Stay Home Research Articles

The Impact of COVID-19 on Urban Water Consumption in the United States

The COVID-19 pandemic has changed how we define “home”, which is recast as the new coffee shop, restaurant, entertainment center, and office during the pandemic. The shift toward working from home led to substantial changes in how consumers behave, affecting the consumption of resources in some cases for years to come. Using data from six water utilities in various states in the U.S., we investigated how water consumption has changed attributable to the implementation of stay-at-home (SAH) orders. The results indicated an overall increase of between 3.08% and 13.65% in daily water consumption during the SAH orders compared to the same period in 2018 and 2019, with the gaps closing as lockdown restrictions eased. The findings also revealed that the changes in water consumption across sectors and user groups were heterogeneous. Specifically, the results showed that total daily residential water demand during SAH orders in 2020 increased significantly, between 11.80% and 13.65%, relative to the same period in 2018 and 2019, but the changes in water consumption for non-residential properties headed in opposite directions with reductions between −22.53% and −45.08%. In addition, we found that the low-income groups did not change their water consumption even with the lockdown.

The Impact of Covid-19 Pandemic on the Mental Health Among University Going Students in Aligarh City

Abstract: The stresses and restrictions associated with the pandemic COVID-19 have increased the risk of university students developing mental health issues, which may have a significant impact on their academic success, social interactions, and future career and personal opportunities. The aim of this study was to analyse the impact of COVID-19 pandemic on the mental health of university going students aged 18 to 24 in Aligarh City. The data was collected from 100 domestic Aligarh University student’s (18-24) years of age through self - prepared questionnaire created by using Google Form and shared on social media sites, the data was analysed statistically. The results indicate that students faced anxiety (60.8%), (54.1%) feel loneliness, and depression (59.8%). About (20%) of them reported worries for the health of loved ones most impacted their mental health status. Almost (46.7%) of students engage themselves in physical activities to take care of their mental health. While (36.5%) did not have strained familial relationships, (60.9%) found it harder to complete the semester at home and (70%) spent time during the pandemic watching television. Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-athome orders, the COVID-19 pandemic brings negative impacts on higher education.

National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume

BackgroundThe COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic. MethodsAll trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect. ResultsThere were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).

Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

BackgroundThe COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. MethodsA multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. ResultsOf 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01–1.012), African American race (OR=2.4, 95% CI: 1.3–4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4–21.6). ConclusionNon-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.

Stay home, stay safe? High habitat suitability and environmental connectivity increases road mortality in a colonizing mesocarnivore

ContextAnthropogenic structures have considerable effects on ecosystems, disrupting natural population processes and representing a serious risk in terms of vehicle collisions. The golden jackal (Canis aureus) is a mesocarnivore species whose range is expanding in Europe. Roadkills are one of the main human-induced mortalities in Italy to the species.ObjectivesIdentify road-related characteristics and ecological factors related to golden jackal roadkill risk in Italy.MethodsWe used habitat suitability (Maxent) and connectivity (Circuit theory) models to derive 15 metrics potentially affecting roadkill risk. We tested their influence using Bayesian generalized linear models and generalized linear models comparing golden jackal roadkill locations to random locations. Furthermore, we tested if there were significant sex, age-related and seasonal differences among road-killed individuals.ResultsWe found that roadkill risk was higher in areas characterized by higher values of habitat suitability and connectivity, habitat fragmentation and along highways. It was lower with increasing distance to the source population and in the presence of guardrails. No significant differences were detected in terms of roadkill risk between sexes, age classes and seasonConclusionsThe identified factors affecting road mortality of golden jackals in Italy provide insights on how to mitigate wildlife-vehicle collisions. Crossing areas, and visual and acoustic warnings for wildlife, as well as the importance of managing fences along high traffic volume roads could help mitigate further damage. Finally, there is a need to further investigate the effectiveness of mitigation measures in the light of the golden jackal’s ongoing expansion in a human-modified landscape.

COVID-19 & informal settlements: is 'Stay Home' safe?

The disproportional burden of coronavirus (COVID-19) and vulnerability to containment measures in informal settlements have been recognised; however, the role of poor housing conditions in propagating these remains neglected. Poor housing conditions makes it difficult to effectively implement social distancing measures. With increased time spent in cramped, dark and uncomfortable indoor environments, water and sanitation outside the home, and no outdoor space, higher exposure to existing health hazards and high levels of stress, with women and children being most vulnerable, are anticipated. Through this commentary paper, we reflect on these interconnections and recommend immediate measures and the long-term need for adequate housing for health and well-being.

