraveling COVID-19 Diagnostics: A Roadmap for Future Pandemic

Pandemic-related prenatal maternal stress, model of maternity care and postpartum mental health: The Australian BITTOC study

ProblemWomen pregnant during the COVID-19 pandemic may be at risk of elevated postpartum mental health problems. BackgroundSocial support protects maternal mental health during a pandemic. It is possible that formal supports, such as continuity maternity models of care, may also support maternal wellbeing. AimTo investigate whether model of care moderates the association between prenatal maternal stress from the COVID-19 pandemic, and postpartum (a) depression and (b) anxiety. MethodsWomen in Australia, pregnant during the COVID-19 pandemic (n = 3048), completed a survey detailing their COVID-19-related objective hardship and subjective distress during pregnancy and completed depression and anxiety measures at birth to six weeks (“Early”), seven to 21 weeks (“Moderate”), and/or 22–30 weeks (“Late”) postpartum. FindingsHigher subjective distress was associated with elevated depression and anxiety at all timepoints. Model of care did not moderate the association of objective hardship or subjective distress and depression or anxiety at any timepoint. Compared with Standard Care, women receiving private midwifery care had a 74 % reduction in the odds of elevated anxiety in early postpartum. DiscussionWomen receiving private midwifery may have experienced lower anxiety due to a greater duration of postpartum in-home care, fewer changes to service delivery, and the option of homebirth. Women pregnant during a pandemic should be screened for higher subjective distress about the event. ConclusionThese results suggest that continuity of private midwifery care may be beneficial for supporting postpartum mental health during a pandemic, with implications for practice and policy for the current and future pandemics.