Quarantine Policy Research Articles

Responding to a simulated disaster in the virtual or live classroom: Is there a difference in BSN student learning?

AimThis study aim was to investigate if prelicensure baccalaureate nursing students gained more knowledge from a live or virtual disaster simulation. The study goal was to inform the use of e-learning or traditional textbooks in undergraduate nursing population health courses. BackgroundWeather-related disasters have increased in frequency and severity in the past ten years, with 2020 being the most active storm season ever seen (National Oceanographic and Atmospheric Administration, 2021.) Even with advances in early warning systems and mitigation efforts, educating student nurses in disaster response remains a priority. Due to the impact of Covid-19 quarantine policies, many in-person student learning labs and clinical experiences were cancelled. However, virtual simulation offers an alternative to developing nursing student skills and clinical reasoning ability (Aebersold, 2018; Fogg et al., 2020). DesignA randomized quasi-experimental, repeated measures 2 × 2 crossover design (Kim, 2018) was applied, which allowed students to participate in both the live and virtual simulations. MethodsAnalysis was conducted using paired samples t-test to evaluate knowledge gains. To measure students’ self-assessment of knowledge, Unver et al. (2018) 12-item survey was administered. To explore students’ own perceptions about the disaster simulations, semi-structured interview questions were offered through private Wiki postings. The responses were analyzed using Saldaña’s in vivo coding (2015) and thematic analysis. ResultsStudents retained more empirical knowledge following the virtual assignment as compared to the disaster simulation, except in two items addressing triage. Neither age, years of education, or GPA impacted test results. However, students’ own assessment of learning did not differ between live and virtual simulations. In all but three items, students perceived a significant increase (p < .05) in their learning following the simulation, regardless whether it was live or virtual.In narrative responses, students overwhelmingly cited the benefit of an in-person simulation. However, they did not believe that they were prepared adequately for the live simulation. They also expressed that they would be more prepared if the simulation was repeated. Students expressed discomfort, even distress, regarding not being able to care adequately for everyone, even though it was a simulation (See Table 5). This highlighted that live simulations can affect students emotionally, and follow-up debriefing is essential to help in both acknowledging and processing student feelings. ConclusionThese findings, which support the use of virtual disaster training in nursing education, are especially important in the light of Covid-19 and increasing threat of storm disasters.

Utilization of Environmentally Minded Open Space on New Normal Era

Indonesia has been battling Covid-19 by modifying the regional quarantine (lockdown) policy into large-scale social restrictions (LSSR) that are local according to the severity of the region. The government is trying to regulate the New Normal policy to avoid a prolonged economic impact that can cause a crisis. The objectives of this Community Service (CS) activity are: 1) To encourage people to stay productive in the new standard era by doing activities around the house. 2) Inviting the community to organize environmental space and use of the yard. Most people in the Villa Pabittei housing estate, Bengkulu City, Bengkulu Province are civil servants, temporary or non-permanent employees, so they carry out their activities at home because the government has closed offices and schools. To anticipate the boredom of the people who laid off, the methods of this CS activity are 1) Counseling using learning by doing techniques and providing motivation for the community to use vacant land with FMP (family medicinal plants), 2) Simulation of structuring space into an environmental park

Assessment of Knowledge, Attitude, Practise and Health Literacy (KAPH) Towards COVID-19 in Post-COVID-19 New Reality: The Need and Its Challenges in Malaysia.

