COVID-19 and children's health in the United States: Consideration of physical and social environments during the pandemic

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

BACKGROUND

Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus.

METHODS

In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures.

RESULTS

We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression.

CONCLUSIONS

The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

Pandemic play moderates the relation between caregiver stress and child emotional distress in contexts of economic adversity

It is well-established that caregiver stress is linked to increased emotional distress among children, and recent evidence highlights similar associations between caregiver and child emotional well-being during the coronavirus (COVID-19) pandemic. Examining protective factors and coping mechanisms that are associated with resiliency in the face of pandemic-related stress can highlight potential strategies that may help children adapt to other unexpected hardships outside of a global pandemic. Previous research found that playing about the pandemic moderated an association between caregiver stress and children's emotional distress. However, few studies have explored "pandemic play" among children from low-income households, where pandemic-related stressors were often exacerbated. In the present study, 72 caregivers of Head Start preschoolers between 3 and 6  years of age were surveyed between late 2020 and early 2021. Results revealed that 32% of children engaged in pandemic play frequently. Caregiver stress was positively associated with child emotional distress, but only among children who did not engage in pandemic play frequently. These findings support the idea that child-directed play may be a developmentally appropriate and accessible coping mechanism to reduce the emotional burden of stressful events on children, regardless of economic context.

Effects of short-term quarantine on growth and development of children aged 1-36 months during the Omicron outbreak

Consequences of epidemic quarantine on children's well-being are not clear and there are scarce data about the short-term impact of epidemic quarantine on children's growth and development. The study aimed to explore and analyze the potential impacts of the Omicron outbreak on children's growth and development during the lockdown in Shanghai, China. Totally, 4565 children aged 1-36 months who had a routine physical examination in the child health departments of hospitals before (June 1, 2021, to July 6, 2021) and after (June 1, 2022, to July 6, 2022) Shanghai's lockdown were included in this study. A population-based cross-sectional study was conducted by using the Infant Toddler Growth Development Screening Test (ITGDST). The children's growth and development in these two periods were compared with a propensity score matching (PSM) approach. After 1:1 matching, a total of 2462 children aged 1-36 months were analyzed. After PSM, there was no significant difference in terms of overall development, gross motor, fine motor, and language development for children before and after the Omicron lockdown. However, statistically significant decrease of wasting was observed for children after the lockdown (p < 0.05). Further interaction analysis indicated older age group (OR = 0.26, 95% CI 0.11-0.59) and the group of second parity (OR = 0.30, 95% CI 0.11-0.83) were favorable to language development during the lockdown.  Conclusion: Short-term quarantine had no significant adverse, but rather beneficial, effects on growth and development of children aged 1-36 months during the Omicron epidemic in Shanghai, China. What is Known: • Consequences of epidemic quarantine on children's well-being are not clear. Long-term psychological effects of coronavirus disease 2019 pandemic on children have been reported. However, there are scarce data about the short-term impact of epidemic quarantine on children's growth and development. What is New: • Short-term quarantine had no significant adverse, but rather beneficial, effects on growth and development of children aged 1-36 months during the Omicron epidemic in Shanghai, China.

Family Economics and Mental Health Among High-School Students During COVID-19

INTRODUCTION

The COVID-19 pandemic has had unprecedented socioeconomic and health impacts in the U.S. This study examined racial/ethnic and school poverty status differences in the relationship between parent job loss, experiences with hunger, and indicators of mental health problems among public high-school students nationwide during the COVID-19 pandemic.

METHODS

The study analyzed data from the Adolescent Behaviors and Experiences Survey, conducted in January-June 2021. The Adolescent Behaviors and Experiences Survey was a 1-time, cross-sectional, online survey that used a stratified, 3-stage cluster sample to obtain a nationally representative sample of high-school students in the U.S. This study was limited to public-school students (n=7,379).

RESULTS

Among public high-school students nationwide, 36.9% experienced poor mental health during the pandemic, and during the past year, 43.9% experienced persistent feelings of sadness or hopelessness, 19.8% seriously considered attempting suicide, and 9.1% attempted suicide. Parent job loss and having gone hungry were associated with indicators of mental health problems overall and across racial/ethnic groups and school poverty status levels.

