Social Security, Exponential Inequalities, and Covid-19: How Welfare Reform in the UK Left Larger Families Exposed to the Scarring Effects of the Pandemic

Covid-19 has put social security systems under immense pressure. Governments saw demand for social security rise dramatically whilst attempting to support those whose employment had temporarily stopped once severe economic restrictions were put in place. Drawing on a range of evidence (including original interviews), this chapter focuses on the experience of larger families (households with three or more children) during the pandemic as a way of illuminating how these pandemic-induced policy responses often failed to reach those groups who have been subject to austerity measures over the previous decade. We explore this in three ways. First, we unpack how the government's response to Covid-19 left larger families in a precarious position. Secondly, we situate the experience of larger families in the context of a wider set of reforms to social security-such as the benefit cap, the two-child limit, and the benefits freeze-which have already pushed even more larger families into poverty over the last decade. The final section of the chapter draws out how these policy decisions exacerbate inequalities between groups, while alluding to implications for protected characteristics as enshrined in the Equality Act 2010. This analysis not only illuminates how the pandemic has increased gender and ethnic inequalities but also suggests that the degree to which the pandemic was inequality-generating is rooted in policy decisions made before the pandemic even began. Avoiding exponential inequalities in response to future crises requires that policies-and the discourses which surround them-are sensitive to the potential for other kinds of societal shock. © The several contributors 2022. All rights reserved.

Geauxhealth.org - A technological approach to addressing social determinants of health in New Orleans

Purpose of Study: GeauxHealth! is a multi-institutional, multi-disciplinary collaboration designed to create an easy-to-use guide for community health resources based on significant need in the Greater New Orleans area. The 2019 New Orleans Community Health Assessment found that New Orleanians identified mental health, substance use, women's health and chronic medical diagnosis management as areas of concern. Health barriers identified include crime and violence, infrastructure, environmental factors, healthy food, housing and income Additionally, the COVID-19 pandemic has further highlighted health inequity in communities across the United States. In an effort to address these findings and to promote awareness of social determinants of health among providers, Geauxhealth.org was created with a vision to be an updated, user-friendly website created by medical trainees for medical trainees and patients. Methods Used: 139 residents and fellows across multiple specialties within Tulane School of Medicine and LSUHSC School of Medicine were surveyed before and after the introduction of Geauxhealth.org. Summary of Results: When asked about confidence in referring patients to community resources when needed, 27% of trainees answered "Definitely not confident" and 31% answered "Somewhat confident." Nearly all respondents noted that barriers to referring patients to resources included: "Lack of Time" and "Lack of Knowledge." 96% of trainees noted they would use a website or app if available for referring patients to community resources. Post-intervention results are currently being analyzed. Conclusion(s): Awareness of social determinants of health is the first step in addressing health inequity experienced by the patients we serve. GeauxHealth! is designed to bridge the gap between awareness and action. Over time, the hope is for GeauxHealth! to serve as education for [Table presented] incoming residents, to be a utilized tool by providers, hospital employees and patients and to create a framework for the development of health resource guides in other cities. Copyright © 2023 Southern Society for Clinical Investigation.

