Considering community care in public health responses: A national study regarding palliative care during a prolonged coronavirus disease 2019 lockdown.

OBJECTIVE: To describe changes in palliative care characteristics, utilisation and outcomes in Victoria during a period of enhanced public health management and a prolonged lockdown due to coronavirus disease 2019. METHODS: A national retrospective cohort study with palliative care service setting comparisons in Victoria and other mainland states was conducted. RESULTS: Analysis of 48 non-Victorian services (n=53,428 patients) and 20 Victorian services (n=31,125 patients) showed that for community services, patient volume, average length of stay, functional dependency and the proportion of admissions in a deteriorating phase increased during the lockdown in Victoria, yet little changed in comparator states. Regarding inpatient services, the management of family/carer problems remained constant in comparator states, yet substantial fluctuations in outcomes in Victoria were observed. CONCLUSIONS: As health systems adapt to changing circumstances during the pandemic, the ability to upscale community services is critical. Addressing the implications of shifting inpatient care to the community needs attention. IMPLICATIONS FOR PUBLIC HEALTH: Our study highlights the need to ensure community care providers are adequately considered within public health management responses. 'Joined up' policy and implementation across care settings are essential, especially as major barriers to infection control and increased utilisation may be evident in the community during the coronavirus disease 2019 pandemic.

Google Street View as a Teaching Tool for Assessing Earthquake Building Damage

Damage to infrastructure is one of the most visible impacts that earthquakes have on our daily lives. For this reason, introductory undergraduate courses in seismology and related fields often cover earthquake damage in relation to seismic hazard and risk. This topic is commonly introduced by viewing examples of damage, either through static images or videos. Subsequent coursework frequently involves excursions to the field for in-person site inspections and relating the damage to seismic intensity and other parameters of strong ground motion. These field visits provide students with valuable opportunities to apply classroom knowledge to real-world settings. At the time of writing, the recent COVID-19 pandemic has forced many university classes to cancel field visits, depriving students of these experiences. In this EduQuakes article, I present a lesson plan that attempts to simulate a field visit for assessing earthquake damage in an online setting using the interactive online resource Google Street View to view an area before and after an earthquake. This format facilitates active and exploratory learning and encourages students to build the necessary skills required for further studies in more advanced geoscience courses. I include the lesson plan and a compilation of relevant resources in the supplemental material to this article.

Navigating community health: An intervention for low-income asthmatic adults adapted due to COVID-19

RATIONALE: Asthma disproportionately affects low-income and minority adults who are mostly women. The Helping Asthma Patients-3 (HAP-3) Study is designed to engage patients and reveal where health disparity gaps could be reduced. During the intervention, all participants work with a Community Health Navigator, who prepares participants for clinic visits, attends visit while taking notes, and after the session reviews care recommendations with participants. Half of participants are randomized to receive home visits by Navigators, where clinic recommendations are reviewed;health goals are discussed and reported to the patient's clinician. When COVID-19 pandemic forced a widespread shut-down, we were in the 8th month of recruitment and ontarget to reach our enrollment goals for adults with uncontrolled asthma living in low-income neighborhoods. During this unprecedented event, the target community was also traumatized by nationwide episodes of police brutality, hate crimes, and gun violence. With the shutdown and local civil unrest, enrollment slowed. Our goal is to boost enrollment and maintain retention. METHODS: Using a community-based participatory approach, the role of the Community Health Navigator was adapted to boost recruitment, engage participants, and keep clinicians informed of implementation changes, while maintaining the original aims. Using an iterative process with daily huddles of the Navigators and weekly meetings of the Navigators and other team members, including community participants, the protocol was adapted. RESULTS: Over the nine months since the shutdown, we enrolled 73 patients, 60 clinic visits, and 39 number of home visits. We achieved approximately 50% of our original target recruitment goal. We implemented the following innovative adaptations to facilitate enrollment and retention: 1) developed the option of virtual visits for clinic and homes;2) created IRB-approved questionnaires to assess the impact of the pandemic on participants' asthma, general health, and well-being;3) recruited two additional clinics;4) surveyed the impact of social determinants of health on participants;5) standardized our approach to patients;and 6) convened our Community Advisory Board for feedback on adaptations. We improved participant and provider communications through news briefs and fliers, and maintained our presence in clinical offices through in-person and virtual office visits. CONCLUSION: In clinical research, especially of lowincome vulnerable communities, natural events can influence the research and require adaptation of the protocol to preserve its mission. The role of Community Health Navigators is integral in the innovative adaptation of community-based research to capture the needs of patients and inform clinicians.