CONCLUSIONS

Students who experience parent job loss and hunger are likely to also experience poor mental health and may be at higher risk for suicide.

The Resilience of Caregivers and Children in the Context of COVID-19: A Systematic Review

The COVID-19 pandemic has necessitated caregivers and school-aged children to adapt to ongoing changes and uncertainty. Understanding why some caregivers and school-aged children area able to adapt and others are not could be attributed to resilience. The relationships between caregiver or child resilience and socioeconomic status (SES) in the context of COVID-19 remain largely un-explored. Therefore, the purpose of this qualitative systematic review was to explore (1) what is currently known about the relationship between caregiver and child resilience in the context of COVID-19; and (2) the role of SES on caregiver or child resilience throughout the COVID-19 pandemic. Four databases (i.e., MEDLINE, Scopus, PsycINFO, and CINAHL) were systematically searched, title/abstract and full-text screening were conducted, and 17 articles met the inclusion criteria (i.e., discussed resilience of caregivers/children during COVID-19, mean age of children between 7-10, primary research/grey literature, English), including 15 peer-reviewed and two grey literature sources. Thematic analysis revealed five themes: (1) the mitigating effects of child resilience; (2) overcoming the psychological toll of the pandemic; (3) the unknown relationship: caregiver and child resilience; (4) family functioning during COVID-19; and (5) the perfect storm for socioeconomic impacts. Results from this review provide the first synthesis of the impact of the COVID-19 pandemic on the resilience of caregivers and school-aged children. Future research should conduct longitudinal data collection to understand the possible long-term impacts of the pandemic on these populations' resilience. Understanding these impacts will be integral to assisting families in bouncing back from the long-lasting adverse circumstances caused by the COVID-19 pandemic.

Child Flourishing, School Engagement, Physical Activity, and Screen Time During the Coronavirus Disease 2019 Pandemic in 2020

OBJECTIVE

To examine changes in flourishing, school engagement, physical activity, and recreational screen time among school-aged children in the United States during the Coronavirus Disease 2019 (COVID-19) pandemic in 2020.

METHODS

In this cross-sectional study, data come from the 2018-2020 National Survey of Children's Health for 68,203 children aged 6 to 17 years. Flourishing is always/usually curious to learn, resilient and having self-regulation. School engagement is always/usually completing homework and having interest in doing well in school. Other outcomes are daily 60+ minutes physical activity or number of such days, and daily recreational screen time or 2+ hours/day. Weighted regression models compare 2020 to 2019 and 2019 to 2018 adjusting for child/household covariates and state indicators.

RESULTS

Among children age 6 to 17 years in 2020, there was a decline in flourishing (OR = 0.69; 95% CI, 0.63, 0.75), school engagement (OR = 0.71; 95% CI, 0.64, 0.79), physically active days (0.26 days, 95% CI, 35, 0.17), and daily 60+ minutes activity (OR = 0.91; 95% CI, 0.83, 1.00), and increase in daily recreational screen time (0.29 hours; 95% CI, 0.25, 0.34) and 2+ hours/day (OR = 1.65; 95% CI, 1.49-1.83) compared to 2019. These differences were observed across all evaluated demographic and socioeconomics subgroups. There were no significant differences between 2019 and 2018, indicating that the 2020-2019 differences were related to the pandemic rather than a continuation of prepandemic trends.

CONCLUSIONS

Children's flourishing, school engagement, and physical activity declined while recreational screen time increased during the COVID-19 pandemic in 2020. Monitoring these outcomes in the long-run is important to assessing needs and promoting children's learning and development.

The influence of home and environmental characteristics on 5-18 years old children's health during the COVID-19 pandemic: A cross-sectional study in Iran

Background

The coronavirus disease (COVID-19) pandemic has dramatically changed the health and wellbeing of children. Therefore, this study aimed to investigate the relationship between the home environment and the environmental characteristics on 5-18 years old children health in Iran.

Method

An online survey was conducted among parents of children aged 5 to 18 living in large cities in Iran in 2021. The statistical population of this cross-sectional study was 500 people. In this survey, questionnaires on the quality of the home environment, exterior and interior landscapes of homes, and the Child Health Questionnaire (CHQ) were used to investigate the relationship between the home environment and environmental characteristics on 5-18 years old children health during the COVID-19 pandemic. The t-test and analysis of variance were used in SPSS 24, and the structural equation modeling (SEM) was utilized in AMOS 24 for analyzing the data.

