COVID-19, Risk, Fear, and Fall-out

Mistrustful Dependency: Mistrust as Risk Management in an Italian Emergency Department

Mistrust is increasingly a daily reality of healthcare delivery worldwide. Yet it remains understudied as a form of relationship and a force in its own right. I address this gap through the ethnography of an Italian Emergency Department (ED), where conflicts have increased since the 2008 financial crisis. I show how mistrust does not result in a breakdown of healthcare interactions. Rather, mistrust is used in ambivalent care relationships to negotiate the roles, the risks, and the power that patients and staff are willing to entrust to others. Mistrust manifests in risk management strategies within relationships of "mistrustful dependency."

Was lockdown worth it? community perspectives and experiences of the Covid-19 pandemic in remote southwestern Haiti

Public experiences of COVID-19 pandemic lockdown differed dramatically between countries and socio-economic groups. Low-income countries raise unique empirical and ethical concerns about (1) the balance between benefits and social harms and (2) how explanatory disease models and everyday life realities influenced the experience and interpretation of lockdown itself. In this paper, we present qualitative data on community perceptions and experiences of the pandemic from a remote area of Haiti, with a focus on the 2020 lockdown. We conducted in-depth interviews with 30 community leaders in Grand'Anse Department, southwest Haiti, at two time periods: May 2020 and October-December 2021. We divide our results into five sections. First, our analysis showed that lockdown was widely considered ineffective at controlling COVID-19. Despite the lack of testing, community leaders believed most of the local population had caught COVID-19 in the first half of 2020, with limited reported mortality. Public concern about the pandemic largely ended at this time, overtaken by other socio-economic and political crises. Second, we found that popular explanations for the low fatality rate were related to various coping strategies: the strength of people's immune systems, use of natural prophylactic folk teas, beliefs about the virus, spiritual protections and the tropical weather. Third, we found that lockdown was widely seen to have not been appropriate for the Haitian context due to various challenges with compliance in the face of socio-economic vulnerability. Fourth, we found strong negative feelings about the social consequences of lockdown measures, which lasted from March-August 2020, including adverse effects on: food security, household income, education, health, and psychosocial well-being. Finally, these perceptions and experiences reinforced popular ideas that lockdown had been imposed by elites for financial and/or political gain, something that was also reflected in the discourse about the low vaccine acceptance rate. Our study showed that pandemic respiratory virus response in Haiti should better balance restrictive non-pharmaceutical interventions (NPIs) with existing socio-economic vulnerability. Local socio-behavioral dynamics and risk perceptions decrease the overall effectiveness of NPIs in fragile states and alternatives to lockdown, such as shielding the most vulnerable, are likely to be a more appropriate strategy.

Compounded Caregiving: Mexican Women in Migrant-Sending Families During COVID-19

Based on qualitative interviews conducted remotely with twenty-five women heads of migrant-sending households in rural Mexico, we examine the impact of the COVID-19 pandemic on gender inequities in caregiving and social reproduction. Taking medical anthropology's call to attend to the disparate impacts of the pandemic along lines of existing social inequities and vulnerabilities, we describe how women navigated interruptions to remittance flows, social distancing and stay-at-home orders, and the shift to remote schooling for their children, and how all of these transformations compounded women's caregiving responsibilities and negatively impacted their health and well-being.

Power and politics in a pandemic: Insights from Finnish health system leaders during COVID-19

Power and politics are both critical concepts to engage with in health systems and policy research, as they impact actions, processes, and outcomes at all levels in health systems. Building on the conceptualization of health systems as social systems, we investigate how power and politics manifested in the Finnish health system during COVID-19, posing the following research question: in what ways did health system leaders and experts experience issues of power and politics during COVID-19, and how did power and politics impact health system governance? We completed online interviews with health system leaders and experts (n = 53) at the local, regional, and national level in Finland from March 2021 to February 2022. The analysis followed an iterative thematic analysis process in which the data guided the codebook. The results demonstrate that power and politics affected health system governance in Finland during COVID-19 in a multitude of ways. These can be summarized through the themes of credit and blame, frame contestation, and transparency and trust. Overall, political leaders at the national level were heavily involved in the governance of COVID-19 in Finland, which was perceived as having both negative and positive impacts. The politicization of the pandemic took health officials and civil servants by surprise, and events during the first year of COVID-19 in Finland reflect recurring vertical and horizontal power dynamics between local, regional, and national actors. The paper contributes to the growing call for power-focused health systems and policy research. The results suggest that analyses of pandemic governance and lessons learned are likely to leave out critical factors if left absent of an explicit analysis of power and politics, and that such analyses are needed to ensure accountability in health systems.

Public Knowledge, Attitudes, and Practices Toward COVID-19 Pandemic: A Cross-Sectional Study in Delhi and National Capital Region (NCR), India

To assess knowledge, attitudes, and practices of people toward coronavirus disease 2019 (COVID-19) pandemic in National Capital Territory of Delhi and National Capital Region (NCR), India. Various nations, including India, devised strategies to impose lockdowns and movement restrictions on their citizens in order to mitigate the effects of COVID-19. Cooperation and compliance by the populace are crucial to the effectiveness of such measures. People's knowledge, attitudes, and behavior toward such diseases are crucial in determining the adaptability of a society to such changes. Using Google Forms, a self-designed semi-structured questionnaire was created. This study is cross-sectional. Participants were eligible to participate if they were over the age of 18 and presently resided in the study area. The questionnaire included demographic variables such as gender, age, location, occupation, and income level. A total of 1,002 people completed the survey. A 48.80% of the respondents in the study group were females. The mean knowledge score was 13.14 (Maximum Score = 17), while the mean attitude score was 27.24 (Maximum Score = 30). Most of the respondents (96%) had adequate knowledge about the disease's symptoms. A 91% of the respondents had an average attitude score. A 74.85% of respondents accepted that they had avoided large social events. Gender had a negligible impact on the average knowledge score, while the score differed significantly across education levels and occupation categories. Consistent dissemination of messages regarding the virus, its spread, control measures implemented, and precautions expected from the public aids in reassuring the public and reducing their anxiety regarding the virus.