Simulation of Remdesivir Disposition and Its Drug Interactions

Purpose: Remdesivir, a drug originally developed against Ebola virus, is currently recommended for patients hospitalized with coronavirus disease of 2019 (COVID-19). In spite of United States Food and Drug Administration's recent assent of remdesivir as the only approved agent for COVID-19, there is limited information available about the physicochemical, metabolism, transport, pharmacokinetic (PK), and drug-drug interaction (DDI) properties of this drug. The objective of this in silico simulation work was to simulate the biopharmaceutical and DDI behavior of remdesivir and characterize remdesivir PK properties in special populations which are highly affected by COVID-19. Methods: The Spatial Data File format structures of remdesivir prodrug (GS-5734) and nucleoside core (GS-441524) were obtained from the PubChem database to upload into the GastroPlus software 9.8 version (Simulations Plus Inc., USA). The Absorption, Distribution, Metabolism, Excretion and Toxicity (ADMET) Predictor and PKPlus modules of GastroPlus were used to simulate physicochemical and PK properties, respectively, in healthy and predisposed patients. Physiologically based pharmacokinetic (PBPK) modeling of GastroPlus was used to simulate different patient populations based on age, weight, liver function, and renal function status. Subsequently, these data were used in the Drug-Drug Interaction module to simulate drug interaction potential of remdesivir with other COVID-19 drug regimens and with agents used for comorbidities. Results: Remdesivir nucleoside core (GS-441524) is more hydrophilic than the inactive prodrug (GS-5734) with nucleoside core demonstrating better water solubility. GS-5734, but not GS-441524, is predicted to be metabolized by CYP3A4. Remdesivir is bioavailable and its clearance is achieved through hepatic and renal routes. Differential effects of renal function, liver function, weight, or age were observed on the PK profile of remdesivir. DDI simulation study of remdesivir with perpetrator drugs for comorbidities indicate that carbamazepine, phenytoin, amiodarone, voriconazole, diltiazem, and verapamil have the potential for strong interactions with victim remdesivir, whereas agents used for COVID-19 treatment such as chloroquine and ritonavir can cause weak and strong interactions, respectively, with remdesivir. Conclusions: GS-5734 (inactive prodrug) appears to be a superior remdesivir derivative due to its hepatic stability, optimum hydrophilic/lipophilic balance, and disposition properties. Remdesivir disposition can potentially be affected by different physiological and pathological conditions, and by drug interactions from COVID-19 drug regimens and agents used for comorbidities.

Improving CF outpatient clinic documentation

Background: Clinical documentation affects clinic flow, care delivery and coordination of care. CF patient complexity and multiple caregiver involvement require accurate and usable notes. Clinic notes also provide data for research, impacting future care. This project is to improve data entry into and extraction from clinic notes in the CF outpatient clinic through a standardized note template. Methods: Staff completed satisfaction surveys to identify areas for improvement. Specific aims were developed from survey results and team meetings. Fifty clinic notes were evaluated for key data. Epic Signal Reports (ESRs) were reviewed for measures of note efficiency. A key driver diagram was developed to map aims and change ideas. A prototype note and flowsheets were developed and revised through several plan-do-study-act cycles. Approved note was uploaded to Epic and is now in production. Results: Satisfaction surveys indicated areas for improvement: data entry time, minimal extraneous data, utilize flowsheets, optimal and accessible information, and consistent data across providers. Review of 50 clinic notes showed inconsistent documentation of key data (Figure 1) and delayed completion time for notes (Figure 2). ESRs showed an average of 10.2 (9.7-11) minutes of active documentation in clinic note per appointment and 35 (32-37) minutes per day, with an average note length of 12.66k (8k-18k) characters. Time studies of data extraction for and entry into the CF Patient Registry were unobtainable. Discussion: Identification of areas for improvement from satisfaction surveys were supported by data review. Clinic note and ESR evaluation revealed inefficient note documentation and completion times. Gaps in key data were identified across clinic notes. Due to COVID-19, implementation of the new note template and flowsheets has been delayed. When clinic visits resume and the new template is implemented, we will reassess satisfaction surveys, note content and ESRs. We anticipate a more relevant clinic note, improved satisfaction in data entry and extraction, decreased data entry time and increased documentation of key data.

Palliation or protection: How should the right to equality inform the government’s response to Covid-19?

This article examines what role equality law can play in addressing the inequalities created and exacerbated by the British government’s response to the Covid-19 pandemic. We argue that while there is great potential in existing legislation, there is a need for both policy-makers and courts to apply a more searching and nuanced understanding of the right to equality if this potential is to be realised. We begin by examining how the burdens of confronting this pandemic as a society fall more heavily on those already at the bottom end of the scale of inequality. We then ask whether and to what extent the current legal structures protecting the right to equality can be mobilised to redress such inequalities, paying particular attention to the Public Sector Equality Duty under the Equality Act 2010 and on the Human Rights Act 1998. Finally, we argue that, to fulfil the requirements of both these legal duties, the courts should subject policies and practices to close scrutiny under the four-dimensional approach. When making and operationalising policies around Covid-19, substantive equality requires account to be taken simultaneously of the four dimensions of inequality to the greatest extent possible. © The Author(s) 2020.