Coronavirus disease 2019 (COVID-19) is a public health emerging infection globally with a terrifying impact. The rise in COVID-19 cases is still alarming, despite many preventive and control measures implemented, including the recent “promotion” of herd immunity. This emergence caused by a newly discovered coronavirus has alerted the Malaysian health system on preparedness to combat a pandemic crisis. Despite the acceleration of vaccine development, Malaysians must adjust to a new normal post-COVID-19, as, thus far, it is still the best preventive measure at the population level. Many countries, including Malaysia, succeeded in flattening the curve for the earlier waves and achieved zero new cases at one point in time; however, the latest deterioration of the transmission of the disease, the rise in COVID-19 cases and the death toll have put a great concern to all countries, including Malaysia (1). This study aims to describe the indications for the need to assess knowledge, attitude, practise and health literacy (KAPH) of Malaysians towards COVID-19 including (i) analysing factors that attribute to the trend of KAPH level, (ii) providing the baseline for the effect of vaccination and (iii) imparting crucial tool to be incorporated into the new home quarantine policy in Malaysia and the anticipated challenges for such assessment in the post-COVID-19 era. The topic is critically important but is often neglected in the decision-making process to support the management of COVID-19 and vaccination strategies. To date, there were three substantial indicators observed by the authors including the following: Public Compliance Towards the COVID-19-Related Standard Operating Procedures (SOPS) The KAPH levels affect the public compliance towards the COVID-19-related SOPs. This pandemic has gotten worse as compared to when it was first started, perhaps due to the suboptimal awareness of the disease within the community. The sudden surge of daily cases since October 2020 triggered the Malaysian government to announce the implementation of Movement Control Order (MCO) 2.0 from 13 January 2021, which is a more targeted version of the MCO implemented in March 2020, considering the impact on livelihoods of people and the economic stability of the country. Even though the current daily confirmed cases showed a reduction in trend starting the end of February 2021, we could visualise the recent increasing trend of reproduction number that is worrisome (2). With many sectors opening recently, including the schools and stores, this may pose the rise of risk of transmission in the community. Thus, public compliance towards the SOPs is substantial in affecting the changes in the infectivity trend. We need to assess the KAPH of the community on COVID-19 from time to time and analyse factors related to the trend of KAPH level, as these may assist public health authorities to plan and implement the appropriate preventive and control measures accordingly. Besides that, fake news remains a significant concern to the public health fraternity as this could lead to grave misunderstanding and confusion. Subsequently, this will affect their attitudes and how people react to COVID-19. This issue also could seriously affect the level of KAPH among the public if it is not handled effectively.

Distinguishing repeated polymerase chain reaction positivity from re-infections in COVID-19.

BackgroundPossibility of reinfection with SARS‐CoV‐2 changes our view on herd immunity and vaccination and can impact worldwide quarantine policies. We performed real‐time polymerase chain reaction (RT‐PCR) follow‐up studies on recovered patients to assess possible development of reinfections and re‐positivity.MethodsDuring a 6‐month period, 202 PCR‐confirmed recovering COVID‐19 patients entered this study. Follow‐up RT‐PCR tests and symptom assessment were performed 1 month after the initial positive results. Patients who tested negative were tested again 1 and 3 months later. The serum IgG and IgM levels were measured in the last follow‐up session.ResultsIn the first two follow‐up sessions, 82 patients continued their participation, of which four patients tested positive. In the second follow‐up 44 patients participated, three of whom tested positive. None of the patients who tested positive in the first and second follow‐up session were symptomatic. In the last session, 32 patients were tested and four patients were positive, three of them were mildly symptomatic and all of them were positive for IgG.ConclusionsA positive RT‐PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The immune response developed during the first episode of infection (e.g., IgG or T‐cell mediated responses that were not measured in our study) may have abated the symptoms of the reinfection, without providing complete protection.