Results

The average age of respondents was 37.13 ± 7.20, and that of children was 11.57 ± 3.47. 73.02% of the families were covered by insurance, and 74.08% of them lived in the metropolis. In addition, 65.04% of the families complied with the restrictions of the quarantine period. A share of 31% of the families live in villas, and 55% paid more attention to cleaning their homes during the COVID-19 pandemic than before. A positive and significant statistical relationship (β = 0.414, p < 0.001) was observed between the residence environment and child health. Thus, explained 17.5% of variations in child health.

Conclusion

The results showed that the children who lived in homes with an exterior landscape in nature had better health. In addition, the 5-18 years old children whose home landscape was a garden, compared to the other two groups (yard, balcony), had better health. Gardens are a potential source of health and not necessarily replaced by other natural environments, thus providing them along with green space is one of the crucial issues that should be considered.

The effects of COVID-19 transmission on environmental sustainability and human health: Paving the way to ensure its sustainable management

The transmission dynamics and health risks of coronavirus disease 2019 (COVID-19) pandemic are inextricably linked to ineract with environment, climate, air pollution, and meteorological conditions. The spread of COVID-19 infection can thus perturb the 'planetary health' and livelihood by exerting impacts on the temporal and spatial variabilities of environmental pollution. Prioritization of COVID-19 by the health-care sector has been posing a serious threat to economic progress while undermining the efforts to meet the United Nations' Sustainable Development Goals (SDGs) for environmental sustainability. Here, we review the multifaceted effects of COVID-19 with respect to environmental quality, climatic variables, SDGs, energy resilience, and sustainability programs. It is well perceived that COVID-19 may have long-lasting and profound effects on socio-economic systems, food security, livelihoods, and the 'nexus' indicators. To seek for the solution of these problems, consensus can be drawn to establish and ensure a sound health-care system, a sustainable environment, and a circular bioeconomy. A holistic analysis of COVID-19's effects on multiple sectors should help develop nature-based solutions, cleaner technologies, and green economic recovery plans to help maintain environmental sustainability, ecosystem resilience, and planetary health.

How Do Perceived Changes in Child and Adolescent Activities Relate to Perceptions of Health during COVID-19? Exploring Heterogeneity during the Pandemic

COVID-19 affected child/adolescent activities (e.g., extra-curricular, screen time), along with physical health (PH) and mental health (MH); however, less is known about the relationship between changes in activities and PH and MH in the United States and how these relationships vary by race/ethnicity. To address this gap, data were used from a national survey (Socio-Economic Impacts of COVID-19 Survey) administered May-June 2021 (n = 853). Multinomial logistic regression explored changes in outdoor, school, extracurricular, friend, and screen time activities with changes in PH and MH; interactions explored moderation by race/ethnicity. Results showed increases in outdoor (RRR 2.36, p = 0.003), school (RRR 3.07, p < 0.001), and extracurricular activities (RRR 3.05, p < 0.001), which were associated with increases in chances of better PH. Better MH was more likely for children/adolescents where friend activities (RRR 3.34, p < 0.001) and extracurriculars (RRR 4.48, p < 0.001) increased. Except for extracurriculars, heterogeneous relationships were observed (e.g., increases and decreases in activities were simultaneously related to better and worse health). The relationship between outdoor activities and screen time with health were moderated by race/ethnicity. Findings support facilitating outdoor, school, extracurricular, and friend activities, which were positively related to health. Given heterogeneity and variation by race/ethnicity, more research is needed to understand the complex relationship between activities and health during COVID-19.

Race, Ethnicity, and Health Disparities in US Children With COVID-19: A Review of the Evidence and Recommendations for the Future

Coronavirus disease 2019 (COVID-19) is an important cause of morbidity in children in the United States (U.S.). Moreover, the U.S. has witnessed significant disparities affecting American Indian/Alaska Native, Black, and Hispanic/Latino children, stemming from systemic racism and social-structural inequalities and not differences in innate biological susceptibility. We review what is known on COVID-19 and health disparities in disease burden, access to care, pharmaceutical interventions, and clinical research in children, with a focus on the U.S. context. In addition, we propose strategies to communicate scientific data in ways that do not promote racism and biological susceptibility themes, and to address pediatric disparities in clinical infectious diseases research.

