Life under lockdown: Illustrating tradeoffs in South Africa's response to COVID-19

Co-creation of a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in Mopani District, Limpopo Province: nominal group technique

Introduction

Effective supply chain management (SCM) of point-of-care (POC) tests for diseases like severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) requires active participation from diverse stakeholders, government entities, and regulatory bodies. The responsibility for overseeing various aspects of POC tests, including procurement, quality assurance, storage, inventory management, distribution, and human resource capacity, lies with national, provincial, and local levels of government. This study aimed to collaboratively develop an innovative approach to enhance SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings, using the Mopani District in Limpopo province, South Africa, as a case study.

Methods

Key stakeholders were invited to participate in an online workshop using purposive sampling. The study employed the nominal group technique (NGT) for data collection, which consisted of two phases. Phase 1 focused on identifying barriers in the supply chain of COVID-19 rapid tests, while phase 2 aimed to devise strategies to overcome the priority barriers identified in phase 1. Participants used a Likert scale of 1-5 to rank barriers and strategies, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback.

Results

Eleven key stakeholders from national (n = 1), provincial (n = 4), and local government (n = 2) levels, research entities (n = 3), and non-governmental organizations (n = 1) took part in the study. Participants identified significant barriers in the supply chain, such as the availability of testing kits, unknown demand, information on SCM during a pandemic, methods of controlling stock, and procurement processes. Strategies suggested by key stakeholders included monitoring stock levels and optimizing stock visibility systems to improve test availability, enhancing information visibility and consistent data updates to address unknown demand and improve SCM during a pandemic, employing data capturing and digitization for effective stock control, and implementing demand planning and standardized procurement processes at the national level to enhance stock procurement.

Discussion

The successful collaboration with key stakeholders, facilitated by the NGT, resulted in the co-creation of a novel approach to enhance SCM for COVID-19 diagnostic services in resource-limited settings. This study holds the potential to support the provision of COVID-19 diagnostic services in such settings. A recommended follow-up study would assess the feasibility of implementing this approach.

The lived experiences of tuberculosis survivors during the COVID-19 pandemic and government lockdown in South Africa: a qualitative analysis

BACKGROUND

Tuberculosis (TB) is a major health concern in South Africa, where prior to COVID-19 it was associated with more deaths than any other infectious disease. The COVID-19 pandemic disrupted gains made in the global response to TB, having a serious impact on the most vulnerable. COVID-19 and TB are both severe respiratory infections, where infection with one places individuals at increased risk for negative health outcomes for the other. Even after completing TB treatment, TB survivors remain economically vulnerable and continue to be negatively affected by TB.

METHODS

This cross-sectional qualitative study, which was part of a larger longitudinal study in South Africa, explored how TB survivors' experienced the COVID-19 pandemic and government restrictions. Participants were identified through purposive sampling and were recruited and interviewed at a large public hospital in Gauteng. Data were analyzed thematically, using a constructivist research paradigm and both inductive and deductive codebook development.

RESULTS

Participants (n = 11) were adults (24-74 years of age; more than half male or foreign nationals) who had successfully completed treatment for pulmonary TB in the past two years. Participants were generally found to be physically, socioeconomically, and emotionally vulnerable, with the COVID-19 pandemic exacerbating or causing a recurrence of many of the same stressors they had faced with TB. Coping strategies during COVID similarly mirrored those used during TB diagnosis and treatment, including social support, financial resources, distraction, spirituality, and inner strength.

CONCLUSIONS

Implications and suggestions for future directions include fostering and maintaining a strong network of social support for TB survivors.

Coping strategies employed by public psychiatric healthcare workers during the COVID-19 pandemic in southern Gauteng, South Africa

Within the context of the novel coronavirus pandemic and new challenges to a resource-constrained public healthcare system, many healthcare workers in South Africa have faced numerous stressors that have compromised their mental health. While the current literature on COVID-19 in South Africa highlights the widespread psychosocial stress experienced by healthcare workers during the pandemic, little is known about the coping strategies utilized to continue service delivery and maintain one's mental health and well-being during this ongoing public health emergency. In this study, we sought to explore the coping strategies used by healthcare workers employed in the public psychiatric care system in southern Gauteng, South Africa during the coronavirus disease (COVID-19) pandemic. Psychiatric healthcare workers (n = 55) employed in three tertiary public hospitals and two specialized psychiatric facilities participated in in-depth interviews between July 2020 and March 2021. We found that coping strategies spanned multi-level and multi-systemic efforts. Intrapersonal, interpersonal, material, and structural coping were mapped across individual, family, and hospital systems. The most commonly utilized coping strategies included positive mindsets and reappraisal, social support systems, and COVID-19 specific protections. Findings also highlighted the contextual and interconnected nature of coping. Healthcare workers applied multiple coping strategies to combat the negative mental health effects of the COVID-19 pandemic. Better understanding these strategies, contexts in which they are employed, and how they interact can be used to develop evidence-based interventions to support healthcare workers experiencing healthcare-related stressors during the COVID-19 pandemic.

Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis

BACKGROUND

Adverse childhood experiences and adult trauma, including sexual abuse, physical abuse, neglect, and interpersonal violence, are highly prevalent in low-resource settings and associated with adverse psychological outcomes. However, there is limited focus on the impact of ACEs and trauma on mental health in sub-Saharan Africa. Therefore, this study examines the impact of traumatic events and ACEs on depression, anxiety, and stress scores among outpatients receiving psychiatric care at two public mental health treatment facilities in Johannesburg, South Africa.

METHODS

A sample of 309 participants were recruited between January and June 2022 at Helen Joseph Hospital and Alexandra 18th Avenue Clinic. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 7-item General Anxiety Disorder scale (GAD-7) and the 10-item Perceived Stress Scale. We fitted modified Poisson and linear regression models to estimate the impact of ACEs and adult experiences of trauma on depression, anxiety, and stress scale scores.

RESULTS

47.57% (n = 147) of participants screened positive for anxiety, 44.66% (n = 138) for depression, and 17% (n = 54) for severe stress. More females screened positive for anxiety (65.31%), depression (65.94%), and stress (77.78%). Each ACE was associated with a 12% increased risk of depression, a 10% increased risk of anxiety, and a 17% increased risk of stress. In separately estimated models, each additional traumatic event during adulthood was associated with a 16% increased risk for depression, an 8% increased risk of anxiety, and a 26% increased risk of stress. Across all models, being male and self-reported physical health were consistently associated with a reduced risk for depression, anxiety, and stress.

CONCLUSIONS

ACEs and experiences of traumatic events as adults were associated with significantly increased risks of anxiety, depression, and severe stress. Given high exposure to ACEs and trauma and the associated impact on the mental health of individuals, families, and communities, there is a need to strengthen and scale innovative combination interventions that address multiple stressors impacting people in low-resource settings.

The lived experiences of Tuberculosis survivors during the COVID-19 pandemic and government lockdown in South Africa: a qualitative analysis

Background Tuberculosis (TB) is a major health concern in South Africa, where prior to COVID-19 it was associated with more deaths than any other infectious disease. The COVID-19 pandemic disrupted gains made in the global response to TB, having a serious impact on the most vulnerable. COVID-19 and TB are both severe respiratory infections, where infection with the one place individuals at increased risk for negative health outcomes for the other. Even after completing TB treatment, TB survivors remain economically vulnerable and continue to be negatively affected by TB. Methods This cross-sectional qualitative study, which was part of a larger longitudinal study in South Africa, explored how TB survivors' experienced the COVID-19 pandemic and government restrictions. Participants were identified through purposive sampling and were recruited and interviewed at a large public hospital in Gauteng. Data were analyzed thematically, using a constructivist research paradigm and both inductive and deductive codebook development. Results Participants (n = 11) were adults (24-74 years of age; more than half male or foreign nationals) who had successfully completed treatment for pulmonary TB in the past two years. Participants were generally found to be physically, socioeconomically, and emotionally vulnerable, with the COVID-19 pandemic exacerbating or causing a recurrence of many of the same stressors they had faced with TB. Coping strategies during COVID similarly mirrored those used during TB diagnosis and treatment, including social support, financial resources, distraction, spirituality, and inner strength. Conclusions Implications and suggestions for future directions include fostering and maintaining a strong network of social support for TB survivors.

How does COVID-19 lockdown affect air quality: Evidence from Lanzhou, a large city in Northwest China

Coronavirus disease (COVID-19) has disrupted health, economy, and society globally. Thus, many countries, including China, have adopted lockdowns to prevent the epidemic, which has limited human activities while affecting air quality. These affects have received attention from academics, but very few studies have focused on western China, with a lack of comparative studies across lockdown periods. Accordingly, this study examines the effects of lockdowns on air quality and pollution, using the hourly and daily air monitoring data collected from Lanzhou, a large city in Northwest China. The results indicate an overall improvement in air quality during the three lockdowns compared to the average air quality in the recent years, as well as reduced PM_2.5, PM₁₀, SO₂, NO₂, and CO concentrations with different rates and increased O₃ concentration. During lockdowns, Lanzhou's "morning peak" of air pollution was alleviated, while the spatial characteristics remained unchanged. Further, ordered multi-classification logistic regression models to explore the mechanisms by which socioeconomic backgrounds and epidemic circumstances influence air quality revealed that the increment in population density significantly aggravated air pollution, while the presence of new cases in Lanzhou, and medium- and high-risk areas in the given district or county both increase the likelihood of air quality improvement in different degrees. These findings contribute to the understanding of the impact of lockdown on air quality, and propose policy suggestions to control air pollution and achieve green development in the post-epidemic era.