Assessing the Effects of COVID-19-Related Stay-at-Home Orders on Homicide Rates in Selected U.S. Cities

Most U.S. states issued stay-at-home orders (SAHOs) to limit the spread of COVID-19 in 2020. These orders required people to remain in their residences except when undertaking essential activities. While SAHOs are a powerful public health tool against infectious diseases, they can have significant social and economic consequences. Grounded in general strain and routine activities theories and using interrupted time series analyses, this study assesses the effects of SAHOs on homicide rates in 10 U.S. cities. Substantive results suggest SAHOs were associated with changes in homicide rates in theoretically identifiable ways.

Important role of acute care surgery during pandemic time.

Pandemic impacts acute care surgery for diseases, such as gallbladder disease and acute appendicitis. At the early stage of coronavirus disease 2019 (COVID-19) pandemic, the case number of patients needing surgery decreased in hospitals from different countries. This decline was associated with the stay-home order and fear of getting COVID-19 infection. However, recent reports show that the case number for acute surgery returns to the normal level, which is comparable to that before the beginning of the pandemic. In addition, a variety of diseases show more severe than the cases before the pandemic, which might be caused by factors such as lack of regular follow-up and screening diagnosis and infection of viruses.

Impact of mandatory COVID-19 shelter-in-place order on controlled substance use among rural versus urban communities in the United States.

PurposeMandatory COVID‐19 shelter‐in‐place (SIP) orders have been imposed to fight the pandemic. They may also have led to unintended consequences of increased use of controlled substances especially among rural communities due to increased social isolation. Using the data from the American Association of Poison Control Centers, this study tests the hypothesis that the poison control centers received higher rates of calls related to exposures to controlled substances from rural counties than they did from urban counties during the SIP period.MethodsCall counts received by the poison control centers between October 19, 2019 and July 6, 2020 due to exposure to controlled substance (methamphetamine, opioids, cocaine, benzodiazepines, and other narcotics) were aggregated to per‐county‐per‐month‐per‐10,000 population exposure rates. A falsification test was conducted to reduce the possibility of spurious correlations.FindingsDuring the study period, 2,649 counties in the United States had mandatory SIP orders. The rate of calls reporting exposure to any of the aforementioned controlled substances among the rural counties was higher (14%; P = .047) relative to the urban counties. This overall increase was due to increases in the rates of calls reporting exposure to opioids (26%; P = .017) and methamphetamine (39%; P = .077). Moreover, the rate of calls reporting exposures at home was also higher among the rural counties (14%; P = .069).ConclusionThe mandatory SIP orders may have had an unintended consequence of exacerbating the use of controlled substances at home in rural communities relative to urban communities.

Following the Science? Examining the Issuance of Stay-At-Home Orders Related to COVID-19 by U.S. Governors.

Informed by the public health policymaking literature, this study’s objective is to identify scientific, political, social, economic, and external factors related to U.S. governors’ decisions to issue stay-at-home orders (SAHOs) in response to the first wave of the COVID-19 pandemic. Public health experts advocate for social distancing to slow the spread of infectious diseases, but government mandates to social distance can impose substantial social and economic costs. This study uses event history analysis to investigate the issuance of COVID-19-related gubernatorial SAHOs during a 41-day period in the 50 U.S. states. The findings indicate that scientific, political, and economic factors were associated with the issuance of SAHOs, but that external considerations played the largest role, particularly those related to the timing of other governors’ decisions. This study offers evidence about how some U.S. political leaders balance public health concerns against other considerations and, more broadly, how state governments address crisis-level issues.

Spatio-temporal stratified associations between urban human activities and crime patterns: a case study in San Francisco around the COVID-19 stay-at-home mandate

Crime changes have been reported as a result of human routine activity shifting due to containment policies, such as stay-at-home (SAH) mandates during the COVID-19 pandemic. However, the way in which the manifestation of crime in both space and time is affected by dynamic human activities has not been explored in depth in empirical studies. Here, we aim to quantitatively measure the spatio-temporal stratified associations between crime patterns and human activities in the context of an unstable period of the ever-changing socio-demographic backcloth. We propose an analytical framework to detect the stratified associations between dynamic human activities and crimes in urban areas. In a case study of San Francisco, United States, we first identify human activity zones (HAZs) based on the similarity of daily footfall signatures on census block groups (CBGs). Then, we examine the spatial associations between crime spatial distributions at the CBG-level and the HAZs using spatial stratified heterogeneity statistical measurements. Thirdly, we use different temporal observation scales around the effective date of the SAH mandate during the COVID-19 pandemic to investigate the dynamic nature of the associations. The results reveal that the spatial patterns of most crime types are statistically significantly associated with that of human activities zones. Property crime exhibits a higher stratified association than violent crime across all temporal scales. Further, the strongest association is obtained with the eight-week time span centred around the SAH order. These findings not only enhance our understanding of the relationships between urban crime and human activities, but also offer insights into that tailored crime intervention strategies need to consider human activity variables.