Impacts of exposure to air pollution, radon and climate drivers on the COVID-19 pandemic in Bucharest, Romania: A time series study

During the ongoing global COVID-19 pandemic disease, like several countries, Romania experienced a multiwaves pattern over more than two years. The spreading pattern of SARS-CoV-2 pathogens in the Bucharest, capital of Romania is a multi-factorial process involving among other factors outdoor environmental variables and viral inactivation. Through descriptive statistics and cross-correlation analysis applied to daily time series of observational and geospatial data, this study aims to evaluate the synergy of COVID-19 incidence and lethality with air pollution and radon under different climate conditions, which may exacerbate the coronavirus' effect on human health. During the entire analyzed period 1 January 2020-21 December 2021, for each of the four COVID-19 waves were recorded different anomalous anticyclonic synoptic meteorological patterns in the mid-troposphere, and favorable stability conditions during fall-early winter seasons for COVID-19 disease fast-spreading, mostly during the second, and the fourth waves. As the temporal pattern of airborne SARS-CoV-2 and its mutagen variants is affected by seasonal variability of the main air pollutants and climate parameters, this paper found: 1) the daily outdoor exposures to air pollutants (particulate matter PM2.5 and PM10, nitrogen dioxide-NO₂, sulfur dioxide-SO₂, carbon monoxide-CO) and radon - ²²²Rn, are directly correlated with the daily COVID-19 incidence and mortality, and may contribute to the spread and the severity of the pandemic; 2) the daily ground ozone-O₃ levels, air temperature, Planetary Boundary Layer height, and surface solar irradiance are anticorrelated with the daily new COVID-19 incidence and deaths, averageingful for spring-summer periods. Outdoor exposure to ambient air pollution associated with radon is a non-negligible driver of COVID-19 transmission in large metropolitan areas, and climate variables are risk factors in spreading the viral infection. The findings of this study provide useful information for public health authorities and decision-makers to develop future pandemic diseases strategies in high polluted metropolitan environments.

Noise complaint patterns in New York City from January 2010 through February 2021: Socioeconomic disparities and COVID-19 exacerbations

BACKGROUND

Excessive environmental noise exposure and noise annoyance have been linked to adverse physical and mental health outcomes. Although socioeconomic disparities in acoustically measured and geospatially estimated noise have been established, less is known about disparities in noise complaints, one of the most common sources of distress reported to local municipalities. Furthermore, although some studies have posited urban quieting during the COVID-19 pandemic, little empirical work has probed this and probed noise complaints during the pandemic.

OBJECTIVES

Using over 4 million noise complaints from the New York City (NYC) 311 database, we quantified census tract-level socioeconomic disparities in noise complaints since 2010 and examined how such disparities changed during the COVID-19 pandemic.

METHODS

Using data from January 2010 through February 2020, we fit linear mixed-effects models, estimating monthly tract-level noise complaints by the proportion of residents who were low-income, time in months since January 2010, categorical month, their interactions, and potential confounds, such as total population and population density. To estimate COVID-19 pandemic effects, we included additional data from March 2020 through February 2021 and additional interactions between proportion low-income, month of year, and an indicator variable for COVID-19 pandemic onset in March 2020.

RESULTS

Census tracts with a higher proportion of low-income residents reported more monthly noise complaints and this increased over time (time × month × proportion low-income interaction p-values < .0001 for all months), particularly in warmer months. Socioeconomic disparities in noise complaints were exacerbated during the COVID-19 pandemic (month × proportion low-income × pandemic era interaction p-values < .0001 for March through November), also in a seasonal manner.

DISCUSSION

Since 2010, noise complaints have increased the most in the most economically distressed communities, particularly in warmer seasons. This disparity was particularly exacerbated during the COVID-19 pandemic, contrary to some theories of urban quieting. Community-based interventions to ameliorate noise and noise annoyance, both public health hazards, are needed in underserved communities.