Containing COVID-19 and the social costs on human rights in African countries

Multiple social interventions were introduced to contain the COVID-19 pandemic across Africa, limiting social engagement, school and workplace attendance, and travel. In anticipation of negative economic consequences and social impact, many governments introduced cash transfers, social pensions, food aid, and utility and tax waivers. However, people living precariously and/or under conditions of structural vulnerability were often unable to access to this support. A rapid review was undertaken on COVID-19 and the effects of interventions on human rights in African countries, examining primary studies, editorial notes, opinion papers, and literature reviews, with focus on qualitative approaches and discussions. In examining the links between health, human rights and non-pharmaceutical interventions on vulnerable populations, the review identified that: (1) people who were vulnerable were excluded from or not adequately represented in policy responses to COVID-19; (2) the precarious socio-economic conditions of these populations were not adequately addressed by dominant policy responses; and (3) only partial support was offered to those whose relationship with the state was ambiguous or conditional, so compromising human rights. Interactions between health, human rights, and underlying social and economic conditions amplified poor health and impoverishment of those who were already vulnerable. The challenge is to find a balance between stopping the spread of COVID-19 and the protection of human rights; to implement population-specific responses to supplement uniform public health responses; and to address causes (structural vulnerability) rather than symptoms. There is a need to plan rather than react to pandemics, and to co-construct interventions with rather than delivering instructions to populations. These recommendations serve as instruments to be considered when designing new policies, to incorporate a human rights perspective in responses to current and future pandemics.

COVID19 in Latin America: informal settlements and the politics of urbicide

Informal settlements in Latin America express pandemic idiosyncrasies, calling global attention to historical problems related to a specific urbanization pattern. This article stresses COVID19 implications in the main urban planning canon: the notion of densification as an urban solution. Traditionally invisible social groups and territories acquire relevance, but now as a source of biological risk. Urban density appears as a contradictory trigger point, outlining new debates about informal settlements and their metrics. Evidence shows that trends in health discourse are striving to legitimize and enhance "urbicides" in this scenario, already underway through State action or inaction.

"I Think I Have Enough for Now": Living with COVID-19 Antibodies in the Philippines

Drawing on face-to-face and virtual fieldwork in the Philippines, I document the emergence of antibody testing as a popular practice among Filipinos during the COVID-19 pandemic, helping them make decisions about vaccines and other life choices. Antibodies gave people a sense of agency and control amid a health crisis for which political and medical authorities failed to offer certainty and hope, particularly at a time of vaccine scarcity and viral surges. However, by diverting attention from the health care system to individual immune systems, antibodies also reinforced the individual "responsibilization" that has characterized the Philippine government's pandemic response.

COVID-19 and older people’s wellbeing in northern KwaZulu-Natal – the importance of relationships

Background: The COVID-19 pandemic and the non-pharmacological prevention methods have affected the wellbeing of older people.  In this paper we focus on the wellbeing, and vulnerability, of older people in rural northern KwaZulu-Natal, South Africa during the first year of the pandemic. Methods: We conducted a series of up to four monthly in-depth interviews with 26 people aged 60 years and older.  Interviews were conducted by telephone, because of restrictions on face-to-face contact, and digitally recorded.  After transcription and translation, the data were coded thematically, with analysis guided by a wellbeing theoretical framework. Results: Having access to food, to healthcare and to somewhere they felt safe to stay, was essential for everyone, but for many managing expenses became more of a struggle as adult children who had lost their source of employment came home to stay.  However, despite the shortages of money, the importance of relationships, whether they are familial or the close community of neighbours, was highlighted in the accounts from a number of participants. Older people not only got help with day-to-day life from others, but also found solace in the company of others. The sense of community, from family and neighbours, helped to ease some of the stress experienced as a result of the lockdowns. Conclusions: The COVID-19 pandemic and the restrictions imposed to limit the spread of the virus impacted the wellbeing of older adults in rural KwaZulu-Natal. Wellbeing for many older people has been nurtured by relationships with family and friends.

Pandemic governance: Developing a politics of informality

South Africa had the privilege of learning from how other countries responded to the crisis engendered by the COVID-19 pandemic. However, this opportunity seems to have been lost as the South African government made the mistake of transposing a developed world preventive response onto a largely developing-world populace. The government failed to map out how factors such as South Africa’s demographic composition, spatial architecture, the incidence of poverty and informality, and competing epidemics would interact synergistically and shape epidemiological outcomes. In this article shaped by sociological insights, we show how the application of governance systems can give rise to many unintended social consequences when the knowledge forms upon which they are based are not suitably tailored to meet the needs of the specific local context. We highlight how informality can play a valuable role in fighting the COVID crisis and suggest that, to truly succeed, the government should include rather than override informal principles of governance.

Economic vulnerability and poor service delivery made it more difficult for shack-dwellers to comply with COVID-19 restrictions

In South Africa, demand for housing close to viable/sustained sources of employment has far outstripped supply; and the size of the population living in temporary structures/shacks (and in poorly serviced informal settlements) has continued to increase. While such dwellings and settlements pose a number of established risks to the health of their residents, the present study aimed to explore whether they might also undermine the potential impact of regulations intended to safeguard public health, such as the stringent lockdown restrictions imposed to curb the spread of COVID-19 in 2020 and 2021. Using a representative sample of 1381 South African households surveyed in May–June 2021, the present study found that respondents in temporary structures/shacks were more likely to report non-compliance (or difficulty in complying) with lockdown restrictions when compared to those living in traditional/formal houses/ flats/rooms/hostels (OR: 1.61; 95% CI: 1.06, 2.45). However, this finding was substantially attenuated and lost precision following adjustment for preceding socio-demographic and economic determinants of housing quality (adjusted OR: 1.20; 95% CI: 0.78, 1.87). Instead, respondents were far more likely to report non-compliance (or difficulty in complying) with COVID-19 lockdown restrictions if their dwellings lacked private/indoor toilet facilities (adjusted OR: 1.56; 95% CI: 1.08, 2.22) or if they were ‘Black/ African’, young, poorly educated and under-employed (regardless of their socio-economic position, or whether they resided in temporary structures/shacks, respectively). Restrictions imposed to safeguard public health need to be more sensitively designed to accommodate the critical roles that poverty and inadequate service delivery play in limiting the ability of residents living in temporary structures/shacks and inadequately serviced dwellings/settlements to comply.