982-P: Perfect Storm in Mississippi: High Rate of Obesity Leading to Surge in Pediatric Diabetes during the COVID-Pandemic

Background: Mississippi ranks second for childhood obesity prevalence (22%) above the national average of 16 % with significant racial and health disparities. Since March 2020, stay-at home orders, virtual learning, stress, and poor lifestyle may have provided a perfect setup leading to new diagnosis of diabetes and accounting for record high hospitalizations. Objective: To determine the impact of the COVID-pandemic on the rate and clinical characteristics of newly diagnosed pediatric diabetes at University of Mississippi Medical Center. Methods: Chart review and data comparison completed for patients with new-onset-diabetes between January 20-February 2020 (pre pandemic) ; and between March 2020-October 2020 (pandemic) . Results: Table 1. African Americans were disproportionately diagnosed with diabetes (64%) . Eighty percent of obese patients had type 2 diabetes with 38% presenting in DKA, 3 patients in HHS. Four patients were COVID-positive on admission. Conclusions: Our observations corroborate the steep rise in the number of new-onset type 1 and type 2 diabetes, particularly in African Americans, in a highly prevalent obese pediatric population. Additional studies are required to determine the detailed effects of SARS-CoV-2 infection and pandemic associated psychosocial, clinical and biochemical effects on development of diabetes in the pediatric population. Disclosure N.Dixit: Research Support; Ascendis Pharma A/S, Boehringer Ingelheim International GmbH, Speaker's Bureau; Ascendis Pharma A/S. S.Pasha: None. A.P.Sukumaran: None. K.Armstrong: None. K.Topaloglu: None. L.Gholson: None. F.Kamran: None.

Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else?

COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social interactions affect development. This has the potential to change adolescent trauma. A post-hoc multicenter retrospective analysis of adolescent (13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed. Patients were divided into 3 groups based on injury date: historical control (CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH (POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL groups in separate analyses. 726 ATPs were identified across the 3 time periods. POST had a similar penetrating trauma rate compared to both PRE (15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%, P = .69). POST also had a similar rate of suicide attempts compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2% vs 2.1%, P = .43). However, POST had a higher rate of drug positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but was similar in all other comparisons of alcohol and drugs to PRE and POST periods (all P > .05). Hence ATPs were affected differently than adults and children, as they had a similar rate of penetrating trauma, suicide attempts, and alcohol positivity after SAH orders. However, they had increased drug positivity compared to the CONTROL, but not PRE group.

Stay home, save lives: Characterizing sickness presenteeism and motives among healthcare personnel in the COVID-19 pandemic

Background: Working while ill, or presenteeism, has been documented at substantial levels among healthcare personnel (HCP) along with its consequences for both patient and HCP safety. Limited literature has been published on HCP presenteeism during the COVID-19 pandemic, and specific motivations for this behavior are not well described. Understanding both individual and systemic factors that contribute to presenteeism is key to reducing respiratory illness transmission in the healthcare setting. We characterized the frequency of and motivations for presenteeism in the workforce of a large academic medical center during the COVID-19 pandemic. Method: We deployed a voluntary, anonymous electronic survey to HCP at University of North Carolina (UNC) Medical Center in December 2021, which was approved by the UNC Institutional Review Board. We received 591 responses recruited through employee newsletters. Respondents recounted their frequency of presenteeism since March 2020, defined as coming to work feeling feverish plus cough and/or sore throat. In total, 24.6% reported presenteeism at least once, with 8.1% reporting twice and 5.3% 3 or more times. Asking more generally about any symptoms while working, the following were most common: headache (26%), sinus congestion (20%), sore throat (13%), cough (13%), and muscle aches (9.3%). Results: Motivations for presenteeism fell broadly into 4 categories: (1) perception of low risk for COVID-19 infection, (2) concerns about workplace culture and operations, (3) issues with sick leave, and (4) concerns about employment record and status. Among HCP reporting at least 1 instance, the most common motivations for presenteeism included feeling low risk for COVID-19 infection due to mild symptoms (59.9%), being vaccinated (50.6%), avoiding increasing colleagues’ workload (48.3%), avoiding employment record impact (39.6%), and saving sick days for other purposes (37.9%). Asked to identify a primary motivation, 40.3% reported feeling low risk for COVID-19 infection due to mild symptoms or vaccination, 21.2% reported a workplace culture issue (ie, increasing colleague workload, perception of weakness, responsibility for patients), 20.6% reported sick leave availability and use (including difficulty finding coverage) and 17.8% reported employment record ramifications including termination. Conclusions: This survey coincided with 2the onset of the SARS-CoV-2 ο (omicron) variant locally, and as such, risk perceptions and motivations for presenteeism may have changed. Responses were self-reported and generalizability is limited. Still, these results highlight the importance of risk messaging and demonstrate the many factors to be considered as potential presenteeism motivators. Mitigating these drivers is particularly critical during high-risk times such as pandemics or seasonal peaks of respiratory illness.Funding: NoneDisclosures: None