The impact of COVID-19 on mobility choices in Switzerland

We study the effect of the COVID-19 pandemic and the associated government measures on individual mobility choices in Switzerland. Our data is based on over 1,600 people for which we observe all trips during eight weeks before the pandemic and until May 2021. We find an overall reduction of travel distances by 60 percent, followed by a gradual recovery during the subsequent re-opening of the economy. Whereas driving distances have almost completely recovered, public transport re-mains under-used. The introduction of a requirement to wear a mask in public transport had no measurable impact on ridership. The individual travel response to the pandemic varies along socio-economic dimensions such as education and house-hold size, with mobility tool ownership, and with personal values and lifestyles. We find no evidence for a significant substitution of leisure travel to compensate for the reduction in work-related travel.

Lockdown stringency and employment formality: evidence from the COVID-19 pandemic in South Africa

In response to COVID-19 most governments used some form of lockdown policy to manage the pandemic. This required making iterative policy decisions in a rapidly changing epidemiological environment resulting in varying levels of lockdown stringency over time. While studies estimating the labour market effects of lockdown policies exist in both developed and developing countries, there is limited evidence on the impact of variation in lockdown stringency, particularly in developing countries. Such variation may have large heterogenous effects both on aggregate and between worker groups. In this paper, we estimate the causal effect of lockdown stringency on employment probabilities, adopting a quasi-experimental design on unique labour force panel data from South Africa. South Africa is a useful case study given its upper-middle-income status and relatively small informal sector, thus serving as an example to a variety of developing and developed country economies. We find that the negative employment effects of the country's lockdown policy were driven by effects on the informal sector. Furthermore, we observe important effect heterogeneity by employment formality as the stringency of the country's lockdown regulations changed over time. We find that more stringent lockdown levels negatively affected informal, but not formal sector employment, while less stringent levels negatively affected formal, but not informal sector employment. From a policy perspective, evidence of such heterogeneity can inform decisions around the optimal targeting of support as the pandemic progresses and lockdown policies are reconsidered.

Does poverty increase COVID-19 in Africa? A cross-country analysis

BACKGROUND

Most economies in African countries are informal. As such, households in these countries tend to face higher levels of informality coupled with a lack of social protection, and have no replacement income or savings in the event of unexpected external shocks, such as COVID-19. Thus, the COVID-19 shock and its negative economic effects triggered a cascade of income losses and bankruptcies that pushed a significant share of households in African countries into poverty. This research analyzes the effect of poverty on the spread of COVID-19 using a sample of 52 African countries.

METHODS

To achieve the objective of this research, this paper uses a multiple linear regression model and a sample of 52 African countries observed in 2020 to conduct a cross-country analysis. More importantly, two COVID-19 indicators (total number of officially reported cases and disease severity) and six poverty indicators (average poverty, poverty incidence, poverty depth, poverty severity, multidimensional poverty index, and extreme poverty) were used in this research.

RESULTS

The results show a positive and significant relationship between poverty and the spread of COVID-19.

CONCLUSIONS

These results suggest that more attention needs to be paid to poor populations in African countries during the pandemic. These populations are generally vulnerable, and there is a need for support programs targeting them to be put in place quickly. These programs may include food aid, distribution of supplies, health care support, fee waivers, and interest deferrals. In addition, sensitization of these disadvantaged groups on vaccination against COVID-19 to achieve herd immunity is strongly encouraged.

Knowledge acquisition and precautionary behaviors for individual resilience to the COVID-19 pandemic: A study of rural Latin America

The concept of resilience gains prominence as human society faces more frequent and impactful shocks and disturbances. This study seeks to investigate how rural populations build resilience amid the COVID-19 pandemic. A simple theoretical model is presented to illustrate the determinants of knowledge acquisition and precautionary behaviors among rural residents. Based on a High Frequency Phone Survey of 10,583 Latin American adults, this study found that rural residents were less capable of using informal channels (e.g., the internet) to collect COVID-19 information. Younger generations were generally less likely to adopt precautionary behaviors than the elderly. The age disparity, however, was relatively minor for rural populations. Costly preventive measures such as staying at home are less affordable for rural residents. Meanwhile, confidence in government ensures better compliance to ensure public health guidelines. We argue that internet skills, prosociality, and political confidence are necessary to build rural residents' resilience during the pandemic.

