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The COVID-19 pandemic occasioned significant financial distress and uncertainty for many U.S. transit operators. In the face of this crisis, the federal government provided substantial supplemental operating support. To understand how this fiscal turmoil and relief have affected U.S. transit systems, we conducted two nationwide surveys of transit agency staff in 2020 and 2021-2022. While pandemic-induced financial shortfalls affected service in 2020, with capital projects delayed too, these effects became much more muted by 2021/2022. Most systems reported moderate to substantial increases in federal funding during the pandemic, more so than other funding categories. However, nearly half foresee financial shortfalls once federal relief funding expires. Agencies with higher pre-pandemic ridership and farebox recovery are particularly affected by fare revenue losses and more likely to anticipate shortfalls. In the near term, difficulty hiring and retaining front-line workers was a pressing concern, while very few had plans to maintain pandemic fare suspensions. © The Author(s) 2023.
ABSTRACT
The COVID-19 crisis elevated the importance of private vehicles. The pandemic drove riders off public transit and spawned additional car-based activities such as drive-through testing and vaccinations and curbside pick-ups. Yet millions of low-income and non-white households do not own vehicles. This chapter draws on a unique credit panel dataset to examine automobile debt and delinquency in California. In particular, we examine whether automobile debt patterns during the pandemic differed from those during and coming out of the Great Recession (December 2007–June 2009). We also analyze the response to the COVID-19 recession across neighborhoods by income and race. Similar to the situation during the Great Recession, we find that the number of automobile loans per borrower declined. While the automobile debt burden (the ratio between total automobile debt and aggregate income) also declined, it fell far less during the pandemic than during the Great Recession. Moreover, automobile loan delinquencies spiked during the Great Recession but instead continued to drop during the pandemic. Finally, the COVID-19 crisis affected consumers differently by both race and income. Automobile debt burden rose in low-income, Latino/a, and Black neighborhoods, a pattern that preceded but continued unabated during the pandemic. The findings suggest that COVID-19 relief may have helped some families manage their automobile-related expenditures. However, other factors, such as increasing automobile prices, likely contributed to growing debt burdens, a potential source of financial distress. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Objectives: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy). Materials and Methods: We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders. Results: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p=0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p=0.9) or death or non-routine discharge (p=0.2). Conclusions: Patients with acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.
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Background: Undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may be seen in acute stroke patients. Rapid screening is important to reduce exposure to medical professionals and other patients during acute assessment and treatment. Chest computed tomographic (CT) scan may be another time-sensitive option for identification of SARS-CoV-2 infection in acute stroke patients. Objective: We report our experience of incorporating chest CT scan in the initial neuroimaging protocol for evaluation of acute stroke patients. Methods: All acute stroke patients underwent chest CT scan concurrent to CT head, CT angiogram of head and neck and CT perfusion for 10 months. We identified patients who had chest CT scan findings that were suggestive of SARS-CoV-2 infection including bilateral, multilobar ground glass opacification with a peripheral or posterior distribution, and/or consolidation. All patients subsequently underwent polymerase chain reaction (PCR) testing using nasopharyngeal specimen for identification of SARS-CoV-2 with contact isolation. Sensitivity, specificity, and likelihood ratios were calculated. Results: A total of 530 consecutive acute stroke patients (mean age in years 65.6± SD;15.4;280 were men) underwent neuroimaging with concurrent chest CT scan. The chest CT scan identified findings suggestive of SARS-CoV-2 infection in 34 (6.4%) patients. Subsequent PCR testing confirmed the diagnosis of SARS-CoV-2 infection in 21 of 34 patients. Among 491 patients in whom chest CT scan did not identify any findings suggestive of SARS-CoV-2 infection, 387 underwent PCR tests;PCR testing confirmed the diagnosis of SARS-CoV-2 infection in 13 of 34 patients. Sensitivity and specificity of chest CT scan for detecting SARS-CoV-2 infection was 61.9% and 96.2%, respectively. Positive and negative likelihood ratio of chest CT scan for detecting SARSCoV-2 infection is 16.26 and 0.39, respectively. Conclusions: Although specificity was high, the relatively low sensitivity of chest CT scan in identifying SARS-CoV-2 infection limits the value of adding this imaging to standard neuroimaging in acute stroke patients. At our institution, we have subsequently discontinued the protocol.
