COVID-19: a potential public health problem for homeless populations

Comparison of the Mental Health Impact of COVID-19 on Vulnerable and Non-Vulnerable Groups: A Systematic Review and Meta-Analysis of Observational Studies

Vulnerable populations may be more vulnerable to mental health problems posed by the coronavirus disease 2019 (COVID-19) pandemic. A systematic review was performed to compare the mental health impact of COVID-19 between vulnerable and non-vulnerable groups. Five electronic databases were searched for observational studies reporting the psychological outcomes of both vulnerable populations and healthy controls during the COVID-19 era. The primary outcomes are the severity of depression and anxiety, and secondary outcomes include other aspects of mental health such as stress or sleep disturbance. Meta-analysis was performed for the severity of mental health symptoms, and the results were presented as standardized mean difference and 95% confidence intervals. A total of 25 studies were included. According to the findings, the elderly generally experienced significantly lower levels of psychological symptoms including depression, anxiety, and perceived stress. Pregnant women, patients with chronic diseases, and patients with pre-existing severe mental disorders showed mixed results according to each mental health outcome. The results indicate that vulnerable groups have been affected differently in the COVID-19 era. Though the insufficient number and heterogeneity of included studies leave the results inconclusive, our findings may contribute to identifying priorities of mental health needs among various vulnerable populations and allocating health resources with efficiency.

Advocating for Greater Inclusion of Marginalized and Forgotten Populations in COVID19 Vaccine Rollouts

Objectives: Many countries recently approved a number of SARS-CoV-2 vaccines. There is therefore growing optimism around the world about their future availability and effectiveness. However, supplies are likely to be limited and restricted to certain categories of individuals, at least initially. Thus, governments have suggested prioritization schemes to allocate such limited supplies. The majority of such schemes are said to be developed to safeguard the weakest sections of society; that is, healthcare personnel and the elderly. Methods: In this work, we analyse three case studies (incarcerated people; homeless people, asylum seekers and undocumented migrants). We propose a bioethical argument that frames the discussion by describing the salient facts about each of the three populations and then argue that these characteristics entail inclusion and prioritization in the queue for vaccination in their country of residence. Results: Through an analysis informed by ethical considerations revolving around the concepts of fairness and equality, we try to raise awareness of these important issues among decision makers. Conclusion: Our goal is to advocate for the development of more inclusive policies and frameworks in SARS-CoV-2 vaccine allocation and, in general, in all scenarios in which there is a shortage of optimal care and treatments.

Equal incidence of COVID-19 among homeless and non-homeless ED patients when controlling for confounders

Introduction

The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020. Theoretically, homeless patients could have disproportionately worse outcomes from COVID-19, but little research has corroborated this claim. This study aimed to examine the demographics and incidence of COVID-19 in homeless vs non-homeless emergency department (ED) patients.

Methods

This is a retrospective study of all patients seen in the University of Louisville Hospital Emergency Department (ULH ED) from March 2019 to December 2020, excluding January and February 2020. Data was collected from the Kentucky Homeless Management Information System (HMIS) and ULH electronic health records.

Results

A total of 51,532 unique patients had 87,869 visits during the study period. There was a 18.1% decrease in homeless patient visits over the time period, which was similar to the decrease in non-homeless patient visits (19.2%). In the total population, 9471 individuals had known COVID-19 testing results, with a total of 610 positive (6.4% positivity rate). Of the 712 homeless ED patients, 39 tested positive (5.5% positivity rate). After adjusting for age, gender identity, race, and insurance, there was no statistically significant difference in test positivity between homeless and non-homeless patients, OR 1.23 (0.88, 1.73). Homeless patients were less likely to be admitted to either the intensive care unit (ICU) or hospital (OR = 0.55, 95% CI: OR 0.51, 0.60) as they were more likely to be discharged (OR = 1.65, 95% CI: 1.52, 1.79).

Conclusion

Previous literature has indicated that higher disease burden, lack of access to social distancing, and poor hygiene would increase the risk of homeless individuals contracting COVID-19 and experiencing serious morbidity. However, this study found that homelessness was not an independent risk factor for COVID-19 infection.

The side effects of the COVID-19 pandemic on key public health elements - How the global emergency has changed the acute management of myocardial infarction and stroke, the network of cancer care, and assistance to frail individuals

The coronavirus disease 2019 (COVID-19) pandemic is a primary health problem globally. In particular, it has caused troubles even to the advanced health systems of Western countrieswho attempted to limit the spread of the infection and manage patients with severe respiratory distress. However, this sudden contingency has had a much higher cost if we also consider the cost of suspending ordinary clinical care or delays in the emergency pathways of non-COVID-19 patients. Furthermore, the policies applied to contain the contagion have exacerbated the socio-economic disparities of the population and isolated fragile patients, making them subject to clinical relapses or aggravation of chronic diseases. For this reason, the various specialist centers have equipped themselves to guarantee an effective therapeutic path. In this brief review, we have outlined some consequent repercussions on the management of acute and chronic cardiovascular and neurovascular diseases and on oncological treatment. In particular, we have described the effects of the current health reorganization on some acute and time-dependent diseases, such as stroke and acute coronary syndromes, in which therapeutic delay is potentially disabling or fatal. Furthermore, we have focused on cancer treatments, whose essential cornerstones are early screening and follow-up. Finally, the suffering of the local health network has led to a lack of continuity of care in fragile patients, such as psychiatric, marginalized, or multiple comorbid patients.

Seroprevalence of SARS-CoV-2 antibodies among homeless people living rough, in shelters and squats: A large population-based study in France

Background

Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in Marseille, France, taking into account different types of accommodation.

Methods

A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to have a validated rapid antibody assay for immunoglobulins M (IgM) and G (IgG) and to answer a questionnaire on medical health conditions, comorbidities, and previous COVID-19 symptoms. Information on their housing conditions since the COVID-19 crisis was also collected from the participants.

Results

From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. The overall seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3–7.0), ranging from 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P = 0.009). Around one third of the seropositive participants reported COVID-19 symptoms. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced a significantly increased risk of SARS-CoV-2 infection (|z| = 3.65 > 1.96).

Conclusion

These findings highlight the need for regular screening among the homeless to prevent clustering in overcrowded or inadequate accommodations. It is also necessary to provide essential resources to keep homeless people healthy, the vast majority of whom have cumulative risk factors for SARS-CoV-2 infection.

Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana

Background

The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes.

Methods

Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers.

Results

Qualitative content analysis revealed myriad challenges at the individual and interpersonal levels faced by people experiencing homelessness as a result of the pandemic, and multilevel responses for COVID-19 impact mitigation in this community. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that are informing better service delivery moving forward, even beyond the COVID-19 pandemic.