Herd culture and herd immunity

Abstract Although communicable diseases affect our bodies, they occur in a society that interprets and gives them meaning. Herd immunity provides the body protection; however, long-term protection requires shifts in the way people interpret and respond to disease, cultural transformation that enables the development of the knowledge, habits and skills that make herd immunity feasible and sustainable. Herd culture allows individuals to protect themselves and restrict their liberty in order to protect others; it is a form of exercising positive liberty and a necessary complement to herd immunity in a democratic society.

Herd culture and herd immunity

Although communicable diseases affect our bodies, they occur in a society that interprets and gives them meaning. Herd immunity provides the body protection; however, long-term protection requires shifts in the way people interpret and respond to disease, cultural transformation that enables the development of the knowledge, habits and skills that make herd immunity feasible and sustainable. Herd culture allows individuals to protect themselves and restrict their liberty in order to protect others; it is a form of exercising positive liberty and a necessary complement to herd immunity in a democratic society.

Covid-19 Riskscapes: Viral Risk Perceptions in the African Great Lakes

In this article we explore Covid-19 riskscapes across the African Great Lakes region. Drawing on fieldwork across Uganda and Malawi, our analysis centers around how two mobile, trans-border figures - truck drivers and migrant traders - came to be understood as shifting, yet central loci of perceived viral risk. We argue that political decision-making processes, with specific reference to the influence of Covid-19 testing regimes and reported disease metrics, aggravated antecedent geographies of blame targeted at mobile "others". We find that using grounded riskscapes to examine localised renditions of risk reveals otherwise neglected forms of discriminatory discourse and practice.

Levels and Predictors of COVID-19-Related Anxiety in Older Adults

BACKGROUND: Prolonged quarantine during the COVID-19 outbreak is a stressful factor. AIM: This study aims to analyze the psycho-emotional state of Jordan’s older population during the Covid-19 pandemic. MATERIALS AND METHODS: The study on 620 older adults (mean age, 66.4±5.3 years) was conducted in 2020 in Amman (Jordan). All respondents were asked to complete an online survey on coping strategies, a HUDS questionnaire, and a specially designed questionnaire. RESULTS: The dominant predictors of stress were uncertainty (62%) and a fear other family members getting ill (60%). Of all the respondents, 15% agreed with the necessity to prolong the quarantine period, 47% had a neutral attitude, and 38% exhibited a negative attitude. High levels of anxiety in older population were associated with the lower use of humor (H=11.498, p≤0.002). On the other hand, such respondents demonstrated the higher use of planning (H=6.227, p≤0.039), venting (H=11.087, p≤0.004), avoidance (H=7.457, p≤0.019), and active coping (H=6.043, p≤0.037). CONCLUSIONS: Most of Covid-19 cases are registered in healthcare institutions and for that reason, there is a need to provide psychiatric care to medical workers who do not have the necessary experience in this area. This may also require the state to promote psychiatric care training.

COVID-19 and human flourishing: The moderating role of gender

COVID-19 fear restricts human freedom and decreases human flourishing. This paper examines the relationship between COVID-19 fear and human flourishing. Additionally, it tests gender's moderating effect in this relationship. Although studies show the relationship between COVID-19 fear and human flourishing, this study is a first attempt to determine gender's moderating role. Data were obtained from 326 hotel staff in the United States and analyzed using structural equation modeling and hierarchical regression. This study found that COVID-19 negatively affected human flourishing and gender moderated this relationship. The current study will contribute to the literature by clarifying that women's flourishing is more negatively affected than men due to COVID-19. This finding further indicates how to reduce women's COVID-19 fears from both practical and legal standpoints.

Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies

(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic.

The impact and implications of COVID-19: Reflections on the Zimbabwean society

The article is an attempt to provide a kaleidoscopic interpretation of how social science scholarship views the socio-cultural terrain of Zimbabwe during and after the global health crisis, and the societal and business haemorrhage induced by the coronavirus (COVID-19). Built through a multi-perspective and triangulation involving a modified Delphic approach that engages archival methods involving document and literature review, content analysis and expert interpretation; the article unveils the various effects of COVID-19 on Zimbabwe. It is concluded that COVID-19 by its nature is disruptive to everyday life, restrictive to human-social relations and is an instigator to tradition, spirituality and intellectuality in the country. The challenge of the virus brings to society a deliberate consciousness that global processes and events are converging (borders are porous) while local embeddedness is being entrenched through practices like lockdowns and confinement.

A Deep Learning BiLSTM Encoding-Decoding Model for COVID-19 Pandemic Spread Forecasting

The COVID-19 pandemic has widely spread with an increasing infection rate through more than 200 countries. The governments of the world need to record the confirmed infectious, recovered, and death cases for the present state and predict the cases. In favor of future case prediction, governments can impose opening and closing procedures to save human lives by slowing down the pandemic progression spread. There are several forecasting models for pandemic time series based on statistical processing and machine learning algorithms. Deep learning has been proven as an excellent tool for time series forecasting problems. This paper proposes a deep learning time-series prediction model to forecast the confirmed, recovered, and death cases. Our proposed network is based on an encoding–decoding deep learning network. Moreover, we optimize the selection of our proposed network hyper-parameters. Our proposed forecasting model was applied in Saudi Arabia. Then, we applied the proposed model to other countries. Our study covers two categories of countries that have witnessed different spread waves this year. During our experiments, we compared our proposed model and the other time-series forecasting models, which totaled fifteen prediction models: three statistical models, three deep learning models, seven machine learning models, and one prophet model. Our proposed forecasting model accuracy was assessed using several statistical evaluation criteria. It achieved the lowest error values and achieved the highest R-squared value of 0.99. Our proposed model may help policymakers to improve the pandemic spread control, and our method can be generalized for other time series forecasting tasks.

