Unpaid Family Caregiving-The Next Frontier of Gender Equity in a Postpandemic Future.

This Viewpoint discusses how the COVID-19 pandemic has spotlighted the critical role of unpaid family caregiving.

Streamlining Test-to-Treat: A Novel Care Delivery Model for Covid-19 Oral Antiviral Access to Close the Equity Divide in Los Angeles County

The Los Angeles County Department of Public Health, in collaboration with Healthvana, a well-established private-sector partner, was able to quickly stand up a program to target patients in socially and economically disadvantaged communities for access to time-sensitive oral antiviral remedies. The Covid-19 pandemic has revealed the urgent need for a new care model that serves socially and economically disadvantaged communities by providing timely and widespread access to therapeutics that is free of cost to the patient and agnostic to insurance status, provider, and physical location of Covid-19-positive individuals. The Los Angeles County Department of Public Health (LAC DPH) - in partnership with Healthvana, a Health Insurance Portability and Accountability Act of 1996-compliant patient engagement platform that digitally delivers test results directly to patients and providers - piloted an innovative treatment-dispensing model cost-free to the patient to address both inequitable access and the time-sensitive nature of Covid-19 medication prescriptions - in particular, oral antivirals such as Pfizer's Paxlovid. The intervention combined confidential digital delivery of Covid-19 test results, antiviral education, and direct access to therapeutics within hours of a positive polymerase chain reaction (PCR) result for severe acute respiratory syndrome coronavirus 2 infection. Between April 5 and July 5, 2022, this care model delivered 25,237 PCR-positive test results from 77 LAC DPH Covid-19 test sites and enabled patients to connect with a clinician within hours of receiving a positive test result to receive a free Covid-19 screening and prescription for Covid-19 antiviral treatment. During that 3-month period, 1,471 prescriptions for oral antivirals were prescribed through the LAC DPH telehealth line, and 1,177 of those patients who were contacted via a follow-up survey had filled their prescriptions. Success was attributable to rapid rollout, leveraging Healthvana's existing infrastructure and brand recognition built over the preceding 2 years of the pandemic, and provision of an instant-access medical consult and prescription cost-free to patients. This intervention demonstrates the potential for digital health technologies to facilitate more equitable interventions at the intersection of public health and clinical practice.

A Brief History of Exposure Notification During the COVID-19 Pandemic in the United States, 2020-2021.

The swift global spread of COVID-19 prompted public health authorities to explore digital technologies to aid in contact tracing for infection control. Exposure notification, a mobile device-based technology that notifies individuals of potential exposure to COVID-19 without requiring personally identifiable information, has been broadly favored because of its relative ease of use, scalability, and protection of personal privacy. Although several exposure notification protocols were developed, a partnership between Google and Apple led to the development of the most widely implemented exposure notification protocol in the world, including in the United States. In this article, we first describe the development of the Google Apple Exposure Notification (GAEN) protocol, noting the value of the discourse among software developers and public health authorities concerning the protocol's design and features. We track states' deployment of GAEN mobile applications (apps) and population-level adoption rates, finding the nationwide rollout of GAEN apps to be more fragmented than anticipated. We then discuss how the limited data collected from these apps make assessments of their effectiveness challenging. Finally, we consider the importance of the federal government playing a greater role in GAEN's early development, emphasize the power of public-private partnerships, and highlight the overriding importance of public messaging over technological details.