Conclusions

Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

Using community-based participatory research methods to inform care for patients experiencing homelessness: An opportunity for resident education on health care disparities

People experiencing homelessness (PEH) suffer higher burdens of chronic illnesses, have higher rates of emergency medicine (ED) use and hospitalization, and ultimately are at increased risk for premature death compared to housed counterparts. Structural racism contributes to a disproportionate burden of homelessness among people of color. PEH experience not only significant medical concerns but also complex social needs that need to be addressed concurrently for effective healing, issues that have been magnified by the COVID-19 pandemic. As health disparities and structural racism intersect among PEH, it is critically important to develop PEH-centered interventions to improve care and health outcomes as part of an effort to dismantle racism. One opportunity to address these disparities in care for PEH is through training ED physicians on methods for identifying and intervening on the unique needs of vulnerable patient groups. The Accreditation Council for Graduate Medical Education has outlined health quality pathways in the clinical learning environment to address health disparities. Community-based participatory research (CBPR) is particularly well suited for this scenario as it allows experiential learning for trainees to work with and understand a diverse group of stakeholders, to deepen their knowledge of local health disparities, and to lead research and measure outcomes of interventions to tackle health disparities. In this paper, we highlight the utility of CBPR in fostering experiential learning for EM residents on tackling health disparities and the importance of community collaboration in trainee-led interventions for comprehensive ED care.

Reservoir computing on epidemic spreading: A case study on COVID-19 cases

A reservoir computing based echo state network (ESN) is used here for the purpose of predicting the spread of a disease. The current infection trends of a disease in some targeted locations are efficiently captured by the ESN when it is fed with the infection data for other locations. The performance of the ESN is first tested with synthetic data generated by numerical simulations of independent uncoupled patches, each governed by the classical susceptible-infected-recovery model for a choice of distributed infection parameters. From a large pool of synthetic data, the ESN predicts the current trend of infection in 5% patches by exploiting the uncorrelated infection trend of 95% patches. The prediction remains consistent for most of the patches for approximately 4 to 5 weeks. The machine's performance is further tested with real data on the current COVID-19 pandemic collected for different countries. We show that our proposed scheme is able to predict the trend of the disease for up to 3 weeks for some targeted locations. An important point is that no detailed information on the epidemiological rate parameters is needed; the success of the machine rather depends on the history of the disease progress represented by the time-evolving data sets of a large number of locations. Finally, we apply a modified version of our proposed scheme for the purpose of future forecasting.

COVID-19 risk: Adult Medicaid beneficiaries with autism, intellectual disability, and mental health conditions

LAY ABSTRACT

Autistic adults, adults with intellectual disability, and adults with other mental health conditions may have higher risk of contracting COVID-19 or experiencing more severe illness from COVID-19 if infected. We used data from Medicaid to look at whether autistic adults and other adults with intellectual disability and other mental health conditions were more likely to have risk factors for COVID-19, such as living in a residential facility, receiving services regularly in the home from outside caregivers, having had a long hospitalization, having had avoidable hospitalizations, and having high-risk health conditions. We found that autistic adults had higher odds of living in a residential facility, receiving in-home services from outside caregivers, having had an avoidable hospitalization, and having a high-risk health condition, compared to neurotypical adults without mental health conditions. Adults with intellectual disability had similar odds of having these conditions. Adults with other mental health conditions were also more likely to live in a residential facility, receive services from outside caregivers, and have had avoidable hospitalizations compared to the neurotypical population without mental health conditions. They had three times higher odds of having a high-risk health condition. High risk of COVID-19 among autistic adults and adults with intellectual disability and mental health conditions should be recognized by clinicians, and these groups should be prioritized for vaccine outreach.

Determinants of access to the SARS-CoV-2 vaccine: a preliminary approach

BACKGROUND

The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries.

METHODS

The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation.

RESULTS

We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged.

CONCLUSIONS

Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands.

Sociodemographic characteristics and transmission risk factors in patients hospitalized for COVID-19 before and during the lockdown in France

Background

The efficacy of lockdown in containing the COVID-19 pandemic has been reported in different studies. However, the impact on sociodemographic characteristics of individuals infected with SARS-CoV-2 has not been evaluated. The aim of this study was to describe the changes in sociodemographic characteristics of patients hospitalized for COVID-19 and to compare the transmission risk factors of COVID-19 before and during lockdown in France.

Methods

An observational retrospective study was conducted in a University Hospital in Paris, France. Data from patients hospitalized for COVID-19 in the Infectious Diseases Department between February 26 and May 11, 2020 were collected. The study population was divided into 2 groups: group A of patients infected before lockdown, and group B of patients infected during lockdown, considering a maximum incubation period of 14 days. Sociodemographic characteristics and transmission risk factors were compared between the 2 groups using Student’s t-test for continuous variables and Chi-2 test or Fisher exact test for categorical variables.

Results

Three hundred eighty-three patients were included in the study, 305 (79.6%) in group A and 78 (20.4%) in group B. Patients in group A were significantly younger (60.0 versus (vs) 66.5 years (p = 0.03)). The professionally active population was larger in group A (44.3% vs 24.4%). There were significantly more non-French-speaking people in group B (16.7% vs 6.6%, p <  0.01). Most patients from group A had individual accommodation (92.8% vs 74.4%, p <  0.01). Contact with a relative was the main transmission risk factor in both groups (24.6% vs 33.3%, p = 0.16). Recent travel and large gathering were found only in group A. The proportion of people living in disadvantaged conditions, such as homeless people or people living in social housing, was significantly higher in group B (11.5% vs 4.3%, p = 0.03) as was the proportion of institutionalized individuals (14.1% vs 3.0%, p <  0.01).

Conclusions

In this study conducted in patients hospitalized for COVID-19 in Paris, France, the likelihood of being infected despite the lockdown was higher for people who do not speak French, live in social housing, are homeless or institutionalized. Targeted measures have to be implemented to protect these populations.

The Homeless People in China During the COVID-19 Pandemic: Victims of the Strict Pandemic Control Measures of the Government

Background: By implementing aggressive control measures, China has rapidly and effectively controlled the Coronavirus disease 2019 (COVID-19) pandemic. However, the neglected homeless population may become victims of that perceived success. Due to political sensitivity, we know little about them. Aims: This study aimed to investigate how the pandemic and the pandemic control strategies of the government affected the lives of the homeless people in mainland China. Methods: A total of 103 eligible participants experiencing absolute homelessness were recruited from Guangzhou City during July and August 2020. Surveys measured demographic characteristics including health status, changes in daily living, and actions of the government toward the homeless during the pandemic. Sankey diagrams and ordered logit regression models were used to examine the impact on the homeless of inhumane government efforts to drive the homeless away. Qualitative materials were analyzed by using an inductive approach to provide more details. Results: First, the homeless people in Guangzhou tended to be male, aged 40 to 64 years, less well-educated, and they originated from outside Guangdong although they were living in the city center. Most had little connection with their families. After a long period of homelessness, almost half of the participants were in poor health with various conditions, which made them extremely vulnerable to COVID-19. Second, the pandemic caused a substantial decline in incomes of homeless people, had less of a negative impact on their food intake, and affected sleep time in different ways. Third, during the COVID-19 pandemic, humanitarian aid from local governments of China decreased, whereas inhumane efforts to drive the homeless away intensified. Fourth, quantitative models and qualitative materials demonstrate the devastating effect of the strict pandemic control strategy of the government on the lives of homeless people, which may further cause their health problems. Conclusion: This study for the first time illustrated the characteristic features of the street homeless population in mainland China and their living situation during the COVID-19 pandemic, and most importantly demonstrated the devastating effect of the strict pandemic control of the government, which has been considered a great success in previous studies, on lives of homeless people. Urgent measures should be taken to ensure the protection of the homeless population and prevent an impending humanitarian crisis.