Actions Speak Louder Than Words: Sentiment and Topic Analysis of COVID-19 Vaccination on Twitter and Vaccine Uptake

Background

The lack of trust in vaccines is a major contributor to vaccine hesitancy. To overcome vaccine hesitancy for the COVID-19 vaccine, the Australian government launched multiple public health campaigns to encourage vaccine uptake. This sentiment analysis examines the effect of public health campaigns and COVID-19–related events on sentiment and vaccine uptake.

Objective

This study aims to examine the relationship between sentiment and COVID-19 vaccine uptake and government actions that impacted public sentiment about the vaccine.

Methods

Using machine learning methods, we collected 137,523 publicly available English language tweets published in Australia between February and October 2021 that contained COVID-19 vaccine–related keywords. Machine learning methods were used to extract topics and sentiments relating to COVID-19 vaccination. The relationship between public vaccination sentiment on Twitter and vaccine uptake was examined.

Results

The majority of collected tweets expressed negative (n=91,052, 66%) rather than positive (n=21,686, 16%) or neutral (n=24,785, 18%) sentiments. Topics discussed within the study time frame included the role of the government in the vaccination rollout, availability and accessibility of the vaccine, and vaccine efficacy. There was a significant positive correlation between negative sentiment and the number of vaccine doses administered daily (r267=.15, P<.05), with positive sentiment showing the inverse effect. Public health campaigns, lockdowns, and antivaccination protests were associated with increased negative sentiment, while vaccination mandates had no significant effect on sentiment.

Conclusions

The study findings demonstrate that negative sentiment was more prevalent on Twitter during the Australian vaccination rollout but vaccine uptake remained high. Australians expressed anger at the slow rollout and limited availability of the vaccine during the study period. Public health campaigns, lockdowns, and antivaccination rallies increased negative sentiment. In contrast, news of increased vaccine availability for the public and government acquisition of more doses were key government actions that reduced negative sentiment. These findings can be used to inform government communication planning.

Urban mobility patterns and the spatial distribution of infections in Santiago de Chile

The process of a virus spread is inherently spatial. Even though Latin America became the epicenter of the COVID-19 pandemic in May 2020, there is still little evidence of the relationship between urban mobility and virus propagation in the region. This paper combines network analysis of mobility patterns in public transportation with a spatial error correction model for Santiago de Chile. Results indicate that a 10% higher number of daily public transportation trips received by an administrative unit in the city was associated with a 1.3% higher number of confirmed COVID-19 cases per 100,000 inhabitants. Following these findings, we propose an empirical method to identify and classify neighborhoods according to the level and type of risk for COVID-19-like disease propagation, helping policymakers manage mobility during the initial stages of an epidemic outbreak.

Comprehensive Literature Review on the Impacts of COVID-19 Pandemic on Public Road Transportation System: Challenges and Solutions

The COVID-19 pandemic is a significant public health problem and the leading cause of reduction in the demand and supply of public transit in the last three years. It has caused an unprecedented reduction in the demand for public road transportation, and it has changed passengers’ perceptions from positive to negative when it comes to using public transportation amenities. There is an increasing concern that the public road transportation systems are witnessing a new horizon, especially now that developed and developing countries are trying to resume their daily activities post COVID-19 pandemic. In this research, we focused on the overview of literature reviews of research within the past three years that focused on the challenges and solutions of the impact of the COVID-19 pandemic on public road transportation systems, especially when it comes to the enforcement of physical distancing in public transportation, usage of face masks and government interventions. The inclusion and exclusion criteria were used in reviewing the articles used for this literature review, and an original 140 articles were reduced to 100 articles that were used in this literature review. This research aims to create an overview literature review that highlights the impact of the pandemic on public transportation and identifies strategic ways in which urban planners and public road transportation researchers can develop constructive and efficient public road transportation planning to ensure the sustainability of public transportation systems in the post-COVID-19 era. This literature review extends our knowledge of the COVID-19 pandemic in public road transportation. It also provides additional evidence concerning the effectiveness of physical distancing and the use of face masks to prevent the COVID-19 virus in public road transportation networks.

Lockdown Efficacy in Controlling the Spread of COVID-19 May Be Waning Due to Decline in Public Compliance, Especially among Unvaccinated Individuals: A Cross-Sectional Study in Israel