The Social Lives of Infectious Diseases: Why Culture Matters to COVID-19

Over the course of the year 2020, the global scientific community dedicated considerable effort to understanding COVID-19. In this review, we discuss some of the findings accumulated between the onset of the pandemic and the end of 2020, and argue that although COVID-19 is clearly a biological disease tied to a specific virus, the culture-mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic. Striking differences have been observed in terms of relative mortality, transmission rates, behavioral responses, official policies, compliance with authorities, and even the extent to which beliefs about COVID-19 have been politicized across different societies and groups. Moreover, many minority groups have very different experiences of the pandemic relative to dominant groups, notably through existing health inequities as well as discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and into the narrative of health and illness in psychological science more broadly. Finally, individual differences in, for example, intolerance of uncertainty, optimism, conspiratorial thinking, or collectivist orientation are influenced by cultural context, with implications for behaviors that are relevant to the spread and impact of COVID-19, such as mask-wearing and social distancing. The interplay between cultural context and the experience and expression of mental disorders continues to be documented by cultural-clinical psychology; the current work extends this thinking to infectious disease, with special attention to diseases spread by social contact and fought at least in part through social interventions. We will discuss cultural influences on the transmission, course, and outcome of COVID-19 at three levels: (1) cross-society differences; (2) within-society communities and intergroup relations; and (3) individual differences shaped by cultural context. We conclude by considering potential theoretical implications of this perspective on infectious disease for cultural psychology and related disciplines, as well as practical implications of this perspective on science communication and public health interventions.

COVID-19 on the Ground: Managing the Heritage Sites of a Pandemic

The standard methodology for the assessment of cultural heritage significance relies on hindsight, with a passage of time elapsed between the creation of the site or object and its assessment. There are, however, cases where heritage significance is instant (e.g., sites associated with the first Moon landing). This paper argues that hindsight will not be required to determine that the COVID-19 pandemic will come to be considered as a significant historic event, as COVID-19 has already manifested itself as a social, cultural and economic disruptor on a global scale with a mortality in the millions. Heritage professionals have the unique opportunity to assess and document places and structures associated with the pandemic, that are poised to be worthy of a heritage listing in the near future, while they are still in use and function as intended. This paper discusses the nature of the sites and structures and explores possible management approaches to safeguard evidence of the pandemic for future generations.

Who is to blame for COVID-19? Examining politicized fear and health behavior through a mixed methods study in the United States

BACKGROUND

Political ideologies drove public actions and health behaviors in the first year of the global pandemic. Different ideas about contagion, health behaviors, and the actions of governing bodies impacted the spread of the virus and health and life. Researchers used an immediate, mixed methods design to explore sociocultural responses to the virus and identified differences and similarities in anxiety, fear, blame, and perceptions of nation across political divides.

METHODS

Researchers conducted 60 in-depth, semi-structured interviews and administered over 1,000 questionnaires with people living in the United States. The team analyzed data through an exploratory and confirmatory sequential mixed methods design.

RESULTS

In the first months of the pandemic interviewees cited economic inequality, untrustworthy corporations and other entities, and the federal government as threats to life and pandemic control. Participants invoked ideas about others to determine blame. Findings reveal heavy associations between lack of safety during a public health crisis and blame of "culture" and government power across the political spectrum.

CONCLUSION

Data indicate anxiety across political differences related to ideas of contagion and the maleficence of a powerful elite. Findings on how people understand the nation, politics, and pandemic management contribute to understanding dimensions of health behaviors and underlying connections between anxiety and the uptake of conspiracy theories in public health. The article ends with recommendations drawn from project findings for future pandemic response.

COVID-19, poverty and inclusive development

The COVID-19 epidemic provides yet another reason to prioritize inclusive development. Current response strategies of the global community and countries expose a low level of solidarity with poorer nations and poorer people in all nations. Against this background, this paper addresses the question: What are the development challenges that the COVID-19 pandemic lays bare and what lessons can be learnt for the way recovery processes are designed? Using an inclusive development and DPSIR lens to assess the literature, our study finds that, first, the current response prioritises the 'state' and 'impact' concerns of wealthier classes at the expense of the remainder of the world population. Second, responses have ignored underlying 'drivers' and 'pressures', instead aiming at a quick recovery of the economy. Third, a return to business-as-usual using government funding will lead to a vicious cycle of further ecological degradation, socio-economic inequality and domestic abuse that assist in exacerbating the drivers of the pandemic. We argue instead for an inclusive development approach that leads to a virtuous cycle by emphasizing human health, well-being and ecosystem regeneration. We conclude that the lost years for development did not commence in 2020 with the onset of COVID-19; the downward trend has actually been waxing over the past three decades. From this perspective, COVID-19 may be the shock needed to put the last first and transform vicious into virtuous cycles of inclusive development.

Could COVID-19 mark a turning point for global action on climate change?

COVID‐19 and climate change are both threats of immense proportions, however, the differing perception of climate change as far‐off, projected and unpredictable, persists as a marked barrier to global action. COVID‐19 is increasing awareness of the connection between human actions and environmental consequences. The current slowdown of fossil fuel use has given a glimpse of the quitter, cleaner and more caring world that effective climate change could also achieve. Decisions made in coming months can either “lock in” economic development patterns that will do permanent and escalating damage to the ecological systems, or, if wisely taken, can promote a healthier and greener world.

PROXEMICS, COVID-19, AND THE ETHICS OF CARE IN SOUTH AFRICA

In South Africa, lockdown and its excesses have opened up questions on the limits of an ethics of care, whose ethics are privileged, how care is delivered, and what care means. We show how an ethics of proxemics and its operationalization as distance highlight everyday inequalities and limit the provision of care. Constraints on physical distancing in line with public health measures intended to limit the spread of the coronavirus echo the controls enforced under apartheid, showing how inequality is both embodied and legally entrenched.