Global Research Trends in Pediatric COVID-19: A Bibliometric Analysis

Background

Coronavirus disease 2019 (COVID-19) emerged in 2019 and has since caused a global pandemic. Since its emergence, COVID-19 has hugely impacted healthcare, including pediatrics. This study aimed to explore the current status and hotspots of pediatric COVID-19 research using bibliometric analysis.

Methods

The Institute for Scientific Information Web of Science core collection database was searched for articles on pediatric COVID-19 to identify original articles that met the criteria. The retrieval period ranged from the creation of the database to September 20, 2021. A total of 3,561 original articles written in English were selected to obtain data, such as author names, titles, source publications, number of citations, author affiliations, and countries where the studies were conducted. Microsoft Excel (Microsoft, Redmond, WA) was used to create charts related to countries, authors, and institutions. VOSviewer (Center for Science and Technology Studies, Leiden, The Netherlands) was used to create visual network diagrams of keyword, author, and country co-occurrence.

Results

We screened 3,561 publications with a total citation frequency of 30,528. The United States had the most published articles (1188 articles) and contributed the most with author co-occurrences. The author with the most published articles was Villani from the University of Padua, Italy. He also contributed the most co-authored articles. The most productive institution was Huazhong University of Science and Technology in China. The institution with the most frequently cited published articles was Shanghai Jiao Tong University in China. The United States cooperated most with other countries. Research hotspots were divided into two clusters: social research and clinical research. Besides COVID-19 and children, the most frequent keywords were pandemic (251 times), mental health (187 times), health (172 times), impact (148 times), and multisystem inflammatory syndrome in children (MIS-C) (144 times).

Conclusion

Pediatric COVID-19 has attracted considerable attention worldwide, leading to a considerable number of articles published over the past 2 years. The United States, China, and Italy have leading roles in pediatric COVID-19 research. The new research hotspot is gradually shifting from COVID-19 and its related clinical studies to studies of its psychological and social impacts on children.

Lessons of the Pandemic for Family and School—The Challenges and Prospects of Network Education

The article contains the study results of the problems with the accessibility and safety of educational resources, applications, and tools of distance educational technologies for schoolchildren during the period of distance learning. In the framework of the study, the focus was also on the satisfaction of the subjects of educational relations with the services of providers and the support system for educational institutions during the COVID-19 pandemic in Moscow. The article identifies the key challenge to contemporary education—are schools capable of reworking and integrating all the achievements and breakthroughs of distance learning? The results show that when implementing distance learning, it is necessary to take account of the threats and risks that it entails—(1) the barrier of technological innovation; (2) the barrier of social factors; (3) the barrier to physical and psychological health; (4) the barrier of digital didactics; (5) the barrier of legal regulation; (6) the barrier of an inclusive environment. The study results can become the basis for the preparation of proposals and the development of recommendations to provide access to high-quality education for all schoolchildren in the context of distance learning.

"It's Very Stressful for Children": Elementary School-Aged Children's Psychological Wellbeing during COVID-19 in Canada

Emerging evidence suggests that the COVID-19 pandemic and associated public health measures, including lockdowns and school closures, have been negatively affecting school-aged children’s psychological wellbeing. To identify supports required to mitigate the negative impacts of the COVID-19 pandemic, we gathered in-depth information on school-aged children’s and parents’ lived experiences of COVID-19 and perceptions of its impact on psychological wellbeing in grade 4–6 students in Canada. In this qualitative study, we conducted telephone-based semi-structured interviews with parents (n = 15) and their children (n = 16) from six schools in small and mid-sized northern prairie communities in Canada. Interviews were analyzed through thematic analysis. Three interrelated themes have emerged. First, the start of COVID-19 brought sudden and stressful changes to children’s lives. Second, disruptions to daily life led to feelings of boredom and lack of purpose. Third, limited opportunities for social interaction led to loneliness and an increase in screen time to seek social connection with peers. Results underscore the need for resilience building and the promotion of positive coping strategies to help school-aged children thrive in the event of future health crises or natural disasters.