Response to the Coronavirus Disease 2019 Pandemic Among People Experiencing Homelessness in Congregant Living Settings in San Diego, California

During April-August 2020, a preemptive testing strategy combined with accessible isolation and symptom screening among people experiencing homelessness in congregant living settings in San Diego contributed to a low incidence proportion of COVID-19: 0.9%. Proactively addressing challenges specific to a vulnerable population may significantly prevent spread and community outbreaks.

What about the babies? A critical review of infants' and toddlers' absence in homelessness scholarship

Rates of family homelessness continue to reach unprecedented levels. As many as two million young children experience family homelessness each year, with an estimated one in 10 younger than one year old. Yet, despite their high prevalence, a dearth of studies have specifically investigated infants' and toddlers' experiences of homelessness. Overall, the available literature suggests homeless infants and toddlers experience increased risk to physical health, development, and well-being at an individual- and family-level. This presents a severely limited understanding of homeless infants' and toddlers' experiences, with substantial gaps remaining. This review documents the scant existing literature on infant and toddler development within the context of homelessness at both the individual and family-system levels, and proposes next steps for research, practice, and policy.

SARS-Cov-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters: Systematic review and meta-analysis

BACKGROUND

People experiencing homelessness (PEH) may be at risk for COVID19. We synthesised evidence on SARS-Cov-2 infection, transmission, outcomes of disease, effects of non-pharmaceutical interventions (NPI), and the effectiveness of strategies for infection prevention and control (IPC).

METHODS

Systematic review of articles, indexed in electronic databases (EMBASE, WHO-Covid19, Web of Science), institutional websites and the Norwegian Institute of Public Health's live map of COVID-19 evidence, and published from December 1st, 2019, to March 3rd, 2021. Empirical papers of any study design addressing Covid-19 and health(-related) outcomes in PEH or shelters' staff were included. (PROSPERO-2020-CRD42020187033).

FINDINGS

Of 536 publications, 37 studies were included (two modelling, 31 observational, four qualitative studies). Random-effect meta-analysis yields a baseline SARS-Cov-2 prevalence of 2•32% (95% Confidence-Interval, 95%CI=1•30-3•34) in PEH and 1•55% (95%CI=0•79-2•31) in staff. In outbreaks, the pooled prevalence increases to 31•59% (95%CI=20•48-42•71) in PEH and 14•80% (95%CI=10•73-18•87) in staff. Main IPC strategies were universal rapid testing, expansion of non-congregate housing, and in-shelter measures (bed spacing, limited staff rotation, reduction in number of residents).

INTERPRETATION

32% of PEH and 15% staff are infected during outbreaks of SARS-Cov-2 in homeless shelters. Most studies were conducted in the USA. No studies were found quantifying health-related outcomes of NPI. Overview and evaluation of IPC strategies for PEH, a better understanding of disease transmission, and reliable data on PEH within Covid-19 notification systems are needed. Qualitative studies may serve to voice PEH and shelter staff experiences, and guide future evaluations and IPC strategies.

FUNDING

None.

Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission

Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.

Mental health of individuals who are deaf during COVID-19: Depression, anxiety, aggression, and fear

This study aims to assess depression and anxiety levels among individuals, who are deaf during the lockdown throughout the first wave of the pandemic United Arab Emirates. The sample of the study consisted of 36 (n = 36) individuals aged 20.3 ± 1.2 years, who were deaf from birth. The respondents were divided into two groups; (1) those who were living with their parents (n = 20), (2) those who were independently living on their own (n = 16). Results of the study indicated that from May to October, there was decrease in the number of normal mental health cases among those living with parents (p ≤ 0.05). The results of the study show that in the time of the pandemic, deaf people constitute a vulnerable portion of the population. The correlation between living alone and stress levels was 0.78. The correlation between living with parents and stress levels was -0.85.

COVID-19 Pandemic Worsening Gender Inequalities for Women and Girls in Sub-Saharan Africa

Pandemics such as COVID-19 have often resulted in international, national and sub-regional crises, with considerable inequities across many societies. With the already existing structural and socio-economic inequalities in sub-Saharan Africa, the stay-at-home orders, lockdowns, and shutdowns across the sub-regional states could worsen and have a tremendous impact on vulnerable groups. Numerous studies across a variety of contexts have well-documented gender, and cultures on varied health outcomes. However, these have not been contextualized in sub-Saharan Africa in the light of the COVID-19 pandemic. This mini review discusses the ways by which COVID-19 has impacted the lives of girls and women across sub-Saharan Africa and the strategies that can help mitigate these challenges. The mini review specifically shares light on a wide array of dimensions where the inequities exist. These include the disproportionate areas affected by COVID-19; household inequities; educational inequalities; work/employment inequalities; disparities related to healthcare, sexual and reproductive health as well as housing inequities. Conclusively, the review accentuates the need for sub-Saharan African countries to adopt low-cost preventive measures such as discouraging mass gatherings (e.g., local community gatherings), and face masking with non-medical cloth like masks for the local populace as these are crucial in managing the spread of the virus among disproportionate women population. For localities with limited access to handwashing facilities, alternative strategies like alcohol-based hand rub solutions could be deployed. The complex interrelated disparities require a broad set of policy actions to lessen the current burden faced by many women in sub-Saharan Africa.

The Spread of COVID-19 in Russia: Immediate Impact on Mental Health of University Students

Amid the spread of COVID-19, a study of mental health in university students from different regions of Russia (n = 3057) was undertaken during the period from April 9 to April 20, 2020. The results were compared to studies conducted earlier within a large-scale research project examining student mental health. Mental health indicators were analyzed during three different periods: long before the onset of the pandemic (period 1); in the early days of the spread of COVID-19 in Russia, though prior to the implementation of containment measures (period 2); during tough measures to contain the first wave of the pandemic (period 3). The comparison of indicators showed no differences in the levels of psychological well-being (F = 0.918; p = .4), significantly lower levels of depression, anxiety and stress during the period 1 compared to the periods 2 and 3 (p < .001), and the highest levels of anxiety and stress during the period 2. We also established a higher increase in the levels of depression (F = 6.883; p = .001), anxiety (F = 11.868; p < .001) and stress (F = 10.384; p < .001) in young men compared to the changes in the same indicators in young women during the pandemic. However, both before and during the pandemic, these indicators showed better mental health in young men than in young women. Thus, when studying the impact of the pandemic on students' mental health, it is crucial to take into account the possible dynamics of their mental state within relatively short periods of time and to pay particular attention to gender differences.