Public compliance is paramount for the success of public health measures and decision making, such as lockdowns, in controlling the spread of diseases. The aim of this population-based cross-sectional study was to investigate the level of reported compliance with home isolation among the adult Israeli population (n = 940) during the first three national lockdowns, compliance with a potential fourth national lockdown if enacted, risk perception of COVID-19, vaccination uptake status, perceived effectiveness of the vaccine, and compliance with additional protective health behaviors (e.g., mask wearing and social distancing). Following widespread compliance with initial lockdowns (90.7% reported "high" or "very high" compliance), as few as 60.1% of participants indicated that they would comply with a fourth lockdown if the government decides to enact it. Non-vaccinated individuals reported the lowest levels of compliance with previous lockdowns, compared to participants who received one or two vaccines and participants vaccinated with three doses. Adjusted for gender and age, the results suggest that fearing being infected with COVID-19, perceiving the vaccine to be effective, and reporting being compliant with other health behaviors-such as mask wearing and maintaining social distance from others-are predictors of lockdown compliance. Considering the effect of pandemic lockdown fatigue, there is little support for additional lockdowns among the Israeli public, unless dramatic changes occur in the characteristics of the COVID-19 pandemic. Compliance with lockdowns is reduced among individuals who are at higher risk of contracting COVID-19, therefore rendering this non-pharmaceutical intervention even less effective in reducing the spread of the disease.

Containing the spatial spread of COVID-19 through the trucking network

The trucking industry is the backbone of domestic supply chains. In the context of the COVID-19 pandemic, road transportation has been essential to guarantee the supply of basic goods to confined urban areas. However, the connectivity of the trucking network can also act as an efficient virus spreader. This paper applies network science to uncover the characteristics of the trucking network in one major Latin American country -Colombia- and provides evidence on freight networks' ability to spread contagious diseases spatially. Network metrics, official COVID-19 records at the municipality level, and a zero-inflated negative binomial model are used to test the association between network topology and confirmed COVID-19 cases. Results suggest that: (i) the number of COVID-19 cases in a municipality is linked to its level and type of network centrality; and (ii) being a port-city and a primary economic hub in the trucking network is associated with a higher probability of contracting earlier a pandemic. Based on these results, a risk-based approach is proposed to help policymakers implement containment measures.

Movement and risk perception: evidence from spatial analysis of mobile phone-based mobility during the COVID-19 lockdown, Nigeria

The emergence of COVID-19 across the globe prompted many countries to institute total lockdown or other models of mobility restrictions to mitigate the spread of the disease. On March 29th, Nigeria instituted a nationwide lockdown. It is pertinent to understand the pattern created by this lockdown. This could offer insights into how people perceive the hazard and the level of compliance across the States in Nigeria. Mobile phone-based mobility data and the number of new cases from the beginning to the end of the lockdown were utilised. The study examines space-time trends across different place categories at the state level. Place categories witnessed mobility reduction as high as 56%, 57%, 65%, 75%, 38% for retail and recreation (RtRc), Grocery and Pharmacy (GrPh), Park, and Transport Hubs (Trst) respectively. Most States recorded mobility uptrend towards workplace, retail and recreational areas. Multiple correspondence analysis (MCA) identified two dimensions from the Space-time trends. The first dimension (D1) accounted for 66% of the variance. Examination of the Object Scores from the MCA showed that there are two classes-two risk perception groups. The pattern of mobility recorded shows that there is a variation in mobility restriction compliance across the States. The trend groupings identified captured an aspect of risk perception within each State. Thus, pointing to difference in levels of risk acceptance. With the level of misinformation currently being experienced worldwide, concerted efforts should be made on improving risk perception to prevent the re-emergence of the disease.

The Mediating Role of Teacher Identification in the Relationship Between Psychological Distress and Teacher Satisfaction During COVID-19

The current study examines the potential mediating role of professional identification of school teachers in the relationship between psychological distress and teaching satisfaction. Professional identification is the extent to which an individual identifies with a professional group, including the values, beliefs, and commitment the individual has in relation to the professional group. Professional identification has been linked to negative work outcomes, such as job performance and turnover intentions, as well as to adverse mental health outcomes. In the context of education, professional identification is the extent to which teachers identify with the teaching profession. Participants (N = 355) were school teachers in South Africa who completed the Center for Epidemiological Depression Scale, the Beck Hopelessness Scale, the Professional Identification Scale, and the Teaching Satisfaction Scale. Structural equation analysis showed that professional identification plays a fully mediational role in the relationship between psychological distress and teaching satisfaction. Interventions that strengthen teachers’ identification with the teaching profession should be considered a priority.

Innovations, contestations and fragilities of the health system response to COVID-19 in the Gauteng Province of South Africa

Background

Gauteng province, with 26.3% of South Africa’s population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa’s reported COVID-19 cases.

Aim

The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response.

Material and methods

Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data.

Results

Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response.

Conclusion

Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.