Transmission risks of respiratory infectious diseases in various confined spaces: A meta-analysis for future pandemics

BackgroundIf the different transmission risks of respiratory infectious diseases according to the type of confined space and associated factors could be discovered, this kind of information will be an important basis for devising future quarantine policies. However, no comprehensive systematic review or meta-analysis for this topic exists. ObjectiveThe objective of this study is to analyze different transmission risks of respiratory infectious diseases according to the type of confined space. This information will be an important basis for devising future quarantine policies. MethodsA medical librarian searched MEDLINE, EMBASE, and the Cochrane Library (until December 01, 2020). ResultsA total of 147 articles were included. The risk of transmission in all types of confined spaces was approximately 3 times higher than in open space (combined RR, 2.95 (95% CI 2.62–3.33)). Among them, school or workplace showed the highest transmission risk (combined RR, 3.94 (95% CI 3.16–4.90)). Notably, in the sub-analysis for SARS-CoV-2, residential space and airplane were the riskiest space (combined RR, 8.30 (95% CI 3.30–20.90) and 7.30 (95% CI 1.15–46.20), respectively). DiscussionBased on the equation of the total number of contacts, the order of transmission according to the type of confined space was calculated. The calculated order was similar to the observed order in this study. The transmission risks in confined spaces can be lowered by reducing each component of the aforementioned equation. However, as seen in the data for SARS-CoV-2, the closure of one type of confined space could increase the population density in another confined space. The authority of infection control should consider this paradox. Appropriate quarantine measures targeted for specific types of confined spaces with a higher risk of transmission, school or workplace for general pathogens, and residential space/airplane for SARS-CoV-2 can reduce the transmission of respiratory infectious diseases.

Role of Chinese government and Public–Private Partnership in combating COVID-19 in China

COVID-19 has been called a Global Health Emergency worldwide. According to their available resources, developed and developing countries' public and private sectors are fighting against this pandemic. This paper examines how effective the Public–Private Partnership (PPP) strategies under the Chinese government response to control this COVID-19. The study takes the Chinese government and private sector's collective efforts for analysis and discussion from January 01 to October 31, 2020. Applying linear regression revealed that public governance strategies have worked to control this pandemic's severity and frequency. The results also show that despite the negative COVID-19 graph, the Chinese government has remained consistent in health and stringency measures. Furthermore, in cooperation with private sectors, China's emergency management has built two makeshift hospitals in 12 days and 5G technology implementation; Health Code application and volunteer works illustrate sharing governance by PPP. The study advises that by keeping in mind the strategy of PPP in China, other countries should also involve private sectors to mitigate emergency issues like COVID-19 for fast and effective outcomes and ask for assistance from the Chinese government and follow their quarantine and prudent policies to control this contagious disease. It further suggests that governments should engage private sectors before draft effective emergency preparedness policies to fight against future calamities.

Cost-Effectiveness Analysis of COVID-19 Case Quarantine Strategies in Two Australian States: New South Wales and Western Australia

Two main strategies, home and hotel isolation, have been used to isolate COVID-19 cases in most countries. Both have proven to be somewhat medically effective, but the costs to produce the desired outcome remain unclear. We used a decision tree model to compare alternatives and a simulation model to determine the household structure and provide recommendations for the most cost-effective way to isolate a COVID-19 patient in two Australian States, New South Wales (NSW) and Western Australia (WA). The results show that although the average cost of isolating a confirmed case at home is lower than that of a hotel quarantine, it is demonstrable that the decision depends on household size and the ages of household members. If the household members’ ages are old or the household size is large, the expected mean cost of home quarantine might be higher than hotel quarantine. Our study, therefore, provides the government with a cost-effective insight into making quarantine policies.

Spatiotemporal analysis of COVID-19 outbreaks in Wuhan, China

Few study has revealed spatial transmission characteristics of COVID-19 in Wuhan, China. We aimed to analyze the spatiotemporal spread of COVID-19 in Wuhan and its influence factors. Information of 32,682 COVID-19 cases reported through March 18 were extracted from the national infectious disease surveillance system. Geographic information system methods were applied to analysis transmission of COVID-19 and its influence factors in different periods. We found decrease in effective reproduction number (Rt) and COVID-19 related indicators through taking a series of effective public health measures including restricting traffic, centralized quarantine and strict stay-at home policy. The distribution of COVID-19 cases number in Wuhan showed obvious global aggregation and local aggregation. In addition, the analysis at streets-level suggested population density and the number of hospitals were associated with COVID-19 cases number. The epidemic situation showed obvious global and local spatial aggregations. High population density with larger number of hospitals may account for the aggregations. The epidemic in Wuhan was under control in a short time after strong quarantine measures and restrictions on movement of residents were implanted.