Double Jeopardy: Maintaining Livelihoods or Preserving Health? The Tough Choices Sex Workers Faced during the COVID-19 Pandemic

The COVID-19 pandemic and associated public health preventive measures such as lockdown and home confinement have posed unique challenges to female sex workers (FSW) globally, including in Canada where the sex trade is not formally recognized. In this commentary, we discuss the unintended consequences the pandemic has had on various social determinants of health among FSW. We draw on a review of scholarly and grey literature, complemented by our experience with the Exit Doors Here program, a sex work exiting program implemented in Toronto, Canada. Due to COVID-19, many FSW suddenly lost their main source of income, work conditions became riskier, and sheltering-in-place presented challenges for women with no safe housing. The slowdown of social and health care services also meant FSW were not receiving the required attention. We make recommendations for intersectoral mitigation strategies to limit the short- and long-term impacts of COVID-19 on FSW health and livelihoods. Recommendations focus on addressing women’s marginalizing circumstances and speak to a gender transformative approach to the COVID-19 recovery. Our recommendations are relevant to FSW and other marginalized groups, in the current context and in the context of future health, social, and economic crises.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review

Background

The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs.

Methods

We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available.

Results

A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or “low-tech” care must also remain available.

Conclusions

The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

“Unforgotten” informal communities and the COVID-19 pandemic: Sitio San Roque under Metro Manila’s lockdown

Purpose

This paper aims to offer Sitio San Roque, an informal settlement in the Philippines as a case study to explore long-term "forgetful" urban development planning in the Philippines, and the renewed visibility of the urban poor under COVID-19 lockdown. It connects scholarship on informality to issues of housing and political rights in Metro Manila to further investigate how vulnerable communities in the Global South are faring in the pandemic.

Design/methodology/approach

This is an exploration of Sitio San Roque, an informal settler community in Metropolitan "Metro" Manila, Philippines. This paper refers to recent journalistic reports pertaining to the community's ongoing evictions and arrests while under Metro Manila's "enhanced community quarantine." Furthermore, it converses with literature from disciplines including health-care policy, urban studies and recent studies on COVID-19 and vulnerable communities to critically discuss the plight of the urban poor in the pandemic-stricken Metro Manila.

Findings

The urban poor and members of informal communities such as Sitio San Roque are especially vulnerable to contracting COVID-19 because of precarious livelihoods and housing instability. The creation of informality in Metro Manila can be traced to political tensions, economic agendas and development planning since the time of Marcos' administration and also to global restructuring during the 1990s. However, also important to note is that under Metro Manila's lockdown, informal settlers are further disenfranchised and stigmatized via ongoing demolitions and evictions, as well as by processes of policing and criminalization by the state. The use of military and police personnel as a way to enforce lockdown in the metropolis further impedes on the rights of informal settlers and the urban poor.

Originality/value

Recent scholarship and reports discuss the challenges for informal communities and the urban poor in navigating the COVID-19 pandemic, mainly due to their housing conditions and loss of economic stability. This paper contributes to a critical understanding of these issues by adding the dimensions of political and housing rights. It refers to the case study of members of Sitio San Roque, who have experienced continuous threats of demolitions and arrests by state police for protesting the lack of government aid under lockdown. Both military approaches of governance and housing informality work in tandem to expose the vulnerabilities of the urban poor in Metro Manila's pandemic. Finally, this paper extends on urban studies scholar Gavin Shatkin's concept of “forgetful planning” (2004) by applying his discussions to the current context. Informal settlers have long been “forgotten” by the state's development plans, but are now remembered and deemed more visible in Metro Manila's ECQ.

Veteran Perspectives on Adaptations to a VA Residential Rehabilitation Program for Substance Use Disorders During the Novel Coronavirus Pandemic

Individuals attending residential rehabilitation programs for substance misuse are particularly vulnerable to treatment disruptions spurred by the novel coronavirus disease 2019 (COVID-19) pandemic. We describe adaptations to services within a large residential rehabilitation program for under-resourced veterans, report veterans' experiences with these changes, and outline successes and challenges encountered throughout adjustment to the pandemic. Data collected from two focus groups with nine veterans engaged in this program during the pandemic highlight experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation. Overall, these findings suggest the need for health systems to support clients in taking an active role in communications, provide additional technical and social support in transitioning to virtual health services, and offer alternative means for clients to maintain social connection during a pandemic. Understanding clients' perspectives can inform strategies to promote continuity of care and enhanced care experiences.

Sex Workers and Syndemics: A Population Vulnerable to HIV and COVID-19

COVID-19 has disproportionately affected vulnerable populations across the U.S. Street-based sex workers are one vulnerable population whose health and impact of COVID-19 have been understudied to date. The goal of this study was to evaluate findings from a community needs assessment with street-based sex workers on impact of COVID-19 on health behaviors and social circumstances. A brief survey was developed at a community-based harm reduction and recovery services organization. Surveys were administered by peer specialists to street-based sex workers during street outreach in April and May 2020. A total of 46 surveys were analyzed. Many individuals reported continuing to do sex work and use substances during the COVID pandemic. Slightly more than a quarter of individuals (n = 13; 28.3%) indicated using personal protective equipment while doing sex work and described challenges to using precautions when working with clients. Individuals had used marijuana (n = 32, 71.1%), cocaine (n = 17, 39.5%), prescription stimulants (n = 9, 21.4%), methamphetamines (n = 5, 11.9%), prescription opioids (n = 12, 27.3%), street opioids (n = 12, 27.3%), sedatives (n = 11, 25.0%), hallucinogens (n = 3, 6.8%), inhalants (n = 3, 7.0%), or some other substance (n = 4, 8.7%) in the past 30 days. About half (48.8%) reported that COVID-19 had a major impact on their lives. This study is among the first to characterize the impact of COVID-19 on street-based sex workers. From a public health standpoint, this group also represents a high-priority population given their vulnerability and close contact with others, which increases the potential for community spread.

Challenges for Students in the Creation, Growth, and Management of an Academic, Student-run Asylum Clinic

Medical school asylum clinics are complex organizations that blend medical and legal expertise with service to assist individuals seeking refuge from human rights violations. The balance of power shared by the students and faculty who lead these clinics varies widely across institutions, usually in an inverse reciprocal relationship. The Weill Cornell Center for Human Rights will observe its 10th anniversary in 2020 and is notable for espousing maximal student autonomy in the organization's governance with minimal faculty control or administration participation. This level of autonomy requires that, in addition to successfully running the organization, student leaders must adeptly manage logistical, administrative, and ethical challenges without compromising the trust and confidence of the medical college and larger university. This article describes a series of difficult decisions involving policy, conflict resolution, and resource management made expeditiously by the student leadership. Ethical dilemmas, operational challenges, and the difficulties imposed by an unexpected global catastrophe-the COVID-19 pandemic-are presented alongside detailed descriptions of how these issues were deliberated and resolved by the student leadership.