The effect of different COVID-19 public health restrictions on mobility: A systematic review

Background

In response to the COVID-19 pandemic, most countries have introduced non-pharmaceutical interventions, such as stay-at-home orders, to reduce person-to-person contact and break trains of transmission. The aim of this systematic review was to assess the effect of different public health restrictions on mobility across different countries and cultures. The University of Bern COVID-19 Living Evidence database of COVID-19 and SARS-COV-2 publications was searched for retrospective or prospective studies evaluating the impact of COVID-19 public health restrictions on Google Mobility. Titles and abstracts were independently screened by two authors. Information from included studies was extracted by one researcher and double checked by another. Risk of bias of included articles was assessed using the Newcastle Ottowa Scale. Given the heterogeneous nature of the designs used, a narrative synthesis was undertaken. From the search, 1672 references were identified, of which 14 were included in the narrative synthesis. All studies reported data from the first wave of the pandemic, with Google Mobility Scores included from January to August 2020, with most studies analysing data during the first two months of the pandemic. Seven studies were assessed as having a moderate risk of bias and seven as a low risk of bias. Countries that introduced more stringent public health restrictions experienced greater reductions in mobility, through increased time at home and reductions in visits to shops, workplaces and use of public transport. Stay-at-home orders were the most effective of the individual strategies, whereas mask mandates had little effect of mobility.

Conclusions

Public health restrictions, particularly stay-at-home orders have significantly impacted on transmission prevention behaviours. Further research is required to understand how to effectively address pandemic fatigue and to support the safe return back to normal day-to-day behaviours.

Using mobile phone data for epidemic response in low resource settings—A case study of COVID-19 in Malawi

The COVID-19 global pandemic has had considerable health impact, including sub-Saharan Africa. In Malawi, a resource-limited setting in Africa, gaining access to data to inform the COVID-19 response is challenging. Information on adherence to physical distancing guidelines and reducing contacts are nonexistent, but critical to understanding and communicating risk, as well as allocating scarce resources. We present a case study which leverages aggregated call detail records into a daily data pipeline which summarize population density and mobility in an easy-to-use dashboard for public health officials and emergency operations. From March to April 2021, we have aggregated 6-billion calls and text messages and continue to process 12 million more daily. These data are summarized into reports which describe, quantify, and locate mass gatherings and travel between subdistricts. These reports are accessible via web dashboards for policymakers within the Ministry of Health and Emergency Operations Center to inform COVID-19 response efforts and resource allocation.

Childcare and depression during the coronavirus pandemic in South Africa: A gendered analysis

BACKGROUND

The 2019 coronavirus disease (COVID-19) pandemic resulted in the closure of businesses and schools, the remote provision of services and the disruption of the services of professional childminders. These disruptions resulted in a significant increase in parental responsibility for childcare. Such a substantial increase in time requirements for childcare domestically has potential mental health consequences. We therefore ascertained the relationship between childcare and depression in South Africa during the pandemic.

METHODS

Data came from the National Income Dynamics Study-Coronavirus Rapid Mobile Survey, a longitudinal telephonic survey conducted during the COVID-19 pandemic in South Africa. The outcome was a depression index obtained from the two-item Patient Health Questionnaire while the main covariate was the average number of hours spent in taking care of children per weekday. We employed the ordered logit model.

FINDINGS

We found a positive relationship between spending more hours on childcare and worse depressive health for caregivers in both periods analyzed. Childcare responsibilities preventing/mitigating the ability of caregivers to work as well as preventing caregivers from searching for jobs moderated the depression-childcare relationship.

CONCLUSION

These findings highlight the need to carefully consider policy responses aimed at containing the pandemic. We advocate a multi-stakeholder approach to mitigating the mental health impact of COVID-19 by encouraging more collaboration between government, school authorities, employers and parents/guardians.

Pandemic Fatigue: The Effects Of The COVID-19 Crisis On Public Trust And Compliance With Regulations In Israel

Social resilience and trust are two major components of the mitigation of the spread of contagious diseases. Although measures such as the imposition of national lockdowns and self-quarantines have been proven to be effective in reducing morbidity, their efficacy is dependent on public trust and compliance. The purpose of this study was to assess public attitudes toward the COVID-19 outbreak over the course of a year. A cohort study of the adult population in Israel was conducted during three waves of COVID-19 morbidity in that country, with February 2020 as the baseline, March 2020 for the first wave, August 2020 for the second, and January 2021 for the third. The results suggest that there is a relationship between risk perception and compliance with health regulations. Moreover, trust is a major component in public compliance. Fluctuations in risk perception and trust were found to affect compliance with regulations. The failure of decision makers to appropriately address the economic constraints imposed on the public during prolonged disasters, such as the COVID-19 outbreak, is likely to lead to a reduction in public trust in the government and to a decrease in societal resilience.

A Data-Free Digital Platform to Reach Families With Young Children During the COVID-19 Pandemic: Online Survey Study

BACKGROUND

The COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries.

OBJECTIVE

The study objectives were two-fold. The first objective was to gather data on the impact of the COVID-19 pandemic on families of young children using an online survey. The second objective was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa.

