ABSTRACT
The initial surge of the COVID-19 pandemic and public health measures in response dramatically impacted Adult Protective Services' (APS) ability to conduct investigations and provide services, requiring agencies to quickly adapt. Our goal was to describe challenges for APS and strategies they developed to respond. We conducted 6 focus groups and 7 interviews during March-April 2021 used a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and case workers in New York City, a community hard hit by the initial COVID surge. Focus groups and interviews were recorded and transcribed, with data analyzed to identify themes. Participants identified 9 major challenges, including: clients using concern about COVID-19 to refuse APS workers' access to their home, necessity to perform home visits/wellness checks on behalf of other agencies who had suspended home visits, and dependence on in-office activities including receiving paper mail. Participants reported 30 formal and informal strategies adopted to address challenges. These included 13 focusing on maximizing client engagement while maintaining client and APS worker safety, such as: adding a pre-investigation before a home visit to assess COVID-19 risk/exposure, offering clients masks and hand sanitizer to build trust, and close collaboration with other agencies/programs including joint visits. Also, 17 strategies were reported to allow for remote work and support staff, including: modifying processes to replace paper mail with electronic communication/processing, offering counseling services, formally recognizing excellent performance, and leadership reaching out personally to check on staff members. These findings may inform APS planning for future large-scale societal disruptions.
ABSTRACT
The number of pediatric emergency department (PED) visits fell significantly during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the ongoing pandemic on PED patients suffering from asthma attacks in Taiwan has not been studied. We thus analyzed patients with asthma attacks visiting a PED during the early stage of the COVID-19 pandemic and the following (resurgent) waves. We retrospectively studied pediatric patients with asthma attacks who visited the PED from 01 January 2019 to 30 September 2021. We retrieved patient numbers, demographic characteristics, triage acuities, medications, and PED dispositions during the various waves of the COVID-19 pandemic. A total of 1842 patients with asthmatic attacks presented to the PED during the study period. PED visits caused by asthmatic attacks declined by 55% after the first COVID-19 outbreak in early 2020 (p = 0.009) and fell even more remarkably (by 85%) in mid-2021 (p = 0.038), during the time when the numbers of confirmed COVID-19 cases skyrocketed (the second wave). However, neither the high-triage acuity rate nor the rate of admission differed between the two periods (p = 0.08 and 0.406, respectively). However, the proportion of systemic corticosteroid (SCS) prescriptions increased during the pandemic (81.90 vs. 77.77%, p = 0.029). The COVID-19 pandemic notably impacted the number of asthmatic PED visits not only during the first peak period but also during the following waves, but asthma severity did not vary over time. Physicians tended to prescribe more SCSs during the pandemic to control respiratory symptoms. We suggest that SCSs should be used cautiously even during the pandemic to minimize their adverse effects. Copyright © 2022 The Author(s). Published by MRE Press.