Anxiety, depression and concerns of pregnant women during the COVID-19 pandemic

PURPOSE

In December 2019, the emerging of a novel coronavirus (COVID-19) has influenced the whole world. The current pandemic also triggers several psychological changes. Uncertainties and changes in health practices may cause anxiety, depression, and concerns on vulnerable populations such as pregnant. This study aims to survey the pregnant women to capture the psychological impact and perceptions during the pandemic.

METHODS

A total of 297 pregnant women aged ≥ 18 years were enrolled in May 2020. We evaluated the hard-copy survey included questions about demographic and clinical information of patients, 95% confidence intervals of a COVID-19-related questionnaire in a Likert scale and 14-item Hospital Anxiety and Depression Scale (HADS).

RESULTS

A total of 297 pregnant women were included in this study with a mean age of 27.64. Most patients (82.5%) had concerns about infecting their babies during delivery. The fear of infection of the fetus during delivery revealed elderly age and having anxiety as the unique significant risk factors. Mean HADS-A and HADS-D scores were 7.94 (± 4.03) and 7.23 (± 3.84), respectively. Multivariate analysis showed having anxiety was associated with a high HADS-D score and concern about the inability to reach obstetrician, and being in advanced age, having a high HADS-A score, and concern about the inability to reach obstetrician demonstrated significant effects on HADS-D score.

CONCLUSION

We conclude that in future pandemics, communications and reassurance of the patients should be prioritized upon their routine ante-natal care to avoid increased levels of anxiety and even depression.

Socioeconomic Disparities in Subway Use and COVID-19 Outcomes in New York City

Using data from New York City from January 2020 to April 2020, we found an estimated 28-day lag between the onset of reduced subway use and the end of the exponential growth period of severe acute respiratory syndrome coronavirus 2 within New York City boroughs. We also conducted a cross-sectional analysis of the associations between human mobility (i.e., subway ridership) on the week of April 11, 2020, sociodemographic factors, and coronavirus disease 2019 (COVID-19) incidence as of April 26, 2020. Areas with lower median income, a greater percentage of individuals who identify as non-White and/or Hispanic/Latino, a greater percentage of essential workers, and a greater percentage of health-care essential workers had more mobility during the pandemic. When adjusted for the percentage of essential workers, these associations did not remain, suggesting essential work drives human movement in these areas. Increased mobility and all sociodemographic variables (except percentage of people older than 75 years old and percentage of health-care essential workers) were associated with a higher rate of COVID-19 cases per 100,000 people, when adjusted for testing effort. Our study demonstrates that the most socially disadvantaged not only are at an increased risk for COVID-19 infection, they lack the privilege to fully engage in social distancing interventions.

Service-Learning, Movies, and Infectious Diseases: Implementation of an Active Educational Program in Microbiology as a Tool for Engagement in Social Justice

Service-Learning is an educational methodology that allows student learning while addressing community needs. A program in microbiology and infectious diseases was implemented in Universidad Complutense de Madrid, Spain. University lecturers, clinical microbiologists, doctorate students, and undergraduates from several Bachelor Degrees and courses worked in an interdisciplinary team along with social institutions that attend disadvantaged persons. Using commercial movies that deal with infectious diseases, the students learn clinical microbiology, prepare divulgation materials, visit social centers to accompany, and help others to know about illnesses and prevention. The program was developed through two academic years and involved 58 voluntary students, 13 teachers and tutors, and 4 social entities as community partners. Postsurvey evaluation of the program revealed a highly satisfactory achievement of goals: acquiring scientific and personal competencies by university students, including critical analysis and science diffusion, solving problems or collaborative team working, and contributing, together with the tutors, to the social responsibility of the university.

Prevalence and Factors Associated with Fear of COVID-19 Among Homeless Individuals During the COVID-19 Pandemic: Evidence from the Hamburg Survey of Homeless Individuals

PURPOSE

To clarify the prevalence and determinants of fear of COVID-19 among homeless individuals during the COVID-19 pandemic.

PATIENTS AND METHODS

Data were taken from the Hamburg survey of homeless individuals (n=150) covering homeless adults in Hamburg, Germany. Multiple linear regressions were used. Beyond sociodemographic and lifestyle-related independent variables, COVID-19-related factors were also used as independent variables.

RESULTS

In sum, 56.2% of homeless individuals reported no fear of COVID-19, 23.8% reported a little fear of COVID-19, 9.2% reported some fear of COVID-19 and 10.8% reported severe fear of COVID-19. Regressions showed that an increased fear of COVID-19 was significantly associated with younger age (β=-.01, p<0.05), absence of chronic alcohol consume (β=-.55, p<0.01), an increased perceived own risk of getting infected with the coronavirus one day (β=0.42, p<0.001) and a higher agreement that a diagnosis of the coronavirus would ruin his/her life (β=0.13, p<0.01).

CONCLUSION

Given the poor hygienic conditions and their increased vulnerability, data surprisingly suggest a quite low fear of COVID-19 among homeless individuals. Efforts may be beneficial which contribute to thinking rationally about COVID-19 among homeless people, since low levels of fear of COVID-19 may contribute to careless behavior and can lead to super-spreading events.

Can social capital play a role in contracting services of family doctors in China? Reflections based on an integrative review

BACKGROUND

The family doctors' contract service problem is not about government management alone, but an interaction of a complex social environment. Consequently, the effect of contracted services of family doctors not only depends on policy incentives but also needs to win the participation, acknowledgement, and confidence of community residents. The purpose of this integrative review is to examine whether there is any significant evidence that social capital in the form of social networking groups and other forms of social groups have any positive impact on the acceptance and the effectiveness of family doctors' contractual services.

METHOD

Research on qualitative, quantitative and hybrid methods published in peer-reviewed journals on the social capital role in the process of contract service of family doctors were eligible for inclusion. In view of the increasing attention paid to the contract service effect of family doctors during this period, a 10-year time scale was selected to ensure full coverage of relevant literature in the same period. In total, 809 articles were determined in the database retrieval results which were downloaded and transferred to the Mendeley reference application software.

RESULTS

Twelve articles met the inclusion criteria for this integrative review and the quality of the included studies were assessed using the published criteria for the critical appraisal of quantitative and qualitative research methods. Majority of the articles assessed reported that there was evidence of a positive link between social support, especially a sense of belonging and the presence of regular family doctors. The influencing factors of patients' contract behavior of studies conducted in China were social interaction of social capital, acceptance of the first contact in the community, year of investigation, and exposure to the public.

CONCLUSION

The study affirms previous studies that suggest that social resources have the propensity to improve relationship between patients and clients and between doctors and peers for the benefit of the patients and the stability of the overall healthcare system. Through the integration of various social resources family doctor systems accelerate the development of community construction. These social capital (social network groups) can guide residents to use family doctor services to maintain health. Social capital can also help residents have a regular and reliable family doctor.

Equity in access to COVID-19 testing for undocumented migrants and homeless persons during the initial phase of the pandemic

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Equity-based policies can mitigate disparities in access to care and spread of COVID-19.