Gauging the effects of the COVID-19 pandemic lockdowns on atmospheric pollution content in select countries

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Psychological Factors Affecting Risk Perception of COVID-19: Evidence from Peru and China

COVID-19 has spread around the world, causing a global pandemic, and to date is impacting in various ways in both developed and developing countries. We know that the spread of this virus is through people’s behavior despite the perceived risks. Risk perception plays an important role in decision-making to prevent infection. Using data from the online survey of participants in Peru and China (N = 1594), data were collected between 8 July 31 and August 2020. We found that levels of risk perception are relatively moderate, but higher in Peru compared to China. In both countries, anxiety, threat perception, self-confidence, and sex were found to be significant predictors of risk perception; however, trust in the information received by government and experts was significant only in Peru, whereas self-confidence had a significant negative effect only for China. Risk communication should be implemented through information programs aimed at reducing anxiety and improving self-confidence, taking into consideration gender differences. In addition, the information generated by the government should be based on empirical sources. Finally, the implications for effective risk communication and its impacts on the health field are discussed.

Challenges of developing, conducting, analysing and reporting a COVID-19 study as the COVID-19 pandemic unfolds: an online co-autoethnographic study

OBJECTIVES

To capture the complexities and unique experience of a newly formed multidisciplinary and multicentre research team developing and deploying a COVID-19 study and to identify lessons learnt.

DESIGN

Co-autoethnographic study.

SETTING

Staff at two UK academic institutions, a national charity and two major UK hospitals.

PARTICIPANTS

Researchers, clinicians, academics, statisticians and analysts, patient and public involvement representatives and national charity.

METHODS

The sampling frame was any content discussed or shared between research team members (emails, meeting minutes, etc), standard observational dimensions and reflective interviews with team members. Data were thematically analysed.

RESULTS

Data from 34 meetings and >50 emails between 17 March and 5 August 2020 were analysed. The analysis yielded seven themes with 'Managing our stress' as an overarching theme.

CONCLUSIONS

Mutual respect, flexibility and genuine belief that team members are doing the best they can under the circumstances are essential for completing a time-consuming study, requiring a rapid response during a pandemic. Acknowledging and managing stress and a shared purpose can moderate many barriers, such as the lack of face-to-face interactions, leading to effective team working.

Positive Organisational Arts-Based Youth Scholarship: Redressing Discourse on Danger, Disquiet, and Distress during COVID-19

This methodological article argues for the potential of positive organisational arts-based youth scholarship as a methodology to understand and promote positive experiences among young people. With reference to COVID-19, exemplars sourced from social media platforms and relevant organisations demonstrate the remarkable creative brilliance of young people. During these difficult times, young people used song, dance, storytelling, and art to express themselves, (re)connect with others, champion social change, and promote health and wellbeing. This article demonstrates the power of positive organisational arts-based youth scholarship to understand how young people use art to redress negativity via a positive lens of agency, peace, collectedness, and calm.

COVID-19 response: mitigating negative impacts on other areas of health

‘Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemented in countries around the world with negative consequences for other health services, people’s access to and use of them, and associated health outcomes, especially in low-income and middle-income countries (LMICs). ‘Lockdowns’ and restrictive measures, especially, have complicated service provision and access, and disrupted key supply chains. Such interventions, alongside more traditional public health measures, interact with baseline health, health system, and social and economic vulnerabilities in LMICs to compound negative impacts. This analysis, based on a rapid evidence assessment by the Social Science in Humanitarian Action Platform in mid-2020, highlights the drivers and evidence of these impacts, emphasises the additional vulnerabilities experienced by marginalised social groups, and provides insight for governments, agencies, organisations and communities to implement more proportionate, appropriate, comprehensive and socially just responses that address COVID-19 in the context of and alongside other disease burdens. In the short term, there is an urgent need to monitor and mitigate impacts of pandemic responses on health service provision, access and use, including through embedding COVID-19 response within integrated health systems approaches. These efforts should also feed into longer-term strategies to strengthen health systems, expand universal healthcare coverage and attend to the social determinants of health—commitments, both existing and new—which governments, donors and international agencies must make and be held accountable to. Crucially, affected communities must be empowered to play a central role in identifying health priorities, allocating resources, and designing and delivering services.

The Past in the Present: What our Ancestors Taught us about Surviving Pandemics

Amidst the recent threat of COVID-19, home gardens have surged in popularity as seed companies and nurseries find it challenging to keep their supplies fully stocked. The victory garden movement that emerged during WWII has today re-emerged as COVID victory gardens. Yet, the global changes and cognitive shifts associated with COVID-19 have differential impacts. The narrative of COVID victory gardens depoliticizes urban agriculture. It is blind to its long history in marginalized, oppressed, and displaced communities where home gardens have always been part of a struggle for identity, autonomy, and self- and communal-determination. I argue the blindness embedded in the narrative of COVID victory gardens violates our “food-related obligations,” which are our responsibilities to ourselves, our food, and each other. Silencing how communities of color have historically grown food in pursuit of dignity disregards how home gardens in communities of color are not merely a reactionary response to crisis but part of a historical legacy whereby people of color have grown food for generations to create and recreate sustainable ways of living that validate their cultures, knowledges, and ways of being.

Perceptions and effects of COVID-19 related information in Denmark and Sweden - a web-based survey about COVID-19 and social media

Aim

Extensive COVID-19 information can generate information overload and confusion. Denmark and Sweden adopted different COVID-19 management strategies.

Aim

This study aimed to compare search strategies, perceptions and effects of COVID-19 information, in general and specifically in social media, in residents in Denmark and Sweden.

Subject and methods

Quantitative data from a sample of respondents (n = 616) from Denmark and Sweden on an international web-based survey was analysed using descriptive and analytical statistics.

