Pre-pandemic Levels Research Articles

Choosing a Vita Site Model: Traditional Face-To-Face versus Alternative Virtual Models

Since the early 1970s, the Internal Revenue Service’s (IRS) Volunteer Income Tax Assistance/Tax Counseling for the Elderly (hereafter, VITA) programs have provided free income tax return preparation and filing assistance for eligible taxpayers in various underserved communities. In 2020, COVID-19 presented VITA Site Coordinators with the unique challenge of either shutting down completely or finding ways to remain open amid a global pandemic. Many of those that remained open found themselves forced to rely upon virtual methods to accomplish at least some of the steps in the return preparation process, prompting heightened concerns over taxpayer identity verification and securitization of taxpayers’ personal information. Post-COVID beginning in 2022, the Internal Revenue Service (IRS), to ensure consistent operation of all sites regardless of the site model being used, began requiring VITA Site Coordinators to document and receive approval for their planned methodologies by December 31 of the year preceding each filing season. The process is more burdensome for those sites using any remote methodologies and could partially explain why the number of VITA sites, VITA volunteers, and returns processed at VITA sites have not returned to pre-pandemic levels. This paper is intended to help VITA Site Coordinators better understand the different models they might use and make a sound choice based on that understanding to motivate greater participation in the VITA program.

Zoom Boom or Bust? Understanding Post-Pandemic Interest in Facial Plastic Surgery via Google Trends.

To understand post-pandemic interest in plastic surgery procedures via Joinpoint analysis of Google Trends search data. Google Trends was used to quantify search volumes from January 2019-December 2022 for select cosmetic face and body procedures in the United States. A keyword analytic tool (Keywords Everywhere) extracted absolute search volumes (average monthly searches). Joinpoint analysis assessed search trends over time reported as monthly percentage change (MPC). All procedures queried, including a non-cosmetic control (cataract surgery), demonstrated expected declines at the start of the COVID-19 pandemic. Blepharoplasty, face lift, neck lift, and Botox demonstrated statistically significant increase in search volumes that remained elevated relative to pre-pandemic levels. Rhinoplasty, fillers, and abdominoplasty interest increased initially followed by return to pre-pandemic levels by the end of 2022. The remainder of search terms did not show a clear temporal associated with COVID-19 lockdowns. The "Zoom Boom" appears to be a real phenomenon reflected by sustained increase in public interest in relation to facial plastic procedures. NA Laryngoscope, 2024.

Assessing downtown recovery rates and determinants in North American cities after the COVID-19 pandemic

North American downtowns are struggling to recover from the global COVID-19 pandemic. This study aims to investigate the varying rates of recovery experienced by downtown areas in the 66 largest cities of the United States and Canada. Leveraging Location-Based Services data extracted from mobile phone location trajectories, we assess the recovery rates in the 2023 post-pandemic period, juxtaposed against pre-pandemic 2019 levels. We find significant disparities in downtown recovery rates. Economic factors emerge as crucial determinants, where downtowns hosting a concentration of sectors with remote/hybrid work options – such as information, finance, professional services and management – displayed sluggish recovery. Conversely, downtowns with a focus on industries like accommodation, manufacturing, education, retail, construction, entertainment and healthcare exhibited greater resilience post pandemic. Furthermore, higher density, crime rates and education levels were correlated with slower recovery rates, as were harsher weather conditions and longer commuting times. Lower-density and auto-orientated downtowns demonstrated a swift rebound, even surpassing pre-pandemic activity levels. These findings underscore the necessity for tailored policies to bolster the revival of North American downtown areas.

Effects of nonpharmaceutical interventions during COVID-19 pandemic on pediatric asthma exacerbations and viral infections