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Disparities in COVID-19 prevalence stresses the need to ensure universal access to vaccine.

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Crisis provide opportunities to reinforce healthcare systems in order to better protect the whole of society.

Introduction

The COVID-19 pandemic has excessively affected socially and economically deprived groups of population. There is a dearth of empirical evidence about the effect of policies regulating access to care for such groups. This study aims to document the impact of an equity-based strategy to facilitate access to COVID-19 testing during the initial phase of the pandemic.

Materials and methods

This cross-sectional study included all outpatients presenting at the Geneva University Hospital for COVID-19 testing in March and April 2020. We compared the testing program uptake, and the proportions of positive tests and of complicated clinical course between undocumented migrants and homeless persons and the general population.

Results

Underserved patients represented 215 (6.5%) of the 3299 participants. There was no significant difference in the time-lag between the first COVID-19 evocative symptoms and the testing, the number of symptoms at presentation, and the participation to the program during its first month of implementation. The proportion of positive tests was significantly higher (32.1% vs. 23.6%, p=.005) among undeserved while the proportion of complicated clinical course was comparable.

Conclusions

Equity-based policies can mitigate disparities in access to care during the pandemic and reduce the spread of COVID-19 in the community by early detection of infective cases. The high proportion of positive test in underserved patients highlight the need to include such groups into future COVID-19 immunization program. More globally, this study highlights the opportunity to reinforce healthcare systems to adapt to new threats and to contribute to a better protection of the whole of society.

Public Interest in Immunity and the Justification for Intervention in the Early Stages of the COVID-19 Pandemic: Analysis of Google Trends Data

BACKGROUND

The use of social big data is an important emerging concern in public health. Internet search volumes are useful data that can sensitively detect trends of the public's attention during a pandemic outbreak situation.

OBJECTIVE

Our study aimed to analyze the public's interest in COVID-19 proliferation, identify the correlation between the proliferation of COVID-19 and interest in immunity and products that have been reported to confer an enhancement of immunity, and suggest measures for interventions that should be implemented from a health and medical point of view.

METHODS

To assess the level of public interest in infectious diseases during the initial days of the COVID-19 outbreak, we extracted Google search data from January 20, 2020, onward and compared them to data from March 15, 2020, which was approximately 2 months after the COVID-19 outbreak began. In order to determine whether the public became interested in the immune system, we selected coronavirus, immune, and vitamin as our final search terms.

RESULTS

The increase in the cumulative number of confirmed COVID-19 cases that occurred after January 20, 2020, had a strong positive correlation with the search volumes for the terms coronavirus (R=0.786; P<.001), immune (R=0.745; P<.001), and vitamin (R=0.778; P<.001), and the correlations between variables were all mutually statistically significant. Moreover, these correlations were confirmed on a country basis when we restricted our analyses to the United States, the United Kingdom, Italy, and Korea. Our findings revealed that increases in search volumes for the terms coronavirus and immune preceded the actual occurrences of confirmed cases.

CONCLUSIONS

Our study shows that during the initial phase of the COVID-19 crisis, the public's desire and actions of strengthening their own immune systems were enhanced. Further, in the early stage of a pandemic, social media platforms have a high potential for informing the public about potentially helpful measures to prevent the spread of an infectious disease and provide relevant information about immunity, thereby increasing the public's knowledge.

Migrants' Quarantine and COVID-19 Pandemic in Italy: a Medico-anthropological View

The COVID-19 pandemic represents an important risk factor for migrants' health. Paul Farmer highlighted the risk of global health response in emergency conditions exacerbating global and social inequalities. We argue that this is the case for quarantine ships and migrants' management during the pandemic. Every aspect of infection-control and prevention measures acquires detention characteristics in these situations. With emphasis to the evolution of the doctor-patient relationship and to the anthropological and cultural aspects that were established during the pandemic, this article aims to provide an integrated view where physicians and anthropologists collaborate to deepen the understanding of the topic.

SARS-CoV-2 screening among people living in homeless shelters in Brussels, Belgium

Background

Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates.

Methods

A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms.

Results

We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic.

Conclusion

This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.

Interventions to Optimise Mental Health Outcomes During the COVID-19 Pandemic: A Scoping Review

Adverse mental health has been a major consequence of the COVID-19 pandemic. This review examines interventions to enhance mental health outcomes and well-being of populations during COVID-19. Four electronic databases (MEDLINE, PsycINFO, Embase, and CINAHL) were searched following Arskey and O’Malley’s six-staged scoping review process. Twenty studies were included in the review. Various study populations were included to ensure greater generalisability of results. Interventions informing treatment of mental health concerns during COVID-19 were included and classified into (a) prevention of poor mental health, (b) therapeutic interventions, and (c) other interventions. Preventative strategies (n = 16) included public health education, modified social media use, technology-based interventions, physical activity, policy adaptations, and therapeutic interventions. Treatment strategies (n = 7) included adapting existing treatment and the creation new treatment programmes and platforms. While current evidence is promising, future research should focus on novel effective interventions to address mental health issues during the pandemic.

Creating an e-cohort of individuals with lived experience of homelessness and subsequent mortality in Wales, UK

BACKGROUND

Homelessness is an extreme form of social exclusion, with homeless people experiencing considerable social and health inequities. Estimates of morbidity and mortality amongst homeless populations is limited due to the lack of recording of housing status across health datasets. The aim of this study is to: (i) identify a homelessness e-cohort by linking routine health data in Wales, and (ii) explore whether a period of reported past homelessness, places this population at greater risk of morbidity and mortality.

METHODS

Homelessness identified through linkage across primary, secondary care and substance misuse datasets in the Secure Anonymised Information Linkage (SAIL) Databank. Mortality was examined through linkage to the Office for National Statistics mortality data.

RESULTS

E-cohort of 15 472 individuals with lived experience of homelessness identified. Of those, 21 individuals died between February and July 2020 involving coronavirus disease of 2019 (COVID-19). Those with lived experience of homelessness had increased mortality from many causes including accidents, liver diseases and suicides.

CONCLUSION

Linking multiple routine datasets provides a more comprehensive dataset of a marginalized population, including individuals who are not included in government homeless statistics. Application of the cohort demonstrated that individuals with lived experience of homelessness have increased mortality involving COVID-19 and other causes. The underlying reasons, health needs and causes of death warrant further exploration.

Social Inequality and Solidarity in Times of COVID-19

The enormous public health burdens of the COVID-19 pandemic are not distributed equally. Inequalities are noticeable along socio-economic and socio-cultural fault lines. These social determinants of health affect both the prevalence and severity of COVID-19 infections as well as the magnitude of negative impacts of the measures taken to slow the spread of the virus. This perspective paper summarizes key inequalities in who is affected by SARS-CoV-2 infection and in who is affected by COVID-19 prevention measures, based on evidence presented in state-of-the-art literature, and discusses the scope of challenges that these inequalities pose to solidarity and social justice. Key challenges for solidarity are highlighted across three areas: challenges to intergenerational solidarity, to global solidarity, and to intergroup solidarity.