Results

The results showed similarities between the countries regarding preferred and trusted information sources, use of (social) media, and psychosocial and behavioural effects of such information. Traditional media and social media were frequently used for COVID-19 information. Especially health authorities and researchers were trusted sources, representing the dominant medico-political discourse. There were no differences in negative effect and social behaviour. Residents in Denmark experienced significantly more positive effects than residents in Sweden.

Conclusion

Summarily, the study showed similarities and small differences among residents in both countries related to usage patterns, perceptions and effects of COVID-19 information from (social) media, despite diverging strategies.

On symbols and scripts: The politics of the American COVID-19 response

The COVID-19 crisis emerged during a divisive time in American politics. We argue that to unravel the American COVID-19 crisis-and to craft effective responses-we need a more sophisticated understanding of the political culture of public health crises. We use data from interviews and online media to examine symbolic representation of public health phenomena (masks; public health institutions) within the first months of the US epidemic. We show how political scripts about pandemic responses are shaped by, and align with, deeply-rooted social values and political cultures. Social processes of meaning-making help explain the evolution of increasingly partisan public health discourse regarding topics like masking and institutional trust. We highlight the lack of memorialization of deaths in America-that has not acquired the same polarized political meaning as other issues-to consider how and why certain issues gain political valence, and what opportunities certain acts of politicization provide in shifting public discourse. The coronavirus pandemic challenged the science of public health strategy, and the legitimacy of its institutions, with devastating consequences. Anticipating and understanding the central role of political cultures, cultural scripts, and meanings in positioning public health measures is essential for more effective responses to COVID-19 and future pandemics.

Lyrics and artistic improvisations in health promotion for the COVID-19 pandemic control in East Africa

News about the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan City, Hubei Province, China in December 2019 diffused gradually to East Africa through mainstream media and social media. The general public construed the pandemic threat as being 'far away' and associated it with foreign practices and behaviours. Social media discourse was initially replete with indifference about the perceived risk. Conflicting views about the possibility of the pandemic spreading to Africa and the complexity of explaining its causes delayed the desired understanding of the reality of the global public health concern. The popular public response to the COVID-19 control discourse is therefore characterised by ambivalence about embracing the pandemic control protocols. Drawing on content and discourse analysis of musical and poetic compositions on COVID-19 by artists in East Africa and shared among WhatsApp users in Kenya, this article describes local perspectives on COVID-19 risk and their health promotion implications. It explores local construction of the meaning of the COVID-19 pandemic and its consequences for effective health promotion. The article considers the spontaneous musical and poetic performances by experienced and amateur artists as local attempts to enhance compliance with the global COVID-19 control protocols and popular participation in local health promotion. The basic premise is that artists' creation and sharing of digital COVID-19 lyrics denote their attempt to go beyond the medical logic of health promotion by including broad aspects of a cultural logic of care. This approach would establish an integrated and sustainable health promotion framework to prevent the spread of COVID-19 and its impact on local societal wellbeing.

Diversity lost: COVID-19 as a phenomenon of the total environment

If we want to learn how to deal with the COVID-19 pandemic, we have to embrace the complexity of this global phenomenon and capture interdependencies across scales and contexts. Yet, we still lack systematic approaches that we can use to deal holistically with the pandemic and its effects. In this Discussion, we first introduce a framework that highlights the systemic nature of the COVID-19 pandemic from the perspective of the total environment as a self-regulating and evolving system comprising of three spheres, the Geosphere, the Biosphere, and the Anthroposphere. Then, we use this framework to explore and organize information from the rapidly growing number of scientific papers, preprints, preliminary scientific reports, and journalistic pieces that give insights into the pandemic crisis. With this work, we point out that the pandemic should be understood as the result of preconditions that led to depletion of human, biological, and geochemical diversity as well as of feedback that differentially impacted the three spheres. We contend that protecting and promoting diversity, is necessary to contribute to more effective decision-making processes and policy interventions to face the current and future pandemics.

The impact of COVID-19 pandemic on bariatric patients' self-management post-surgery

Background

The coronavirus disease 2019 (COVID-19) pandemic has had far reaching consequences on the health and well-being of the general public. Evidence from previous pandemics suggest that bariatric patients may experience increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery.

Objective

We aimed to examine the impact of the novel COVID-19 public health crisis on bariatric patients’ self-management post-surgery.

Method

In a nested-qualitative study, semi-structured telephone interviews were conducted with 23 post-operative bariatric patients who had undergone Roux-en-Y gastric bypass (RYGB) at a Canadian Bariatric Surgery Program between 2014 and 2020. A constant comparative approach was used to systematically analyze the data and identify the overarching themes.

Results

Participants (n = 23) had a mean age of (48.82 ± 10.03) years and most were female (n = 19). The median time post-surgery was 2 years (range: 6 months–7 years). Themes describing the impact of COVID-19 pandemic on patients’ post-bariatric surgery self-management included: coping with COVID-19; vulnerability factors and physical isolation; resiliency factors during pandemic; and valuing access to support by virtual care. The need for patients to access post-operative bariatric care during COVID-19 differed based on gender and socioeconomic status.

Conclusion

This study showed that the COVID-19 pandemic has impacted patients’ ability to self-manage obesity and their mental health in a variety of ways. These findings suggest that patients may experience unique psychological distress and challenges requiring personalized care strategies to improve obesity self-care and overall well-being.

Limit your body area -a COVID-19 mass radicalisation challenging autonomy and basic human rights

Purpose

This paper aims to explore articulations of how individuals internalise official demands on handling COVID-19 and the function of social media in this process, and further to discuss this from a human rights’ perspective.

Design/methodology/approach

A thematic analysis of qualitative data from an international survey on COVID-19 and social media. The analysis was inspired by Berger and Luckmann's theory of reality as a social construction.

Findings

Articulations expressed an instant internalisation and externalisation of the officially defined “new normal”. However, negotiations of this “new normal” were articulated, whereby everyday life activities could proceed. Resistance to the “new normal” appeared, as routines and common sense understandings of everyday life were threatened. Health-care professionals were put in a paradoxical situation, living in accordance with the “new normal” outside work and legitimately deviating from it at work. The “new normal” calls for individuals’ “oughtonomy” rather than autonomy. Social media were used to push individual’s re-socialisation into the “new normal”. The latter both promoted and challenged human rights as the individual's right to self-determination extends beyond the self as it risks threatening other people's right to life.