‏COVID-19 Quarantine Monitoring Based on Geofencing Technique

‏Smartphone and satellite network coverage contributes to a number of useful applications that increase the comfort of everyday people's lives. Using the Global Positioning System (GPS) provided by the satellite, people can be tracked in real time at a specific location. When it comes to infectious diseases such as COVID-19, the most important measure to reduce its spread is to contain it. Quarantine is usually a solution and any tracking system can be employed to specify the location of the infected people. However, as quarantined areas are scattered around the world, it is difficult to accurately trace the boundaries within accommodation. A geo-fenced GPS system, which has adopted an efficient border protection system, is proposed for quarantine and monitoring purposes of COVID-19 carriers. The system is introduced as an application to implement a home/local quarantine policy using bracelets that fit the boundaries of smartphones. From the experimental results obtained, it is observed that the proposed system achieves an effective and high accuracy performance in various location conditions.

Sero-Prevalence of SARS-CoV-2 Antibodies in High-Risk Populations in Vietnam.

As a response to the coronavirus disease 2019 (COVID-19) pandemic, Vietnam enforced strict quarantine, contact tracing and physical distancing policies resulting in one of the lowest numbers of individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) globally. This study aimed to determine the prevalence of SARS-CoV-2 antibody positivity among high-risk populations in Vietnam. A prevalence survey was undertaken within four communities in Vietnam, where at least two COVID-19 cases had been confirmed. Participants were classified according to the location of exposure: household contacts, close contacts, community members, and healthcare workers (HCWs) responsible for treating COVID-19 cases. Participants completed a baseline questionnaire and SARS-CoV-2 IgG antibodies were quantified using a commercial assay. A total of 3049 community members and 149 health care workers consented to the study. Among 13 individuals who were seropositive (0.4%), five household contacts (5/27, 18.5%), one close contact (1/53, 1.9%), and seven community members (7/2954, 0.2%) had detectable SARS-CoV-2 antibodies. All HCWs were negative for SARS-CoV-2 antibodies. Participants were tested a median of 15.1 (interquartile range from 14.9 to 15.2) weeks after exposure. Our study found a low prevalence of SARS-CoV-2 antibodies in high-risk communities and healthcare workers in communities in Vietnam with known COVID-19 cases.

Emotional well-being in COVID-19 mass quarantine: the role of personal response and life activity: a 14-day diary study in China

Objectives This study aims to explore quarantined individuals’ emotional well-being over time and how personal response and life activity predict emotional well-being and its change. Design/Methods Daily data were collected from 134 participants with 71 having 14 consecutive days’ data. Hierarchical linear modeling (HLM) and General Linear Model (GLM) were used to examine the primary tests. Results Overall, positive and negative emotions declined significantly during the surveyed period. Meanwhile, differences were observed in the level of positive, depressed, and negative emotions and/or patterns of change among different population categories. The personal response of worrying about work and life was positively related to depressed and negative emotions at baseline, but was negatively related to the development of both depressed and negative emotions over time. Among life activities, family stressor was a significant predictor for both depressed and negative emotions while social support predicted positive emotions. Moreover, health & hygiene activity was positively related to positive emotions at baseline. Conclusions The results provide scientific evidence for public health policymakers on quarantine policies and inform the general public about quarantine life. They highlight the importance of addressing the needs of vulnerable groups (parents with young children, divorcees, clinicians) during the pandemic, and demonstrate the benefits of promoting healthcare and hygiene activity, having a sense of worry and access to social support.

Optimal quarantine-related strategies for COVID-19 control models.