Clinical and functional effects of the COVID-19 pandemic and social distancing on vulnerable veterans with psychosis or recent homelessness

The COVID-19 pandemic has upended the lives of everyone in the United States, negatively impacting social interactions, work, and living situations, and potentially exacerbating mental health issues in vulnerable individuals. Within the Department of Veterans Affairs (VA) healthcare system, two vulnerable groups include those with a psychotic disorder (PSY) and those who have recently experienced homelessness (recently housed Veterans, RHV). We conducted phone interviews with PSY (n = 81), RHV (n = 76) and control Veterans (CTL, n = 74) between mid-May - mid-August 2020 ("initial") and between mid-August - mid-October 2020 ("follow-up"). At the initial period, we also collected retrospective ratings relative to January 2020 ("pre-COVID-19"). We assessed clinical factors (e.g., depression, anxiety, loneliness) and community integration (e.g., social and role functioning). All groups reported worse clinical outcomes after the onset of the COVID-19 pandemic. However, PSY and RHV exhibited improvements in depression and anxiety from initial to follow up, whereas CTL continued to exhibit elevated levels. There was little change in community integration measures. Our results indicate that all groups reported increased mental health problems after the onset of the pandemic, but vulnerable Veterans were not disproportionately affected and had better mental health resilience (i.e., for depression and anxiety) as the pandemic progressed compared to CTL. This effect could be due to the availability and utilization of VA services for PSY and RHV (e.g., housing and financial support, medical and mental health services), which may have helped to mitigate the impact of the pandemic.

Higher education students' behaviour and mental health during Covid-19 lockdown: a pilot study

Background

The flare-up of Covid-19 in India caused open turmoil and pressure on emotional wellbeing among university students. At first, it was about course finishing; later, the issues moved to assessment. This scourge increases mental issues, stress, dissatisfaction, sorrow, and nervousness.

Aim

The aim of this study was to assess the mental health and behaviour of Mizoram University students during the Covid-19 lockdown period.

Methods

This study was a cross-sectional investigation, and a snowball method sampling technique was utilised for obtainging information from the students.

Results

There were 65.2% of students who revealed that they were giving more consideration to their emotional wellbeing during this pandemic. More than half of the participants (67.2%) reported no expanded worry of stress from scholastic work, and 65.2% reported that they were paying more attention to their emotional wellbeing and mental health following the pandemic. Further, 69.7% reported that they were spending more time exercising. Nearly 55% of students took part in Zoom classes, with a length of 35 to 40 min. About 65.7% of students gained proficiency in their course by means of a learning management system. Students performed activities at home during the lockdown period, watching TV (75.4%), reading books (38.7%), and on writing assignments (34.8%); and 34.5% of the students viewed news from TV, newspapers, and social media about the Covid-19 pandemic each day.

Conclusion

The positive effects on psychological wellbeing may have helped the students adapt to other negative effects and expanded pressure on emotional wellbeing. This pandemic impact will probably be engraved on every individual surveyed.

COVID-19 and the Well-Being of the Homeless Population

A previous editorial by the Editor-in-Chief discusses public health and steps towards recovery from the COVID-19 disaster.1 In addition to the current public health disasters, and multiple disasters such as earthquakes, typhoons and hurricanes, worldwide recession, and global morbidity and mortality, the authors would like to highlight the need for responses to deal with the well-being of the homeless population due to their condition and vulnerability in the society. People who are experiencing homelessness are considered vulnerable and "preferential options for the homeless" must be considered.

Finding opportunity in the COVID-19 crisis: prioritizing gender in the design of social protection policies

The COVID-19 pandemic is highlighting the harm perpetuated by gender-blind programs for marginalized citizens, including sexual and gender minorities (SGMs) and cisgender women. Gender-blind programs are known to augment harms associated with violence and structural stigmatization by reinforcing rather than challenging unequal systems of power. The intersecting marginalization of these populations with systems of class, race, and settler-colonialism is exacerbating the impact that policies such as physical distancing, school closures, and a realignment of healthcare priorities are having on the wellbeing of these populations. The overarching reasons why women and SGM are marginalized are well known and stem from a hegemonic, patriarchal system that fails to fully integrate these groups into planning and decision making regarding public health programming-including the response to COVID-19. In this perspective, we aim to highlight how the exclusion of cisgender women and SGM, and failure to use a gender redistributive/transformative approach, has (i) hampered the recovery from the pandemic and (ii) further entrenched the existing power structures that lead to the marginalization of these groups. We also argue that COVID-19 represents a once-in-a-century opportunity to realign priorities regarding health promotion for cisgender women and SGM by using gender redistributive/transformative approaches to the recovery from the pandemic. We apply this framework, which aims to challenge the existing power structures and distribution of resources, to exemplars from programs in health, housing, employment, and incarceration to envision how a gender redistributive/transformative approach could harness the COVID-19 recovery to advance health equity for cisgender women and SGM.

Political partisanship and stigma against people who use drugs in opinions about allocating COVID-19 prevention resources to vulnerable populations

Background

The distribution of resources during the COVID-19 pandemic has been politicized and contentious in the United States. Vulnerable populations, such as those living in poverty, experiencing homelessness, or who use drugs, are particularly susceptible to becoming infected with COVID-19 and often have limited access to protective supplies, such as masks and hand sanitizer. Our aim was to understand public opinion on increasing the allocation of COVID-19 prevention resources to vulnerable populations.

Methods

Data were from an online survey of 680 United States adults. Participants’ opinions on the allocation of COVID-19 prevention resources to people with low income, experiencing homelessness, or who use drugs were assessed using a five-item Likert scale. We examined the prevalence of these opinions and their relationship to sociodemographic characteristics, COVID-19 beliefs, and drug-related experiences.

Results

Most participants supported increasing resources for individuals with low incomes (79.6%) and experiencing homelessness (74.6%), while a minority supported increasing resources for people who use drugs (33.5%). Politically conservative participants were less likely to support increasing resources for all three populations than those who were politically liberal. Skepticism about the severity of COVID-19 was also associated with less support for increasing resources across groups.

Discussion

Our results demonstrate that people who use drugs continue to be stigmatized in the context of the COVID-19 pandemic, resulting in popular opinion not supporting people who use drugs with potentially lifesaving resources. Overcoming this stigma is essential to prevent COVID-19 among people who use drugs, a population which experiences elevated risk of COVID-19 infection.

Evolution of the Illegal Substances Market and Substance Users' Social Situation and Health during the COVID-19 Pandemic

The outbreak of the COVID-19 pandemic and the measures taken for tackling it had the potential to lead to deep modifications in the supply of illegal drugs and to impact substance users’ health and social situation. To investigate this, we used mixed methods, i.e., quantitative data collected with a brief questionnaire from substance users receiving opioid agonist treatment in a treatment centre in Switzerland (N = 49), and qualitative data obtained using semi-structured phone interviews among a sub-group of participants (N = 17). We repeated data collection twice over four weeks to investigate trends over time (N = 51 and 14 at wave 2). Findings consistently showed the limited impact of the COVID-19 outbreak on the illegal substance market. Over the two waves, the supply, price and purity of three main illegal substances did not significantly vary. Substance use was estimated as usual by most, trending toward a decrease. The impact of the pandemic on participants’ social situation and health was appraised as low to medium. Nevertheless, a minority of participants reported higher impact and multivariate analyses showed a more important impact for those who were female, younger, and not using multiple substances. This process was implemented quickly and provided an understanding of the short-term impact of the pandemic on drug markets and users.