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020 led to the implementation of nonpharmaceutical interventions (NPIs) to curb its spread. Studies have shown that adult asthma exacerbations and viral infections decreased during NPI use. However, few studies have shown the effects of NPIs on pediatric asthma exacerbations and infections during and after the pandemic. This study aimed to understand the impact of NPIs on asthma exacerbations and viral respiratory infections in pediatric patients at our institution from March 2018 to December 2022. The medical record numbers of children with asthma exacerbations seen at our institution between March 2018 and December 2022 were analyzed. Subjects were categorized on the basis of timing of their exacerbation in relation to NPI enforcement. We used the results from clinical testing with the BioFire Respiratory Panel (BRP) to detect up to 22 respiratory pathogens and then correlated these results with asthma exacerbation severity. There were 5,758 asthma exacerbations recorded, with a 50% decline in average weekly exacerbations during NPI enforcement. Of the 70,682 BRP tests performed, 87% returned a positive result for at least 1 pathogen. Several viruses (respiratory syncytial virus, parainfluenza, and influenza) had a decrease in positivity rate with NPIs, whereas rhinovirus/enterovirus positivity rates were unchanged throughout the pandemic. Asthma exacerbations with a positive BRP result required higher clinical levels of care during the admission. NPIs were associated with significantly reduced numbers of asthma exacerbations and respiratory viral infections. The post-NPI period saw a return to prepandemic levels of asthma exacerbations and an unusual surge in respiratory syncytial virus infections, emphasizing the need for continuous monitoring and adaptive strategies in the postpandemic landscape.

Profits and markups during the post-COVID-19 inflation shock in the U.S. economy: a firm-level lens

In this paper, I use firm-level data from Compustat to document the evolution of markups among listed U.S. non-financial firms during the height of the COVID-19 pandemic (2020–2022). I show that, continuing its long-term rise, the aggregate (sales-weighted) markup rises markedly in 2020 and moderately in 2021, and returns to pre-pandemic levels in 2022. I then disaggregate this aggregate trend to, first, show that its 2020 growth reflects growing sales concentration. In contrast, the average within-firm markup is steadier than the aggregate. Second, I show that the markup distribution widens during the pandemic, due largely to increases at its 90th percentile. At the same time, however, the cross-sectional distribution obfuscates that firms with low pre-pandemic markups command notable markup growth in both 2021 and 2022. Third, I document key roles for manufacturing, retail, and information services in these dynamics. Together, these patterns are consistent with accounts of profit inflation, wherein U.S. firms’ market power allowed them to maintain – and, for some firms, increase – their margins over direct costs in the face of input cost shocks in 2020–2022.

Salience and food waste reduction: Evidence from the COVID-19 pandemic

This article investigates the impact of the COVID-19 pandemic on household food waste management behavior. By utilizing 1.6 million dining transactions at 87 restaurants in 10 Chinese cities, we find that an average 8.4 percent reduction in plate waste in restaurants associated with new COVID-19 infections at the national level during the pandemic. Further evidence shows that this change in behavior is not permanent, as the level of plate waste tends to revert to pre-pandemic levels once the pandemic came under control. We test several explanations for the empirical findings and conclude that salience bias is the most plausible explanations. This insight into waste management behavior highlights the importance of utilizing salience-friendly policy instruments to effectively implement resource conservation and waste management policy goals.

Impact of the COVID-19 Pandemic on Home Mechanical Ventilation in Germany: A Descriptive Observational Study

Introduction: Over the last decade, the number of patients receiving home mechanical ventilation (HMV) has increased significantly, which has led to a limited availability of specialist centres, not least due to the scarcity of healthcare professionals. This situation was exacerbated by the COVID-19 pandemic. It is therefore assumed that the repurposing of resources has led to an aggravated change in the healthcare structure in HMV. Methods: This descriptive observational study analysed the Operation and Procedure Classification Codes for patients receiving HMV from 2008 to 2022. The data were provided by the Federal Statistical Office of Germany. Data were additionally analysed with respect to geographical distribution and ventilation status. Results: A total of 737,770 datasets were analysed (mean age in 2020: 66.5 years). There was a steady increase in HMV initiations (+6%) and controls (+9%) per year before the pandemic (2008–2019). Patient admissions during the pandemic revealed a 28% decrease, with the largest decrease in invasive ventilation (IV) follow-up visits (2019: 3,053; 2020: 2,199; −39%), while the number of IV initiations remained stable. There was a 19% decrease in the number of non-IV initiations in 2020 (16,919 vs. 14,227) and a 32% decrease in the number of follow-ups (45,812 vs. 34,813) in comparison with 2019. Conclusion: The pandemic has led to a significant decline of inpatient admissions for patients receiving HMV. This decline was most pronounced in the first year of the pandemic. Control visits in particular did not reach the pre-pandemic level. This is an indication of the ongoing change in the healthcare landscape as a result of the pandemic.