METHODS

We used a data-free mobile messenger platform to conduct a short digital survey of the impact of the COVID-19 pandemic on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey.

RESULTS

More than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of its launch. Respondents were predominantly from lower classes and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns and some underrepresentation of rural households. Mothers comprised 70.2% (11,178/15,912) of respondents and fathers comprised 29.8% (4734/15,912), representing 18,672 children 5 years of age and younger. Response rates per survey item ranged from 74.8% (11,907/15,912) at the start of the survey to 50.3% (8007/15,912) at completion. A total of 82.0% (12,729/15,912) of parents experienced at least one challenge during the pandemic, and 32.4% (2737/8441) did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost.

CONCLUSIONS

Data-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated, or no-cost, services could provide a feasible, sustainable, and equitable basis for ongoing interactions with families of young children.

Poverty and COVID-19 in Africa and Latin America

Since March 2020, governments have recommended or enacted lockdown policies to curb the spread of COVID-19. Yet, poorer segments of the population cannot afford to stay at home and must continue to work. In this paper, we test whether work-related mobility is effectively influenced by the local intensity of poverty. To do so, we exploit poverty data and Google mobility data for 242 regions of nine Latin American and African countries. We find that the drop in work-related mobility during the first lockdown period was indeed significantly lower in high-poverty regions compared to other regions. We also illustrate how higher poverty has induced a faster spread of the virus. The policy implication is that social protection measures in the form of food or cash trasfers must be complementary to physical distancing measures. Further research must evaluate how such transfers, when implemented, have attenuated the difference between poor and non-poor regions in terms of exposure to the virus.

Analyzing the ultimate impact of COVID-19 in Africa

The Covid-19 pandemic has spread quickly across the globe in late 2019 and this has continued into 2020, causing a complete closure of daily routines, depleting global resources and, in extreme cases, causing loss of life. In Africa, with its hot climate, decision makers try to get people to their work as health care professionals or sometimes access health care facilities. For the peak four months; April, May, June, and July, the virus appeared, spread, and began to decrease. This study aims at analyzing the direct impact of Covid-19 in Africa according to the available data until July 2020. It provides statistics and policies prepared by African countries for this pandemic with the aid of other developed countries' experiences. From studying such applicable policies, it can be seen in a number of cases that lockdown restrictions, school and workplace closures, and limitations to the internal movement have the chief effect of reducing virus spread. Change in travel behavior and number of visitors appear in response to such a crisis. Regarding the potential economic repercussions in the studied period, GDP shows a sharp drop of 3.4%, appearing as a reduction of 6% on the price of oil, reducing the number of tourists by 46%, and causing fluctuations in currency. These suggest a mutual influence between the crisis and the transport sector.

Determinants of Social Distancing Among South Africans From 12 Days Into the COVID-19 Lockdown: A Cross Sectional Study

Introduction: Social or physical distancing has been an effective measure for reducing the spread of COVID-19 infections. Investigating the determinants of adherence to social distancing can inform public health strategies to improve the behaviour. However, there is a lack of data in various populations. This study investigates the degree to which South Africans complied with social distancing during the country's COVID-19 lockdown and identifies the determinants associated with being in close contact with large numbers of people. Materials and Methods: Data was collected from a South African national online survey on a data free platform, supplemented with telephone interviews. The survey was conducted from 8 to 29 April 2020. The primary outcome was the number of people that participants came into close contact with (within a 2-metre distance) the last time they were outside their home during the COVID-19 lockdown. Multivariate multinomial regression investigated the socio-demographic, psychosocial and household environmental determinants associated with being in contact with 1-10, 11-50 and more than 50 people. Results: Of the 17,563 adult participants, 20.3% reported having not left home, 50.6% were in close physical distance with 1-10 people, 21.1% with 11-50 people, and 8.0% with >50 people. Larger household size and incorrect knowledge about the importance of social distancing were associated with being in contact with >50 people. Male gender, younger age and being in the White and Coloured population groups were significantly associated with being in contact with 1-10 people but not with larger numbers of people. Employment, at least secondary school education, lack of self-efficacy in being able to protect oneself from infection, and moderate or high risk perception of becoming infected, were all associated with increased odds of close contact with 1-10, 11-50, and >50 people relative to remaining at home. Conclusion: The findings identify subgroups of individuals that are less likely to comply with social distancing regulations. Public health communication, interventions and policy can be tailored to address these determinants of social distancing.