Children Are Back to School, but Is Play Still in Lockdown? Play Experiences, Social Interactions, and Children's Quality of Life in Primary Education in the COVID-19 Pandemic in 2020

The right to play is crucial for the overall development of children. Several studies highlight the need to have time and space to play, especially at school where children spend much of their time. Unfortunately, in formal education the obsession with academic achievements sidelines and ignores the importance of play. The neglection of play had already reached a critical stage before the pandemic, so data are needed to realize how the right to play in school is presently affected. This paper aims to understand children’s play experience in primary education during the pandemic. It investigates what activities children participated in and what materials were used, and provides insight into the social interactions between peers. Furthermore, children’s quality of life is explored. A group of 370 Portuguese children answered a questionnaire on play and social interactions, alongside with Peds 4.0^TM on health-related quality of life (HRQOL). The results showed that recess still emerges as a significant element of children’s daily lives, but COVID-19 has brought limitations on play experiences and peer-interaction. It might also have impacted HRQOL, especially in emotional functioning. Since play, health and well-being are closely connected, play opportunities at school are crucial in helping children to thrive in the pandemic, and should be invested in.

Comparison of Different Waves during the COVID-19 Pandemic: Retrospective Descriptive Study in Thailand

Background

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. An outbreak is called an epidemic when there is a sudden increase in cases. Many countries have experienced a two-wave pattern in the reported cases of COVID-19. The spread of COVID-19 in Thailand was a cluster event distributed over multiple locations. This study aims to compare the characteristics of different waves during the COVID-19 pandemic in Thailand.

Methods

A retrospective cohort study was conducted from January 2020 to May 2021 (17 months) to determine the number of COVID-19 screenings and confirmed cases and deaths as well as sociodemographic characteristics such as gender, age, nationality, and source population at risk factors. The categorical data were compared using a chi-square test.

Results

Three waves of the COVID-19 pandemic occurred within 17 months in Thailand, and the number of cases increased by over 100,000 due to source population at risk factors such as close contact with a previously confirmed patient, community risk, cluster communities, and active and community surveillance. The chi-square test revealed significant differences between the three waves (p < 0.01).

Conclusion

Significant differences between pandemic phases or waves may be due to weak social distancing policies and the lack of public health interventions. A COVID-19 vaccination plan is needed for people at risk of suffering severe symptoms and the general population in outbreak areas to increase immunity.

SARS-CoV-2 and other pathogenic microorganisms in the environment

The title of the Virtual Special Issue (VSI) "SARS-CoV-2 and other pathogenic microorganisms in the environment", clearly indicates a main focus not only on the virus causing the current pandemic, but also on other pathogenic microorganisms and their spatial and temporal dynamics in environmental compartments. Overall, the VSI has received more than 100 submissions relating to most of the possible fields connected to the pandemic, many of them of high scientific value. A rigorous peer-reviewing process has been carried out, with a panel of experts making a great work to evaluate that important number of submissions. As a result, those manuscripts reaching the highest scientific standards were selected for publication. We think that the papers included constitute a set of high-quality contributions, which should help to improve the overall scientific perspective regarding this crucial issue. In this piece, the Editors comment some issues on the papers accepted for publication, and include additional reflections.

COVID-19 Medical Vulnerability Indicators: A Predictive, Local Data Model for Equity in Public Health Decision Making

This article reports the outcome of a project to develop and assess a predictive model of vulnerability indicators for COVID-19 infection in Los Angeles County. Multiple data sources were used to construct four indicators for zip code tabulation areas: (1) pre-existing health condition, (2) barriers to accessing health care, (3) built environment risk, and (4) the CDC's social vulnerability. The assessment of the indicators finds that the most vulnerable neighborhoods are characterized by significant clustering of racial minorities. An overwhelming 73% of Blacks reside in the neighborhoods with the two highest levels of pre-existing health conditions. For the barriers to accessing health care indicator, 40% of Latinx reside in the highest vulnerability places. The built environment indicator finds that selected Asian ethnic groups (63%), Latinx (55%), and Blacks (53%) reside in the neighborhoods designated as high or the highest vulnerability. The social vulnerability indicator finds 42% of Blacks and Latinx and 38% of selected Asian ethnic group residing in neighborhoods of high vulnerability. The vulnerability indicators can be adopted nationally to respond to COVID-19. The metrics can be utilized in data-driven decision making of re-openings or resource distribution such as testing, vaccine distribution and other pandemic-related resources to ensure equity for the most vulnerable.