At the time when this paper was written, quarantine‐related strategies (from full lockdown to some relaxed preventive measures) were the only available measure to control coronavirus disease 2019 (COVID‐19) epidemic. However, long‐term quarantine and especially full lockdown is an extremely expensive measure. To explore the possibility of controlling and suppressing the COVID‐19 epidemic at the lowest possible cost, we apply optimal control theory. In this paper, we create two controlled Susceptible‐Exposed‐Infectious‐Removed (SEIR) type models describing the spread of COVID‐19 in a human population. For each model, we solve an optimal control problem and find the optimal quarantine strategy that ensures the minimal level of the infected population at the lowest possible cost. The properties of the corresponding optimal controls are established analytically using the Pontryagin maximum principle. The optimal solutions, obtained numerically, validate our analytical results. Additionally, for both controlled models, we find explicit formulas for the basic reproductive ratios in the presence of a constant control and show that while the epidemic can be eventually stopped under long‐term quarantine measures of maximum strength (full lockdown), the strength of quarantine can be reduced under the optimal quarantine policies. The behavior of the appropriate optimal solutions and their dependence on the basic reproductive ratio, population density, and the duration of quarantine are discussed, and practically relevant conclusions are made.

A scenario-based robust time–cost tradeoff model to handle the effect of COVID-19 on supply chains project management

The COVID-19 pandemic outbreak deeply impressed supply chains in different aspects. In response to this unexpected situation, supply chain managers have decided to recover and reinforce their supply chains. Considering the expanse of these decisions, project management principle and tools seems inevitable to successfully manage the transformation from before pandemic to post-pandemic supply chains (SCs). In this study, the problem of time–cost tradeoff is extended to time, cost, and risk tradeoff. The risk factor is considered to convey the uncertainty arising from the COVID-19 pandemic situation. Since projects are affected by the level of pandemic expansion and different countries ruled out various quarantine policies (isolation, quarantine, social distancing, and lock-down), the tradeoff problem is influenced accordingly. Therefore, a scenario-based robust optimization model is proposed to deal with time, cost, and risk tradeoff problems to reflect the effects of the global pandemic of COVID-19 on managing projects in supply chains. In addition, various quarantine policies (isolation, quarantine, social distancing, and lock-down) as a prevalent response to the pandemic have been investigated separately. To illustrate the model, a real-world case study in the emerging economy of Iran is examined using the proposed approach. The results indicated that supply chain managers can use the designed model and approach as a tool for a flexible and adaptable decision-making framework dealing with a global pandemic such as COVID-19.

COVID-19 in Taiwan: Economic Impacts and Lessons Learned*

Abstract This paper illustrates Taiwan's experience in controlling the virus and curbing the impact of COVID-19 on its economy. All the following factors contributed to Taiwan's early success in fighting COVID-19: the early establishment of a command center, the “precision-prevention” model of strategies that includes tight border controls and strict quarantine policy, the procuring of sufficient anti-pandemic medical supplies, and educating residents about public health awareness (e.g., promoting face mask wearing in public, maintaining proper social distance, and handwashing procedures). In addition, the country's medical facilities and a national health insurance program that are already in place along with the utilization of technology and big data also played a crucial role during the pandemic. Taiwan's success story may open up opportunities for the country to assume a leading role as a facilitator in the reallocation of the global supply chain and the creation of a new worldwide health coalition that includes Taiwan, unlike its lonely efforts 17 years ago when SARS hit the Southeast Asian and Pacific regions.