The impact of the COVID-19 outbreak on Chinese-listed tourism stocks

This research explored the effects of the coronavirus disease (COVID-19) outbreak on stock price movements of China's tourism industry by using an event study method. The results showed that the crisis negatively impacted tourism sector stocks. Further quantile regression analyses supported the non-linear relationship between the government's responses and stock returns. The results present that the resurgence of the virus in Beijing did bring about a short-term negative impact on the tourism industry. The empirical results can be used for future researchers to conduct a comparative study of cultural differences concerning government responses to the COVID-19.

Assessing the impacts of COVID-19 on women refugees in South Africa

The global COVID-19 pandemic and subsequent lockdowns and restrictions have had uneven impacts on populations and have deepened many pre-existing inequalities along lines of race, ethnicity, class, gender. Refugees have been shown to be particularly negatively impacted in many countries, with existing structures of violence and insecurity worsened by the immediate consequences of the pandemic through policy responses which largely ignore their needs whether by excluding them from targeted COVID-19 mitigation measures, or by imposing restrictions which directly impact on their well-being. Our research with refugee women in Durban, South Africa, illustrates the ways in which COVID-19 has exacerbated their insecurities and intensified structural violence which renders them vulnerable. More importantly, it seems that the impacts of COVID-19 are not just short term but will deepen the violence and insecurities experienced by these women in the longer term if these are not addressed by government and relevant NGOs and civil society organizations.

Escaping from Cities during the COVID-19 Crisis: Using Mobile Phone Data to Trace Mobility in Finland

The coronavirus disease 2019 (COVID-19) crisis resulted in unprecedented changes in the spatial mobility of people across societies due to the restrictions imposed. This also resulted in unexpected mobility and population dynamics that created a challenge for crisis preparedness, including the mobility from cities during the crisis due to the underlying phenomenon of multi-local living. People changing their residences can spread the virus between regions and create situations in which health and emergency services are not prepared for the population increase. Here, our focus is on urban–rural mobility and the influence of multi-local living on population dynamics in Finland during the COVID-19 crisis in 2020. Results, based on three mobile phone datasets, showed a significant drop in inter-municipal mobility and a shift in the presence of people—a population decline in urban centres and an increase in rural areas, which is strongly correlated to secondary housing. This study highlights the need to improve crisis preparedness by: (1) acknowledging the growing importance of multi-local living, and (2) improving the use of novel data sources for monitoring population dynamics and mobility. Mobile phone data products have enormous potential, but attention should be paid to the varying methodologies and their possible impact on analysis.

Presence and mobility of the population during the first wave of Covid-19 outbreak and lockdown in Italy

The non-medical policies implemented by many countries to "flatten the curve" during the COVID-19 outbreak has people stranded in their homes and some, out of their homes unable to return due to the disruptions in the mobility network. The availability of rich datasets (in our case, Facebook) has made it possible to study the mobility dynamics and spatial distribution of people during lockdown in Italy. Our interpretation is an effort to look deeper, describing the movements occurred during lockdown, including the territorial differences. We observe that, initially, tourists left the country and later Italians abroad managed to return, thereby, stabilising the population. With regards to internal mobility, the earliest affected regions see higher number of stationary users in the initial days of the outbreak while this is less significant for the central/southern regions until the decree for the official lockdown on the 9th of March 2020, due 2 days later. Just before lockdown, there was not a significant exodus of people from the North to the rest of the country, instead, relocation of people between cities and their urban belts, but not towards remote areas. This will be elaborated in conclusions shedding light on possible changes in future cities.

Income assurances are a crucial factor in determining public compliance with self-isolation regulations during the COVID-19 outbreak - cohort study in Israel

BACKGROUND

The outbreak of a new Coronavirus disease (COVID-19) poses dramatic challenges to public health authorities worldwide. One measure put in place to contain the spread of the disease is self-quarantine of individuals who may have been exposed to the disease. While officials expect the public to comply with such regulation, studies suggest that a major obstacle to compliance for self-quarantine is concern over loss of income or employment due to the prolonged absence from work.

METHODS

A cohort study of the adult population of Israel was conducted in two time points during the COVID-19 outbreak, the last week of February and the third week of March 2020, in order to assess public attitudes. In particular, public compliance rates to self-quarantine with and without State-sponsored compensation for lost wages were assessed.

RESULTS

The results suggest that public attitudes changed as the threat increased, making people more compliant with regulations. In February 2020, compliance rate for self-quarantine dropped from 94% to less than 57% when monetary compensation for lost wages was removed; however, in March 2020 this drop became more moderate (from 96 to 71%). The multivariate logistic regression revealed that older, non-Jewish, worried over COVID-19, and trusting the Ministry of Health were more likely than their counterparts to comply with self-isolation, even when monetary compensation was not assumed.

CONCLUSIONS

Despite the effects of threat on people's obedience with regulations, this study demonstrates that providing people with assurances about their livelihood during absence from work remains an important component in compliance with public health regulations.