Sleeping behaviors are determined by lockdown and not work-from-home arrangements

Lockdowns and work-from-home arrangements became abrupt realities for people at an unprecedented scale during the COVID-19 pandemic. Here, considering the case of Singapore, we study how peoples’ sleep behaviors—which are closely linked to their mental health—varied as a result. However, different from most studies, this paper uses household electricity consumption data to estimate the sleeping behaviors of nearly 10,000 households in the city-state. With this, we study how the residents’ daily sleep durations changed dynamically during the lockdown and afterwards when restrictions were progressively eased, and show their strong connection to major changes in the public health policy and current events during this period. Our results add to the evidence for the stress endured by the populace during the lockdown; we find that sleep durations for all demographics, while higher than before the lockdown, became more fluctuating across days. A major, and surprising, finding is that it was the lockdown that determined the residents’ sleeping duration, rather than simply working-from-home arrangements. That is, the sleeping durations largely reverted back to their pre-pandemic levels when the lockdown was lifted—with small variations based on demographic factors—although a vast majority of people continued to work from home. This highlights the resilience of the daily routines of the Singapore populace. While providing insights into how a pandemic influences the dynamics of urban sleep patterns, our finding also has broader implications regarding the efficiency of the workforce, suggesting that concerns about asynchronous work routines and productivity may be overblown.

Global Competency Development for Graduate Students from the Perspective of Internationalization at Home

With the advancement of economic globalization, cultivating globally competent international talents has become a key task for domestic universities. As international exchanges gradually return to pre-pandemic levels, the post-pandemic era has introduced challenges due to reduced cross-border movement, making cross-border educational exchanges more difficult to implement. In this context, “internalization at home” becomes crucial for developing internationalized talent. It offers a cost-effective approach and is particularly important as global competence is a core quality for such talents. This study aims to review and analyze relevant practices both domestically and internationally, using specific cases from various universities to discuss global competency training programs for postgraduates and to provide recommendations for advancing internationalization in China’s higher education sector.

Seafood Purchasing Behavior in the U.S. during the Early Recovery Period from the COVID-19 Pandemic

This study examined seafood consumption during the early period of economic recovery following the COVID-19 pandemic. Specifically, surveys of U.S. consumers compared seafood purchasing behavior of the first two quarters of 2021 (Q1, 1 January through 31 March 2021, and Q2, 1 April through 30 June 2021) with those of 2020. Each survey included 100 seafood consumer respondents in each of the 20 U.S. metropolitan market areas. Following data cleaning, there were 1885 valid responses for Q1-2021 and 1940 for Q2-2021. A majority (57%) of respondents had received at least one dose of the COVID-19 vaccine before March 2021 and 70% had received at least one dose as of June 2021. Regardless of vaccination status, few respondents (6% to 9.5% for food generally and 4% to 6.5% for seafood) reported changes in seafood consumption. Seafood consumption away from home increased significantly in Q1-2021 as compared to 2020 and continued to increase but to a lesser degree in Q2-2021. Demographic differences were found in shopping behaviors by age, education, income, and gender, but not by ethnic group. Generally, higher-income females with higher education tended to purchase more seafood. Respondents reported increased numbers of shopping trips per year in Q1-2021 as compared to 2020, which continued into Q2-2021 for general food, but shopping trips for seafood decreased as compared to 2020. The frequency of takeout purchases (times/year) of prepared meals for home consumption of seafood decreased during Q1 from 2020 and remained at that level in Q2-2021, but home delivery purchases of prepared meals of seafood increased during this period. Approximately 50–55% of respondents reported no change in overall seafood consumption levels, while 28% noted an increase in seafood consumption compared to pre-pandemic periods, a significant increase from the 19% who had reported doing so pre-pandemic. In contrast, those reporting a decrease declined from 31% to 17% in comparison to pre-pandemic levels. Seafood consumption in the U.S. remained stable and recovered in early 2021, with a preference for dining out. Consumer behaviors varied by age, income, education, and gender, but not by ethnicity. These changes were primarily driven by access, availability, and income, indicating the need for further research on long-term consumption patterns. This study found apparent stability of seafood consumption by U.S. consumers, which recovered from pandemic consumption levels in early 2021, and there was little change in seafood consumption, frequency, or the types of seafood consumed. Vaccination status did not appear to affect seafood consumption.

