Efficacy of COVID-19 Public Health Measures in Philadelphia, New York City, Baltimore, and Chicago.

Introduction: From the early days of the pandemic, US cities have implemented a variety of public health measures to reduce the spread of COVID-19. This study investigates which policies were most effective in reducing cases of COVID-19 in four major cities: Philadelphia, New York City, Baltimore, and Chicago. Methods: Through a cross-comparative analysis, we developed a timeline that tracked the implementation of a range of public health measures along with changes in COVID-19 cases, hospitalizations, and deaths. Data were collected from publicly available government sites and from press releases. Results: The results from the stay-at-home orders illustrate the delayed impact it has in reducing COVID-19 cases and hospitalizations. The mask mandate led to the immediate and sustained reduction in cases across all four cities. During the spike of COVID-19 in the Fall of 2020, restrictions on indoor dining contributed significantly to reducing COVID-19 cases. Discussion: Of all the measures that were examined, the implementation of mask mandates was most closely associated with a decline in COVID-19 cases, hospitalizations, and deaths across all four cities. Restrictions on indoor dining were also associated with a reduction in COVID-19 cases. Future studies should further investigate the adherence to different policies to better understand their impacts.

Social determinants of health in pulmonary arterial hypertension patients in the United States: Clinician perspective and health policy implications.

Social determinants of health (SDoH) can impact the vulnerable pulmonary arterial hypertension (PAH) population, especially during the COVID-19 pandemic. Providers' understanding of SDoH at the point of care and their impact is unknown. We conducted semi-structured virtual interviews with US clinicians at 17 pulmonary hypertension (PH) centers and one patient advocate from the Pulmonary Hypertension Association. We sought participants' perspective on SDoH in PAH and their impact. Transcripts were developed and analyzed for key themes to assess potential policy implications. Participants served a large PAH population and demonstrated high awareness of SDoH and its impact on treatment and outcomes. They reported that patients' SDoH, including socioeconomic status, health insurance, access to health care, education levels, health literacy, employment status, and insecurities associated with housing, food, transportation, and family support, impacted health and well-being. COVID-19-related social isolation, mental health, and substance abuse contributed to significant inequities in care provision and outcomes. While telemedicine helped clinicians manage patients remotely during the pandemic, there was a concern for patients with limited access to this medium. Participants reported no formal screening for SDoH at the point of care. With the recognition and the desire to act upon health inequities associated with SDoH, participants felt that it was vital for their centers to have a dedicated PH social worker and support staff to optimize care and outcomes. An approach that integrates SDoH in PAH care management, streamlined through institutional policy, could address health disparities leading to improved healthcare access, outcomes, and quality of care.