An integrated framework for modelling quantitative effects of entry restrictions and travel quarantine on importation risk of COVID-19

ObjectiveAs the potential spread of COVID-19 sparked by imported cases from overseas will pose continuous challenges, it is essential to estimate the effects of control measures on reducing the importation risk of COVID-19. Our objective is to provide a framework of methodology for quantifying the combined effects of entry restrictions and travel quarantine on managing the importation risk of COVID-19 and other pandemics by leveraging different sets of parameters. MethodsThree major categories of control measures on controlling importation risk were parameterized and modelled by the framework: 1) entry restrictions, 2) travel quarantine, and 3) domestic containment measures. Integrating the parameterized intensity of control measures, a modified SEIR model was developed to simulate the case importation and local epidemic under different scenarios of global epidemic dynamics. A web-based tool was also provided to enable interactive visualization of epidemic simulation. ResultsThe simulated number of case importation and local spread modelled by the proposed framework of methods fitted well to the historical epidemic curve of China and Singapore. Based on the simulation results, the total numbers of infected cases when reducing 30% of visitor arrivals would be 88·4 (IQR 87·5–89·6) and 58·8 (IQR 58·3–59·5) times more than those when reducing 99% of visitor arrivals in mainland China and Singapore respectively, assuming actual time-varying Rt and travel quarantine policy. If the number of global daily new infections reached 100,000, 85%–91% of inbound travels should be reduced to keep the daily new infected number below 100 for a country with a similar travel volume as Singapore (daily 52,000 tourist arrivals in 2019). Whereas if the number was lower than 10,000, the daily new infected case would be less than 100 even with no entry restrictions. DiscussionsWe proposed a framework that first estimated the intensity of travel restrictions and local containment measures for countries since the first overseas imported case. Our approach then quantified the combined effects of entry restrictions and travel quarantine using a modified SEIR model to simulate the potential epidemic spread under hypothetical intensities of these control measures. We also developed a web-based system that enables interactive simulation, which could serve as a valuable tool for health system administrators to assess policy effects on managing the importation risk. By leveraging different sets of parameters, it could adapt to any specific country and specific type of epidemic. ConclusionsThis framework has provided a valuable tool to parameterize the intensity of control measures, simulate both the case importation and local epidemic, and quantify the combined effects of entry restrictions and travel quarantine on managing the importation risk.

Back to the future: lessons of a SARS hysteria for the COVID-19 pandemic

ABSTRACT During the COVID-19 global pandemic, Taiwan has been universally praised for its policy actions in preventing its initial outbreak there from Wuhan and for its strict measures in containing its communal spread locally. Memory of the SARS crisis played a major role, but people in Taiwan forget that SARS was initially considered a problem confined mostly to Hong Kong. Taiwanese did not seem urgently aware, until infections multiplied locally. Taiwan’s health authorities eventually adopted a draconian quarantine policy, but mainly as a political tactic to contain the widespread panic, as though the dam had suddenly burst. In retrospect, the extremity and internal contradictions of the policy are remarkable, but they are instructive. The initial reaction of unprepared governments, most notably in the US, during COVID-19 mirrors this same ineptitude. Enabling hysteria and resorting to scapegoating were in turn diversions to cover up their inability to prevent a crisis. In the US, racism emerged, China and the WHO were blamed, people were even urged not to wear masks to avoid a run on short supplies. This is the tip of the political iceberg, if one adds tightened immigration and economic effects on the U.S. elections.

Experience of resources management on coronavirus disease 2019 epidemic at a tertiary medical center in Northern Taiwan

Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes infectious symptoms including fever, cough, respiratory and gastrointestinal symptoms, and even loss of smell/taste and to date had caused 489 000 people to be infected with 32 000 deaths. This article aims to develop some strategies in dealing with the COVID-19 epidemic to prevent nosocomial infection and ensure the safety of healthcare workforce and employees. This is a prospectively registered and retrospective descriptive study investigating the clinical characteristics, results of diagnostic tests, and patients' disposition from February 1, 2020, to April 30, 2020, at a tertiary medical center in Northern Taiwan. There is no nosocomial spreading of SARS-CoV-2 in our facility. The following strategies were followed: information transparency; epidemic prevention resources planning by authorities; multidisciplinary cooperation; informative technologies; immigration quarantine policies; travel restrictions; management of diversion/subdivision; self-health monitoring; social distancing; screening of travel, occupation, contact, and cluster (TOCC) history; traffic control bundling (TCB); training of using personal protective equipment; real-name visiting management; and employee care. The patients' basic characteristics and diagnostic results were gathered. Of the 3832 cases, about 25.9% had travel history. Most of them were traveling to Asia (419 people/time, 10.9%) and from China (256 people/time, 6.7%). Meanwhile, healthcare personnel accounted for 316 people/time (8.3%) and cleaning personnel, 6 people/time (0.16%). The 36 cases who care or have contact with confirmed cases have negative results from the COVID-19 test. The most frequent symptoms were fever and upper respiratory infection followed by gastrointestinal symptoms. The above strategies were followed. Patients were stratified based on the risk of TOCC history assessment to ensure the safety of healthcare personnel and patients' appropriate and timely medical services.

Parent Personality Traits During Covid-19 Pandemic: a Correlational Study

The COVID-19 pandemic has had a sudden and profound impact on international communities. The emergence of COVID-19 has led to drastic measures to ensure social distancing throughout the world, in order to prevent disease. In Romania, prevention measures regarding the infection with the new coronavirus and the limitations imposed at national level suddenly changed the routines and interactions of the population and made many parents feel overwhelmed due to work at home, home-schooling and family care, simultaneously. The national home quarantine policy may have influenced parents' mental health. The present study aimed to investigate the anxiety, self-efficacy, anger, energy level, distrust and frustration about the basic psychological needs of parents during the COVID-19 pandemic and to explore the relationship between them.

Psychosocial impact of Covid-19 outbreak on Italian asthmatic children and their mothers in a post lockdown scenario

Italy was the first European country to fight the Covid-19 outbreak. To limit the transmission of the virus, the Italian Government imposed strict domestic quarantine policies and temporary closure of non-essential businesses and schools from March 10th,2020. Although more and more literature is exploring the impact of the pandemic on non-referred children and families, only a few studies are focused on the psychosocial impact of Covid-19 in chronically ill children and their caregivers. The present study investigates asthma control and children and mothers’ psychological functioning (i.e.: psychological well-being, fear of contagion, and mothers’ Covid-19 related fears) in 45 asthmatic children aged 7-to-14, compared to a control sample. The subjects were administered an online survey after the lockdown (from 28th May to 23rd August 2020). The analysis shows that asthmatic children presented higher concern in relation to contagion, however, no difference in psychological functioning was displayed between the two cohorts. Mothers reported more Covid-19 related fears, and greater worries according to the resumption of their children’s activities. Moreover, they indicated a global worsening of their psychological well-being during the lockdown. Furthermore, regarding the clinical sample, the multivariate regression model showed that a worsening of mothers' psychological and children’s physical well-being was associated with a worsening of children’s psychological well-being during the lockdown. The results of this study indicate that mothers of asthmatic children can be more prone to experience psychological fatigue in a pandemic scenario. Special programs should be developed to support caregivers of chronically ill children.

Interacting regional policies in containing a disease.

Regional quarantine policies, in which a portion of a population surrounding infections is locked down, are an important tool to contain disease. However, jurisdictional governments-such as cities, counties, states, and countries-act with minimal coordination across borders. We show that a regional quarantine policy's effectiveness depends on whether 1) the network of interactions satisfies a growth balance condition, 2) infections have a short delay in detection, and 3) the government has control over and knowledge of the necessary parts of the network (no leakage of behaviors). As these conditions generally fail to be satisfied, especially when interactions cross borders, we show that substantial improvements are possible if governments are outward looking and proactive: triggering quarantines in reaction to neighbors' infection rates, in some cases even before infections are detected internally. We also show that even a few lax governments-those that wait for nontrivial internal infection rates before quarantining-impose substantial costs on the whole system. Our results illustrate the importance of understanding contagion across policy borders and offer a starting point in designing proactive policies for decentralized jurisdictions.