Exploring the Hospital Performance during the COVID-19 Pandemic from the Perspective of Intellectual Capital: An Empirical Study of Taipei Hospital in Taiwan

The COVID-19 pandemic, starting in 2019, posed unprecedented challenges to global healthcare systems, with Taiwan's rapid response gaining notable attention (Cheng, Li, & Yang, 2020). This paper examines how non-profit hospitals can improve crisis management capabilities, using Taipei Hospital as an empirical study. It proposes a framework for constructing an intellectual capital report based on the ARC model, enhancing traditional financial statements with a comprehensive view of the hospital's intangible assets. Employing Data Envelopment Analysis (DEA) to evaluate Taipei Hospital's operational performance from 2013 to 2023, the study finds that the hospital's operational efficiency during the pandemic exceeded pre-pandemic levels, demonstrating its ability to leverage the crisis for improvement. This supports the assertion that intellectual capital is crucial for research and development organizations, validating the proposed reporting framework.

Telehealth insights from an integrated care system.

The COVID-19 pandemic accelerated telehealth expansion trends as policy makers instituted flexibilities and coverage changes. Federal telehealth flexibilities expire, however, at the end of 2024. To decide whether to extend those flexibilities, policy makers need information about consumer telehealth preferences, impacts of telehealth on care usage and quality, and telehealth accessibility for the full diversity of patients. Research from one of the nation's largest integrated, value-based health systems provides insights. Findings suggest that telehealth utilization has dropped since the peak of the pandemic but remains higher than prepandemic levels. Telehealth appears to be replacing in-person visits rather than leading to more total visits. Patients generally prefer in-person care but many like having the option to use video- and phone-based telehealth, and both video- and phone-based care appear to be helping patients access primary care. An integrated, value-based care approach may assist a diverse range of patients in accessing telehealth services. Action is still needed, however, to ensure that the full diversity of patients can easily access telehealth offerings. Based on experiences within our health system, we recommend that policy makers maintain public and private payer coverage for video- and phone-based telehealth services; encourage well-designed value-based payment models to simplify and expand telehealth access; improve broadband accessibility and broadband and device affordability so that all patients can access telehealth services; and hold digital health to equivalent high standards for care quality, safety, patient satisfaction, clinical outcomes, and health equity as in-person care.

Rising Auto Loan Delinquencies and High Monthly Payments

Delinquency rates on auto loans rose substantially to above pre-pandemic levels by the end of 2023, after falling to historical lows during the COVID-19 pandemic. Because auto loans are an important sector in consumer credit, accounting for about 25 percent of nonmortgage consumer credit, a deeper analysis of the increase in delinquencies can give insights into the financial health of borrowers in consumer credit markets and overall household financial well-being.

Trends in chlorine and chloramine gas exposures reported to United States poison centers

Introduction Chlorine and chloramine gas inhalation can occur when household cleaners are mixed. The increased emphasis on disinfecting practices during the COVID-19 pandemic may have contributed to an increase in chlorine and chloramine gas exposures in the United States, which has not been studied. Methods In a retrospective review, reported data on chlorine and chloramine gas exposures in the National Poison Data System were collected from January 1, 2015, to December 31, 2022. Data included demographics and exposure details, including location, dose, formulation, co-exposures, treatments, and outcomes. Demographic analyses and descriptive statistics were conducted. Results During the study period, 85,104 total exposures to chlorine and chloramine gas were reported, consisting of 79,281 isolated exposures and 5,823 co-exposures. Total exposures increased by 61% from 8,385 in 2015 to 13,503 in 2022, with the largest increase of 38.3% occurring from 2019 to 2020. Total exposures remained increased through 2022 with no return to pre-pandemic levels. Most exposures occurred in “own residence” (n = 72,213, 84.9%), with a larger proportion of exposures occurring at home peri-pandemic versus pre-pandemic (88.4% versus 81.7%). One percent (n = 1,030) of exposures were admitted to a non-critical care unit, 0.73% (n = 619) were admitted to a critical care unit, and 0.03% (n = 26) resulted in death. Discussion The onset of the COVID-19 pandemic and increased emphasis on cleaning practices were likely contributing factors to the marked increase in exposures in 2020, which persisted through 2022. Cleaning practices that developed during the beginning of the pandemic likely persisted despite returning to more normal daily routines, which may explain the ongoing increase in reported exposures. Most reported exposures were unintentional, mild in symptomatology, and required the use of non-invasive therapies, if any. Conclusions Future efforts should focus on public education on the safe use of cleaning products to prevent exposure to toxic chlorine and chloramine gases.

