Time-Space Companions: Digital Surveillance, Social Management, and Abuse of Power During the Covid-19 Pandemic in China

Based on ethnographic research carried out during the 2022 Covid-19 surge in southern China, this paper examines the roll-out of a contact-tracing tool called the Time-Space Companion project. The project exemplifies a state effort to incorporate data-driven surveillance technology into the public health apparatus during the coronavirus outbreak. By exploring the definition, identification, and management of Time-Space Companions, the paper shows that the project was used to discipline Chinese citizens and shift public health responsibilities onto them by transforming daily life into sites of public health regulation, discipline, and criminalization. The project also exemplified an on-going state effort to leverage surveillance technologies for the purposes of social management. The paper draws attention to the social repercussions that resulted when technology offered a tempting tool to enhance the infrastructural and despotic powers of mundane state actors. © 2023 BCAS, Inc.

PATIENTS WITH CIRRHOSIS EXPERIENCE HIGHER ICU MORTALITY COMPARED TO NON-CIRRHOTIC PATIENTS WHICH CONTINUED WITH OR WITHOUT COVID-19 DESPITE CONTROLLING FOR ORGAN FAILURE SEVERITY

Patients with cirrhosis have a relatively poor prognosis in intensive care (ICU) that could be affected by the9 pandemic. However, the impact of cirrhosis care compared to noncirrhotic patients is unclear pre and post-pandemic. Aim: Define impact of cirrhosis on mortality in ICU patients before & after COVID-19. Methods: ICU pts from a large tertiary hospital who were admitted for >24 hours were divided into pre-COVID (2019) and postpandemic (2020) eras. We excluded patients where cirrhosis diagnosis was unclear. Within the 2020 cohort, we further divided pts into COVID-positive or negative based on PCR. Pts with cirrhosis were matched 1:1 to non-cirrhotic pts with respect to age, ICU admission qSOFA & ICU length of stay in both cohorts. Reasons for ICU admission, infections, organ failures and discharge information were collected. We first compared only COVID negative cirrhosis vs other pts in the pre and post cohorts & then further compared these within the COVID positive pts. Logistic regression with death/hospice as the outcome was used with cirrhosis status, qSOFA, reason for ICU admission and organ failures as independent variables in the three matched cohorts (pre-COVID, post-COVID positive & post-COVID negative). Finally, to evaluate the relative impact of cirrhosis vs COVID-19, we combined the 2020 cohort and determined death/hospice determinants. Results: We included 200 age/LOS/qSOFA-matched pts with/without cirrhosis in pre-COVID cohort. Post-COVID similarly, 200 pts were included in the COVID negative group. 64 COVID+ pts (with/ without cirrhosis) were also included. More non-cirrhotic pts were admitted for procedural observation & stroke while altered mental status (AMS) were similar. Remaining organ failures were higher in cirrhosis in pre- and post-COVID settings (Table 1). In COVIDpositive pts, cirrhosis had lower infections, respiratory failure and intubation but trended towards higher death. Cirrhosis comparison pre vs post-COVID: Post-COVID cirrhosis pts had a higher MELDNa score (15.4±7.9 vs 22.3±10.2, p=0.004)and qSOFA (2.4 vs 1.7, p<0.001) compared to pre-COVID. Logistic regression for death/hospice (Table 2): Pre COVID was significant for cirrhosis, qSOFA , altered mental status & Pressors. Post-COVID in COVID-negative pts it was again significant for cirrhosis, Infection, renal failure & qSOFA. For only COVID positive patients, only renal failure was significant. In the entire 2020 cohort, COVID-19 positive status was not significant in death/hospice prediction, but cirrhosis remained significant. Conclusions: Cirrhosis remains a major cause of mortality in patients admitted to intensive care that continues regardless of COVID-19 pandemic-induced changes in the health system. Cirrhosis is predictive of death independent of COVID-19 despite controlling for demographics and organ failure severity. (Table Presented)

Impact of COVID-19 on mortality and readmissions in patients with chronic liver disease with and without cirrhosis: A single tertiary academic center experience

Background: The immediate outcomes following coronavirus disease 2019 (COVID-19) in patients with chronic liver disease (CLD) are worse than in those without CLD. The impact and interaction of COVID-19 with presence and severity of CLD are not well established with respect to longer term outcomes i.e., rates of readmission and death after initial recovery from the acute infection. The aim of this study was to determine the impact of COVID-19 infection on readmission rates and death after initial recovery from the infection. Methods: In our institution, we conducted an observational cohort study of four groups of adult patients: (1) COVID- group and (2) COVID+ group, with subgroups (a) CLD without cirrhosis, (b) CLD with cirrhosis, who were hospitalized between March 1, 2020, and December 31, 2020. Mortality rates and readmission rates were compared among the groups. Results: A total of 17,934 patients were studied. These included: COVID+ CLD+ (with cirrhosis) n=60, COVID+ CLD+ (without cirrhosis) n=121, COVID+ CLD- (n=1113) and COVID- CLD- (n=14083). The overall characteristics of CLD+ groups are shown in Table 1. In Hospital outcomes for index admission for COVID-19: In COVID+ but non-cirrhotic CLD patients, age, acute kidney injury (AKI), nonalcoholic fatty liver disease (NAFLD) and mechanical ventilation significantly predicted in-hospital mortality. In contrast, in COVID+ CLD with cirrhosis, model for end-stage liver disease (MELD) score, FIB4 and need for mechanical ventilation were independent predictors of death. Post-Discharge outcomes: (1) 3-month re-admission: Amongst those with COVID-19, readmission rates were higher in those with CLD vs without CLD but this did not achieve significance (n= 16% vs 9%, p=0.013). Not surprisingly, within those with CLD who had COVID-19, those with decompensated cirrhosis had a higher readmission rate compared to those with compensated cirrhosis but this did not achieve significance (36% vs 11%, p=0.10). (2) Mortality: There was no statistically significant difference in mortality rate (10% vs 18%, p=0.17) between CLD patients with or without cirrhosis. The most common causes of death and readmissions in CLD patients were liver related in COVID- group, and sepsis and respiratory failure, respectively in COVID+ group. Conclusion: In hospital predictors of mortality during acute COVID-19 infection in CLD vary by presence of cirrhosis. Readmission for patients with COVID-19 was independent of CLD. Sepsis and Respiratory failure are important causes of readmission and death in patients with CLD following initial recovery from COVID-19.

Afterword: a critical reckoning with the 'Asian century' in the shadow of the anthropocene. (Recentering tourism geographies in the 'Asian Century'.)

What does the advent of an 'Asian Century' portend for critical tourism geographies? This commentary argues that two recent developments have made a critical reckoning with the Asian Century more pressing than ever. First, the Asian Century is in danger of being eclipsed by the deteriorating relationship between China and the United States. And second, the COVID-19 pandemic has created unprecedented challenges for tourism throughout the world and threatens to fundamentally upend travel as we've known it for the foreseeable future. These two developments suggest a pressing need not just for a decentering of Eurocentric approaches in tourism scholarship - as has long been argued by critical tourism scholars - but for a more thorough unraveling of the politics of knowledge in tourism scholarship.