Originality/value

With the means of a theoretically based thematic analysis inspired by Berger and Luckmann, the current study shows how articulations on COVID-19 and social media can both support and challenge human rights and reality as a facticity as dictated by dominant organisations and discourses in society.

Preparedness and Readiness Against COVID-19 Pandemic in Prison Institutions and Detention Centers in Southwest Ethiopia

BACKGROUND

Prisons and detention centers in Ethiopia lack adequate hand washing, personal protective equipment, and quarantine areas. As a result, they are vulnerable to the expansion of the COVID-19 pandemic. Despite its high risk for the COVID-19 pandemic, no study has been made to assess the preparedness and readiness in prison institutions and detention centers.

METHODS

A cross-sectional study design mixed with a qualitative approach was conducted from May 1 to June 30, 2020. A total of four prison institutions and 17 detention centers were included in the study. A simple random sampling technique was employed to select the institutions. The data were entered into the EpiData and exported to SPSS Windows version 22 for data management and analysis. Descriptive statistics was employed for the quantitative section and content analysis was used to analyze the qualitative data.

RESULTS

Five out of 17 detention centers and three out of four prison facilities did not fulfill the standards related to human rights. Almost all detention centers and prison facilities did not implement recommended activities of risk assessment and management of COVID-19. In addition, none of the prison facilities and detention centers had quick access to laboratory tests for suspected cases. Neither the prison facilities nor the detention centers had a contingency plan for the COVID-19 pandemic. Moreover, all staff working in prison facilities and detention centers mentioned that training regarding COVID-19 had not yet been given. However, in all prisons and detention centers, preventive measures such as physical distancing, utilization of hand washing facilities, wearing masks, and keeping respiratory hygiene were not practiced.

The Syndemics and Structural Violence of the COVID Pandemic: Anthropological Insights on a Crisis

This paper examines the COVID-19 pandemic in light of two key concepts in medical anthropology: syndemics and structural violence. Following a discussion of the nature of these two concepts, the paper addresses the direct and associated literatures on the syndemic and structural violence features of the COVID pandemic, with a specific focus on: 1) the importance of local socioenvironmental conditions/demographics and disease configurations in creating varying local syndemic expressions; 2) the ways that the pandemic has exposed the grave weaknesses in global health care investment; and 3) how the syndemic nature of the pandemic reveals the rising rate of noncommunicable diseases and their potential for interaction with current and future infectious disease. The paper concludes with a discussion on the role of anthropology in responding to COVID-19 from a syndemics perspective.

Race against death or starvation? COVID-19 and its impact on African populations

BACKGROUND

Born in the Chinese city of Wuhan, the consequences of the coronavirus pandemic on global health and economies have been and continue to be devastating. In Africa, its countries grieve for unprecedented burdens of caseloads and mortality due to COVID-19, the virus responsible for the disease. This narrative review aims to establish the scale of the health and economic crisis wrought by the pandemic in Africa, including its impact on the informal economic sector, projections of the effect on national GDP, as well as its political dimensions.

METHODS

Documentary evidence issued between January and 8 August 2020 was sought from the Google Scholar, PubMed, Scopus, and Web of Science databases. Searches of published and unpublished abstracts were also conducted from appropriate websites, government documents, organizational reports, newspaper commentaries, and reports issued by global, regional, and local centers of disease control and prevention.

RESULTS

The COVID-19 pandemic is responsible for a fourfold crisis in Africa: (1) a health crisis: the victimization of frontline healthcare workers and the looming caseload and death tolls with 1.039 million (12%) cases being confirmed and over 22,966 (2.4%) deaths as of 8 August 2020. The highest death toll was recorded in Southern Africa of 11,024 (48%) followed by North Africa with 6,989 (29.2%) deaths; (2) a social crisis: with the violation of human rights, the killing of citizens by security forces and increased crime. This, in turn, exacerbates social inequalities, the breakdown of households, instances of social unrest, and general impoverishment; (3) an economic crisis: manifested by a decline in GDP and mass unemployment; (4) a political crisis: implementation of measures that may not be appropriate for Africa, discrimination of refugees and immigrants, evacuation of citizens to their home countries, resulting in distrust of political leaders and postponement of national elections, and mounting cases of conflicts and unrest.

CONCLUSION

Lockdown during the COVID-19 outbreak is a prevention mechanism in affluent countries, in contrast to developing regions such as Africa, where it is a race against death and starvation. Policymakers must apply novel and locally relevant prevention and management strategies to cope with this growing disaster.

'Constituent Covid-19 apocalypses: contagious conspiracism, 5G, and viral vaccinations'

The uncertainties and scale of the Covid-19 pandemic has mobilised global anxieties and insecurities, and many cultural groups have conjuncturally embedded conspiracy theories within millennial and apocalyptic thought to explain and find meaning in the pandemic. The apocalypse lends itself well to conspiratorial thinking because conceptually it is flexible enough to reflect any crisis. To this end, the global development of Covid-19 conspiracism is what the authors term 'contagious conspiracism' which is defined as viral global cultural conspiracism. The paper explores how millennialist responses to Covid-19 in various media outlets transcend academic categories of analysis and cultural boundaries between, say, religious and secular, far-right and radical left. First explored is how the crisis became embedded in established (mainly American) contemporary millennial beliefs and prophecies through selected far-right, evangelical and radical left narratives. Second, it is shown how these theories have been 'improvised' to include 5 G and also travelled to Europe and taken on geographical significance in Belfast and Berlin. Third, the authors illustrate the shared ingredients, motivations, and semiotics across apocalyptic conspiratorial Covid-19 narratives, all of which resonate with concerns about power, specifically emergent surveillance technologies, governmental abuse of power, and neoliberal capital, with divergent truths about who is blame from 5 G/vaccine theories to corporate technocapitalism. The paper concludes that these shared discourses across apocalyptic and conspiratorial Covid-19 narratives mean many of us are conspiracists and/or conspiracy theorists at some level and is therefore both revealing of the similarities and has the potential to create democratic constituencies.