Examining longitudinal disparities in COVID-19 prevalence in the U.S.: a county level growth rate perspective

Background: The objectives of the present study are to understand the longitudinal variability in COVID-19 reported cases at the county level and to associate the observed rates of infection with the adoption and lifting of stay-home orders. Materials and Methods: The study uses the trajectory of the pandemic in a county and controls for social and economic risk factors, physical environment, and health behaviors to elucidate the social determinants contributing to the observed rates of infection. Results and conclusion: Results indicated that counties with higher percentages of young individuals, racial and ethnic minorities and, higher population densities experienced greater difficulty suppressing transmission.Except for Education and the Gini Index, all factors were influential on the rate of COVID-19 spread before and after stay-home orders. However, after lifting the orders, six of the factors were not influential on the rate of spread; these included: African-Americans, Population Density, Single Parent Households, Average Daily PM2.5, HIV Prevalence Rate, and Home Ownership. It was concluded that different factors from the ones controlling the initial spread of COVID-19 are at play after stay-home orders are lifted. KEY MESSAGES Observed rates of COVID-19 infection at the County level in the U.S. are not directly associated with adoption and lifting of stay-home orders. Disadvantages in sociodemographic determinants negatively influence the rate of COVID-19 spread. Counties with more young individuals, racial and ethnic minorities, and higher population densities have greater difficulty suppressing transmission.

STAY HOME and Teach”: Educational Reforms and Mental Health Due to COVID 19

COVID 19 created a large disturbance in the education system. The locking down of education institutions has majorly affected large number of students and teachers. The managements of educational institutions, with a lot of thought process have worked on the implementation of innovative teaching and learning. This paper majorly focuses on the intellectual innovation and education reforms initiated by the teaching fraternity to reach the students through the virtual mode. The need of the hour is to innovate the teaching methods with a systematic plan. The teaching fraternity who mostly used chalk and talk were forced to adapt to online mode for teaching which was considered as an opportunity for them to relearn and rethink on implementing the virtual teaching

The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study

BackgroundFirearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypothesized there would be an increase in pediatric firearm injuries during SHO. MethodsThis was a multi institutional, retrospective study of institutional trauma registries. Patients <18 years with traumatic injuries meeting National Trauma Data Bank (NTDB) criteria were included. A “COVID” cohort, defined as time from initiation of state SHO through September 30, 2020 was compared to “Historical” controls from an averaged period of corresponding dates in 2016–2019. An interrupted time series analysis (ITSA) was utilized to evaluate the association of the U.S. declaration of a national state of emergency with pediatric firearm injuries. ResultsNine Level I pediatric trauma centers were included, contributing 48,111 pediatric trauma patients, of which 1,090 patients (2.3%) suffered firearm injuries. There was a significant increase in the proportion of firearm injuries in the COVID cohort (COVID 3.04% vs. Historical 1.83%; p < 0.001). There was an increased cumulative burden of firearm injuries in 2020 compared to a historical average. ITSA showed an 87% increase in the observed rate of firearm injuries above expected after the declaration of a nationwide emergency (p < 0.001). ConclusionThe proportion of firearm injuries affecting children increased during the COVID-19 pandemic. The pandemic was associated with an increase in pediatric firearm injuries above expected rates based on historical patterns.