Mental health landscape in Kosova from 2017 to 2022: A retrospective study of antidepressant and anxiolytic market trends and the impact of COVID-19

ObjectivesThis study explores the mental health situation in Kosova and the impact of the COVID-19 pandemic. MethodsMarketed quantities of antidepressants (N06A) and anxiolytics (N05B) from 2017 to 2022 were analyzed using the Anatomical Therapeutic Chemical/Defined Daily Doses (ATC/DDD) methodology. Caution is advised as these quantities may not directly reflect patient usage and could include uses for conditions outside their primary indications. ResultsPrior to the pandemic, antidepressant quantities remained relatively stable, but rose from 6.8 DDD/1000 inhabitants/day in 2019 to 9.7 in 2020 and 12.4 in 2021, before returning to pre-pandemic levels of 6.8 DDD in 2022. Over 80 % of these were selective serotonin reuptake inhibitors. Meanwhile, anxiolytic quantities initially decreased from 17.4 DDD in 2017 to 9.9 in 2019, then rebounded to 17.9 DDD in 2020. Notably, alprazolam usage surged from 2.9 in 2017 to 6.9 in 2021, subsequently dropping to 2.0 in 2022. ConclusionsThe volatile trends in medication quantities during the pandemic suggest a fragile mental health landscape in Kosova—a developing, post-conflict country with a youthful population—underscoring the need for proactive interventions in similar contexts globally.

Tourism Reactivation in Extremadura (Spain): Post-Covid Analysis of Inland Destinations

Abstract The research analyses the tourism situation in Extremadura (Spain) in recent years to assess whether the COVID-19 pandemic has been an opportunity to revitalise these destinations. An analysis was carried out at the municipal level using contextual variables and tourism indicators obtained from surveys of the National Institute of Statistics. The data were processed and compared using Geographic Information Systems, allowing for a spatial and temporal assessment. The results provide a detailed overview of the current state of tourism in the municipalities of Extremadura, determining whether pre-pandemic levels of activity have been recovered and identifying the municipalities with significant improvements in their tourism potential during the period studied.

Education and Information to Improve Adherence to Screening for Breast, Colorectal, and Cervical Cancer-Lessons Learned during the COVID-19 Pandemic.

The objective of this study was to determine the correlation between adherence to cancer screening programs and earlier diagnosis of the 14 most common types of cancers in the adult population, before and during the COVID-19 pandemic. National data concerning number of admissions and operations in Italy for adult patients admitted with oncologic problems during the COVID-19 pandemic (2020 to 2022) and in the pre-pandemic period (2015 to 2019) were analyzed. We selected 14 types of cancer that present the most common indications for surgery in Italy. This study included 1,365,000 adult patients who had surgery for the 14 most common types of cancer in the period 2015-2022, and interviews concerning adherence rates to screening for breast, colorectal, and cervical cancer were conducted for 133,455 individuals. A higher decrease in the number of operations for the 14 types of cancer (-45%) was registered during the first three acute phases of the pandemic, and it was more evident for screenable cancers like breast, colorectal, and cervical cancer (p < 0.001). During the first year of the COVID-19 pandemic, the number of screened individuals for breast, colorectal, and cervical cancer decreased by 33.8% (from 7,507,893 to 4,969,000) and the number of diagnoses and operations for these three types of cancer decreased by 10.5% (from 107,656 to 96,405). The increase and return to normality of the number of screened individuals in the last year of the pandemic (2022) and in the first post-pandemic year (2023) was associated with a return to the pre-pandemic levels of diagnoses and operations. The adherence rates were lower for individuals living in rural areas, with low socio-economic status, and unmarried persons; however, the most statistically significant factor for reduced adherence was a lower level of educational attainment. Free screening through nationally organized programs reduced social disparities. There were no significant differences between the pre-pandemic and pandemic periods for several types of cancers (stomach, esophagus, pancreas, liver) that are diagnosed for the occurrence of symptoms and for which nationally organized programs might increase the possibility of earlier diagnosis and improved clinical outcomes. Education, information, and appropriate expenditure for preventive care have the potential to reduce cancer mortality. Nationally organized screening programs for several types of cancers, which are often detected for the occurrence of symptoms, may increase the possibility of diagnosis at earlier stages.

