Tourism water use during the COVID-19 shutdown: a natural experiment in Hawai'i

Many popular tourist destinations are on small islands whose resources are in limited supply, and the effects of climate change and burgeoning tourism tend to worsen the outlook. In this study, we identify the relationship between tourism and water use on the Hawaiian island of O'ahu. Hawai'i closed almost entirely to tourism during the COVID-19 pandemic, which provides a unique natural experiment to study the relationship between tourism and water use. We estimate a 1% decline in the number of tourists was associated with a 0.4% to 0.65% lower water use in the hotel sector. However, no such relationship was found in the Airbnb market, which we hypothesize is due to work-from-home arrangements in the residential sector during the pandemic.

Do You Know Where Your ACK Messages Are? Assessing and Correcting Fatal Errors from Vaccine Submissions to a State Immunization Registry

Purpose/Objectives: The COVID-19 pandemic has highlighted the importance of timely, accurate, and complete reporting of immunization information from electronic health records (EHRs) to existing immunization registries. However, vaccine submissions to registries are not always successful, with errors being reported back to the sending interface using HL7 acknowledgement (ACK) messages. Little attention has been paid to a more formal characterization of these fatal error messages, including types of errors and how best to handle them. We describe a collaboration between the Tennessee state immunization registry (TennIIS), EHR technical support engineers, and institutional informaticians to develop and implement a process to visualize, analyze, and correct fatal error messages. This work helped inform the activities of a national CDC-sponsored HIMSS Immunization Integration Program initiative to improve EHR-IIS interoperability. Design/Methods: In July, 2020, TennIIS began generating weekly "Summary of Errors" reports with figures for total vaccine (VXU) messages submitted, number of error messages generated, and a list by frequency of types of errors. This report was iteratively tweaked over the next several months to include additional statistics, and it is currently emailed to our institution each Monday. Concurrently, EHR technical support engineers worked with informaticians to develop workqueue and reporting tools. Weekly text file extracts of specific data elements from ACK messages and corresponding VXU messages are automatically exported every Monday to a secure directory. Additional web-based tools have been developed to import these files for more detailed reporting and analysis. Results are communicated back to TennIIS and EHR technical support personnel to determine causes of errors, possible solutions, and resubmission of vaccine messages if feasible. Results: Multiple types of systematic errors were identified, caused by issues on both the IIS and EHR sides. IIS issues included configuration errors and missing functionalities. An incorrect NDC code setting in the IIS resulted in 2,571 influenza vaccine messages being rejected. The setting was corrected and the vaccines successfully resubmitted. EHR issues included configuration/mapping errors, with one incorrect mapping causing 3,710 vaccines to be rejected. Missing demographics, an unusual 'Name Type Code' error, and invalid characters in patient names were among other discovered errors. 1,602 vaccines were successfully resubmitted after addressing some of these errors - including 519 COVID-19 vaccinations. Conclusion/Discussion: The combination of TennIIS weekly summaries, vendor exporting functionalities, and webbased analysis tools provided previously unknown insights into the types of fatal errors that were occurring with vaccine submissions. These efforts were valuable not only in identifying and successfully resubmitting nearly 8,000 vaccines to the registry, but also in increasing our understanding of various root causes of errors and the different stakeholders who might be best suited to address them. Finally, it should be possible to scale these functionalities across other IIS and EHR vendors to support similar efforts.

Tourism water use during the COVID-19 shutdown a natural experiment in Hawaii

COVID-19 dealt a formidable blow to the US economy. We present a joint analysis of the epidemiological and labor market outcomes across US states. We focus on the relationship across relevant indicators in the pre-vaccination era. As expected, we find strong correlation between changes in economic conditions and mobility. However, mobility fluctuations tend to be uncorrelated with local epidemics and occur simultaneously across most states. The magnitude of the mobility response is highly correlated with the rural vs. urban character of the area. Employment losses are most strongly associated with high population density and concentration of the leisure and hospitality industry. The relationship between job losses and the case fatality ratio is affected by the timing of the most severe COVID-19 waves.