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.

Inter-state transmission potential and vulnerability of COVID-19 in India

Since the first case of COVID-19 traced in India on 30th January, 2020, the total no. of confirmed cases is amplified. To assess the inter-state diversity in spreading potentiality of COVID-19, the exposure, readiness and resilience capability have been studied. On the basis of the extracted data, the outbreak scenario, growth rate, testing amenities have been analysed. The study reflects that there is an enormous disparity in growth rate and total COVID-19 cases. The major outbreak clusters associated with major cities of India. COVID-19 cases are very swiftly amplifying with exponential growth in every four to seven days in main affected states during first phase of lockdown. The result shows the vibrant disproportion in the aspects of, hospital bed ratio, coronavirus case-hospital bed ratio, provision of isolation and ventilators, test ratio, distribution of testing laboratories and accessibility of test centres all over India. The study indicates the sharp inequality in transmission potentiality and resilience capacity of different states. Every state and union territory are not well-prepared to contain the spreading of COVID-19. The strict protective measures and uniform resilience system must be implemented in every corner of India to battle against the menace of COVID-19.

Facing new fears during the COVID-19 pandemic: The State of America's mental health

OBJECTIVE

COVID-19 is rearranging our society with fear and worry about the novel coronavirus impacting the mental health of Americans. The current study examines the intersection of COVID-19 fear, worries and perceived threat with social vulnerabilities and mental health consequences, namely anxiety and depressive symptomatology.

METHODS

Using an online platform, a national sample (n = 10, 368) of U.S. adults was surveyed during the week of March 23, 2020. The sample was post-strata weighted to ensure adequate representation of the U.S. population based on population estimates for gender, race/ethnicity, income, age, and geography.

RESULTS

Fear and worry are not distributed equally across the country; rather they are concentrated in places where the largest number of confirmed COVID-19 cases is found. Additionally, data highlight significant differences in the subjective perception of distress across groups with varying social vulnerabilities. Women, Hispanics, Asians, families with children under 18, and foreign-born respondents reported higher levels of subjective fear and worry compared to their counterparts. Finally, even after controlling for social vulnerability, subjective assessments of distress were positive, and significantly related to anxiety and depressive symptomatology; prior mental health research from China and Europe confirm what others have begun to document in the United States.

CONCLUSIONS

This preliminary work provides practitioners with a glimpse of what lies ahead, which individuals and communities may be the most vulnerable, and what types of strategic interventions might help to address a wide range of mental health consequences for Americans in the months and years ahead.

Applying Blockchain Technology to Address the Crisis of Trust During the COVID-19 Pandemic

BACKGROUND

The widespread death and disruption caused by the COVID-19 pandemic has revealed deficiencies of existing institutions regarding the protection of human health and well-being. Both a lack of accurate and timely data and pervasive misinformation are causing increasing harm and growing tension between data privacy and public health concerns.

OBJECTIVE

This aim of this paper is to describe how blockchain, with its distributed trust networks and cryptography-based security, can provide solutions to data-related trust problems.

METHODS

Blockchain is being applied in innovative ways that are relevant to the current COVID-19 crisis. We describe examples of the challenges faced by existing technologies to track medical supplies and infected patients and how blockchain technology applications may help in these situations.

RESULTS

This exploration of existing and potential applications of blockchain technology for medical care shows how the distributed governance structure and privacy-preserving features of blockchain can be used to create "trustless" systems that can help resolve the tension between maintaining privacy and addressing public health needs in the fight against COVID-19.

CONCLUSIONS

Blockchain relies on a distributed, robust, secure, privacy-preserving, and immutable record framework that can positively transform the nature of trust, value sharing, and transactions. A nationally coordinated effort to explore blockchain to address the deficiencies of existing systems and a partnership of academia, researchers, business, and industry are suggested to expedite the adoption of blockchain in health care.

When science goes viral: The research response during three months of the COVID-19 outbreak

Here we present the results of a bibliometric survey of peer-reviewed and pre-print papers published in the English language on issues related to COVID-19 within the first three months since a cluster of a severe acute respiratory disease of unknown etiology was officially confirmed by the Chinese Center for Disease Control and Prevention on 31 December 2019. A systematic search using PubMed/Medline and Scopus databases and preprint servers was performed. The articles were classified according to their type, subject and country of origin. Up to 31 March 2020, a total of 2062 papers published in 578 peer-reviewed journals and 1425 preprints posted mostly on medRxiv (55.4 %), were identified. The mean number of published journal papers and preprints per day in the considered period was 27 and 12, respectively, and reached a maximum of 51 and 46 per day in March, respectively. The identified articles, journal papers and preprints, mostly covered the epidemiology of COVID-19 (35.7 %), clinical aspects of infection (21.0 %), preventative measures (12.8 %), treatment options (12.5 %), diagnostics (12.2 %), mathematical modeling of disease transmission and mitigation (9.6 %), and molecular biology and pathogenesis of SARS-CoV-2 (8.7 %). The majority of the journal papers were commentaries (38.5 %), reviews (33.6 %) and original research (21.3 %), while preprints predominantly presented original results (89.8 %). Chinese scientists contributed the highest share of original research and were responsible for 32.9 % journal papers and 43.9 % preprints published in the considered period. A high number of contributions was also seen from the United States, the United Kingdom, and Italy. The benefits and potential risks of such a massive publication output are discussed. The scientific response seen during the first 3 months of the COVID-19 outbreak is a demonstration of the capabilities of modern science to react rapidly to emerging global health threats by providing and discussing the essential information for understanding the etiological factor, its spread, preventative measures, and mitigation strategies.

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

INTRODUCTION

With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.

METHODS

In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.

RESULTS

Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.

CONCLUSION

Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.