The effect of hydropower bidding strategy on the iberian day-ahead electricity market

In 2021, the Iberian Electricity Market, which includes Portugal and Spain, experienced a significant increase in electricity prices. On average, prices tripled compared to pre-pandemic levels in 2019, despite stable demand. This trend, though less pronounced in other European markets, has raised concerns about the efficiency and competitiveness of wholesale electricity markets. This study investigates the bidding behavior of non-pumped hydropower plants in the Iberian market, employing a merit order model based on real data from 2019 to 2021. The analysis reveals a clear mismatch between hydropower bid prices and actual production costs. Although this practice is legal, it conflicts with the European Union's goal of promoting fair competition within the internal electricity market.Our findings suggest that aligning hydropower bid prices with 2019 levels could have reduced annual market costs by approximately 2324 million euros under a moderate scenario. This indicates substantial potential for cost savings and improved integration of hydropower. However, this strategy also benefits companies that own these hydropower plants, as they often possess large portfolios and can capitalize on increased market prices through other plants, particularly renewable energy units, which offer electricity at very low prices and have a high likelihood of being dispatched.Furthermore, the study highlights regulatory gaps allowing hydropower plants to price low-cost energy similarly to thermal plants, raising consumer costs and distorting market dynamics. These findings emphasize the need for stronger regulatory oversight and reforms to prevent excessive price inflation by hydropower, which plays a critical role in renewable energy integration and grid stability. Policymakers must ensure fair pricing while compensating hydropower plants for their flexibility and essential contributions to the energy system.

Psychische Belastungen und Auffälligkeiten von Kindern und Eltern im Verlauf der COVID-19-Pandemie (2020–2022)

IntroductionThe COVID-19 pandemic and accompanying containment measures created major changes to everyone’s daily life that had an impact on mental health and psychological burden. MethodsIn five surveys of the COPSY study more than 1,500 parents of 7- to 17-year-olds and their children between the ages of 11 and 17 were interviewed using established mental health assessment tools and a self-developed item on the experience of mental burden. Pre-pandemic comparative data were drawn from the representative BELLA study (BEfragung zum seeLischen Wohbefinden und VerhAlten). ResultsThe majority of children and adolescents as well as their parents in Germany felt stressed by the pandemic between 2020 and 2022. There was an increase in both mental health problems and symptoms of anxiety and depression at the beginning of the COVID-19 pandemic and during the second nationwide lockdown. A slight decrease in the subjective experience of psychological burden and mental health problems among children and their parents was observed in the fall of 2022. However, the prevalence of mental health problems and anxiety remained above pre-pandemic levels. DiscussionThe results illustrate the difficult situation of many children, adolescents and parents, even after 3 years of pandemic. Low-threshold counseling and support services as well as more therapy places and professional support services should be made available.

Attitudes toward Adolescent HPV Vaccination after the COVID-19 Pandemic: A National Survey of Mothers.

In the United States, vaccination rates for many routinely recommended vaccines have recovered to pre-pandemic levels, yet human papillomavirus (HPV) vaccination rates still lag pre-pandemic levels. This study sought to uncover the potential effects of the pandemic on attitudes about the HPV vaccine, and factors associated with changes in attitudes. We conducted a national survey (n = 3968) of U.S. mothers with children aged 9-17 years. Outcome variables measured changes in attitude toward the HPV vaccine following the pandemic. Two logistic regression models identified predictors of (1) those who did not have attitude changes (always negative vs. always positive), and (2) those who reported attitude changes (change to negative vs. change to positive). Attitudes toward the HPV vaccine remained unchanged in 78.9% of participants (58.1% positive, 20.8% negative). Of the 21.1% reporting changed attitudes, 9.6% changed to positive and 11.5% to negative. Those reporting changing to a negative attitude had a greater odds of reporting conservative political views, and being unsure/undecided about vaccinating their child against HPV compared to those who reported changing to a positive attitude. Targeted strategies are needed to address erosion in confidence in the HPV vaccine and other vaccines resulting from mis- and disinformation associated with the COVID-19 pandemic and future pandemics.