Expected Impacts of COVID-19: Considering Resource-Limited Countries and Vulnerable Population

Coronavirus disease in 2019 emerged in Wuhan, Hubei Province, China, in December 2019. After a month, it was declared a global threat to public health. The effects of the pandemic could be socio-economic, undermining the health system and risking livelihoods. Vulnerability to this infection has been associated with underlying comorbidities such as hypertension, diabetes, coronary heart disease, chronic respiratory diseases, cancer, and compromised immune systems. Co-morbidity has been common to the elderly, the disabled, and the homeless. In addition, more severe coronavirus disease outcomes have been reported in older males than females. Nonetheless, multiple variables are related to the concept of cultural gender that should be taken into account as women in more affected sectors are economically disadvantageous and over-represented. Similarly, although children are not the face of this pandemic, calamity has a profound effect on their welfare, especially for those living in poor and inconvenient situations. Moreover, the economic influence could be profound and universal when viewed through a migration lens as it is exacerbating xenophobic and discriminatory treatment. Protection measures to mitigate the outbreak of a pandemic, such as social distancing, may reduce social support for certain categories relied on for their day-to-day activities. The mental health of people would definitely be affected by the additional psychosocial burden of the pandemic, particularly in vulnerable groups. Integrated approaches are therefore mandatory to assist these groups and contain the pandemic.

Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: The role of COVID-19-related stress, social isolation, and financial strain

BACKGROUND

There are significant concerns about mental health problems occurring due to the coronavirus disease 2019 (COVID-19) pandemic. To date, there has been limited empirical investigation about thoughts of suicide and self-harm during the COVID-19 pandemic.

METHODS

A national survey was conducted May 2020 to investigate the association between mental health symptoms, social isolation, and financial stressors during the COVID-19 pandemic and thoughts of suicide and self-harm. A total of 6607 US adults completed an online survey; survey criteria included an age minimum of 22 years old and reported annual gross income of $75,000 or below. Statistical raking procedures were conducted to more precisely weight the sample using US Census data on age, geographic region, sex, race, and ethnicity.

RESULTS

COVID-19-related stress symptoms, loneliness, and financial strain were associated with thoughts of suicide/self-harm in multivariable logistic regression analyses, as were younger age, being a military veteran, past homelessness, lifetime severe mental illness, current depressive symptoms, alcohol misuse, and having tested positive for COVID-19. Greater social support was inversely related to thoughts of suicide/self-harm whereas running out of money for basic needs (e.g., food), housing instability (e.g., delaying rent), and filing for unemployment or disability were positively related.

CONCLUSIONS

Public health interventions to decrease risk of suicide and self-harm in the wake of the COVID-19 pandemic should address pandemic-related stress, social isolation, and financial strain experienced including food insecurity, job loss, and risk of eviction/homelessness.

Dispositional optimism, stress, post-traumatic stress disorder and post-traumatic growth in Greek general population facing the COVID-19 crisis

The aim of this study is to explore psychological and mental health implications of social distancing and lockdown, in Greece in order to gain a better understanding of the COVID-19 crisis. For the purposes of this article, quantitative measures are used: the Greek versions of "Life Orientation Scale-Revised" (LOT-R) (Lyrakos, Damigos, Mavreas, Georgia, & Dimoliatis, 2010) to investigate the presence of dispositional optimism tendencies, "Impact of Event scale" (Mystakidou, Tsilika, Parpa, Galanos, & Vlahos, 2007) to assess the traumatic evaluation of the current events, "Perceived Stress Scale" (Andreou et al., 2011) to measure the stress levels amongst population, and "Posttraumatic Growth Inventory" (Mystakidou, Tsilika, Parpa, Galanos, & Vlahos, 2008) to examine positive aspects of the situation, are used. Questionnaires were distributed online a month after social distancing measures and three weeks following lockdown. The survey is addressed to general adult population and data collection lasted until the end of curfew (May 4th 2020). Hundred and sixty-seven (N = 167) participants completed the survey. Main results show that women obtain higher scores than men on the Impact Event Scale and they identify social distancing and curfew as traumatic events. However, men exhibit higher levels of Posttraumatic growth comparing to women, as to subscales "life appreciation" and "spirituality". Stress and posttraumatic stress are highly correlated to PTG and enable its development in the context of COVID-19. Implications for research and practice will be recommended.

Biobehavioral Aspects of the COVID-19 Pandemic: A Review

OBJECTIVE

This review highlights the scope and significance of the coronavirus disease 2019 (COVID-19) pandemic with a focus on biobehavioral aspects and critical avenues for research.

METHODS

A narrative review of the published research literature was undertaken, highlighting major empirical findings emerging during the first and second waves of the COVID-19 pandemic.

RESULTS

Interactions among biological, behavioral, and societal processes were prominent across all regions of the globe during the first year of the COVID-19 emergency. Affective, cognitive, behavioral, socioeconomic, and technological factors all played a significant role in the spread of infection, response precautions, and outcomes of mitigation efforts. Affective symptoms, suicidality, and cognitive dysfunction have been widely described consequences of the infection, the economic fallout, and the necessary public health mitigation measures themselves. The impact of COVID-19 may be especially serious for those living with severe mental illness and/or chronic medical diseases, given the confluence of several adverse factors in a manner that appears to have syndemic potential.

CONCLUSIONS

The COVID-19 pandemic has made clear that biological and behavioral factors interact with societal processes in the infectious disease context. Empirical research examining mechanistic pathways from infection and recovery to immunological, behavioral, and emotional outcomes is critical. Examination of how emotional and behavioral factors relate to the pandemic-both as causes and as effects-can provide valuable insights that can improve management of the current pandemic and future pandemics to come.

The National Academy of Medicine Social Care Framework and COVID-19 Care Innovations

Despite social care interventions gaining traction in the US healthcare sector in recent years, the scaling of healthcare practices to address social adversity and coordinate care across sectors has been modest. Against this backdrop, the coronavirus pandemic arrived, which re-emphasized the interdependence of the health and social care sectors and motivated health systems to scale tools for identifying and addressing social needs. A framework on integrating social care into health care delivery developed by the National Academies of Science, Engineering, and Medicine provides a useful organizing tool to understand the social care integration innovations spurred by COVID-19, including novel approaches to social risk screening and social care interventions. As the effects of the pandemic are likely to exacerbate socioeconomic barriers to health, it is an appropriate time to apply lessons learned during the recent months to re-evaluate efforts to strengthen, scale, and sustain the health care sector's social care activities.