The efficiency of COVID cases to COVID policies: a robust conditional approach.

This paper examines the efficiency of four major COVID-19 social distancing policies: (i) shelter-in-place orders (SIPO), (ii) non-essential business closures, (iii) mandatory quarantine for travelers, and (iv) bans on large gatherings. Results suggest that the average US state is highly inefficient in producing the fraction of the population that does not have COVID-19 without social distancing policies put in place. We find that having any of the four major social distancing policies increases conditional efficiency by 9.7 (9.5) percentage points in the first 100 days (full sample). This corresponds to 57 (172) fewer total COVID-19 cases per 100,000 population in the first 100 days (full sample). We also find that population density accounts for a majority of unconditional state inefficiency. Evidence suggests considerable heterogeneity in conditional efficiency improvement, indicating that no uniform national social distancing policy would have been more effective; more effective strategies would have been to target more densely populated areas. Conditional efficiency regressions suggest that bans on large gatherings were the most effective policies, with SIPOs and non-essential business closures having smaller impacts. States that implemented social distancing policies except mandatory quarantine for traveler policies were highly effective for the first 100 days, but had less effectiveness over the full sample. There is also preliminary evidence that premature revocations of social distancing policies reduced conditional efficiency, leading to COVID-19 case spikes.

Ozone Trends and the Ability of Models to Reproduce the 2020 Ozone Concentrations in the South Coast Air Basin in Southern California under the COVID-19 Restrictions

The current U.S. emission control requirements for on-road motor vehicles are driven by the ozone problem in the South Coast Air Basin (SoCAB) in southern California. Based on ozone modeling performed for Air Quality Management Plans (AQMPs), the SoCAB ozone attainment plan requires large (&gt;80%) amounts of emission reductions in oxides of nitrogen (NOx) from current levels with more modest (~40%) controls on Volatile Organic Compounds (VOC). The shelter in place orders in response to the 2020 COVID-19 pandemic resulted in an immediate reduction in emissions, but instead of ozone being reduced, in 2020 the SoCAB saw some of the highest observed ozone levels in decades. We used the abrupt emissions reductions from 2019 to 2020 caused by COVID-19 to conduct a dynamic model evaluation of the Community Multiscale Air Quality (CMAQ) model to evaluate whether the models used to develop ozone control plans can correctly simulate the ozone response to the emissions reductions. Ozone modeling was conducted for three scenarios: 2019 Base, 2020 business-as-usual (i.e., without COVID reductions), and 2020 COVID. We found that modeled ozone changes between 2019 and 2020 were generally consistent with the observed ozone changes. We determined that meteorology played the major role in the increases in ozone between 2019 and 2020; however, the reduction in NOX emissions also caused ozone increases in Los Angeles County and into western San Bernardino County, with more widespread ozone decreases further to the east.

Implications for health system resilience: Quantifying the impact of the COVID-19-related stay at home orders on cancer screenings and diagnoses in southeastern North Carolina, USA

COVID-19 impacted hospital systems across the globe. Focus shifted to responding to increased healthcare demand while mitigating COVID-19 spread on their campuses. Mitigation efforts limited medical professional-patient interactions, including patient access to preventive cancer screenings. Data were gleaned from a health information exchange containing records on over 2 million patients in southeastern North Carolina, USA. This study tested five hypotheses: H1: Weekly cancer screenings significantly decreased during North Carolina's (NC) Stay-At-Home (SAH) orders; H2: Weekly cancer diagnoses significantly decreased during NC's SAH orders; H3: Weekly cancer screenings significantly increased after the end of NC's SAH orders; H4: Weekly cancer diagnoses significantly increased after the end of NC's SAH orders; and H5: Weekly advanced cancer diagnoses significantly increased after the end of NC's SAH orders. Time series regression analysis was employed to quantify trends. Results suggested strong support of H1 and H3, moderate support of H4, mixed support of H5, and no support of H2. For example, compared to before the SAH orders, we estimated 662.3 fewer weekly breast cancer screenings during the SAH orders (H1). After the SAH orders (H3), we estimated 232.5 more breast cancer screenings and 10.6 more breast cancer diagnoses. This work quantifies the impact of COVID-19 associated SAH orders on cancer screenings and diagnoses and suggests the potential for delayed or missed cancer diagnoses. This evident disruption in providing routine medical care also highlights the importance of strengthening health systems (or organizations) and improving resilience to natural disasters and infectious disease outbreaks.