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Objective: The effect of Coronavirus disease 2019 (COVID-19) pandemic on performance of neuro-endovascular procedures has not been quantified. Background: The effect of Coronavirus disease 2019 (COVID-19) pandemic on performance of neuro-endovascular procedures has not been quantified. Design/Methods: We performed an audit of performance of neuro-endovascular procedures at 18 institutions (7 countries) for two periods;January to April 2019 and 2020, to identify changes in various core procedures. We divided the region where the hospital was located based on the median value of total number of COVID-19 cases per 100,00 population-into high and low prevalent regions Results: Between 2019 and 2020, there was a reduction in number of cerebral angiograms (30.9% reduction), mechanical thrombectomy (8% reduction), carotid artery stent placement for symptomatic (22.7% reduction) and asymptomatic (43.4% reduction) stenoses, intracranial angioplasty and/or stent placement (45% reduction), and endovascular treatment of unruptured intracranial aneurysms (44.6% reduction) and ruptured (22.9% reduction) and unruptured brain arteriovenous malformations (66.4% reduction). There was an increase in treatment of ruptured intracranial aneurysms (10% increase) and other neuro-endovascular procedures (34.9% increase). There was no relationship between procedural volume change and intuitional location in high or low COVID-19 prevalent regions. The procedural volume reduction was mainly observed in March-April 2020. Conclusions: We provided an international multicenter view of changes in neuro-endovascular practices to better understand the gaps in provision of care and identify individual procedures which are susceptible to change.
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Objective: We report our experience of incorporating chest CT scan in the initial neuroimaging protocol for evaluation of acute stroke patients. Background: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk for acute ischemic stroke but screening for COVID-19 based on clinical criteria or laboratory testing may be difficult in acute stroke evaluation. Chest computed tomographic (CT) scan may be another time-sensitive option for identification. of COVID-19 in such patients. Design/Methods: All acute stroke patients underwent chest CT scan concurrent to CT head, CT angiogram of head and neck and CT perfusion for 4 months. We identified patients who had chest CT scan findings that were suggestive of COVID-19 including bilateral, multilobar ground glass opacification with a peripheral or posterior distribution, and/or consolidation (mainly in the lower lobes). All patients subsequently underwent polymerase chain reaction (PCR) testing of nasopharyngeal swab with contact isolation until COVID-19 could be excluded. Results: A total of 224 consecutive patients (mean age 62.12 years±SD;15.3) underwent acute stroke evaluation with a concurrent chest CT scan. The chest CT identified findings suggestive of COVID-19 in 11 (4.9%) patients. Subsequent PCR testing did not confirm the diagnosis of COVID-19 in any of the patient. Another 99 patients (44%) without any findings suggestive of COVID-19 on chest CT scan underwent PCR testing. PCR testing did not confirm the diagnosis of COVID-19 in any of the patients. Four patients (4.3%) with chest CT scan findings suggestive of COVID-19 were found to have an ischemic stroke while 7 patients (5.9%) with chest CT scan findings suggestive of COVID-19 did not have any ischemic stroke (stroke mimic). Conclusions: We found a very low yield for identifying COVID-19 in acute stroke patients by performing chest CT scan concurrent to standard acute stroke neuroimaging protocol.
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Objective: Acute ischemic stroke may occur in patients with Coronavirus disease 2019 but risk factors, in hospital events, and outcomes are not well studied in large cohorts. Background: We identified risk factors, co-morbidities, and outcomes in patients with Coronavirus disease 2019 with or without acute ischemic stroke and compared with patients without Coronavirus disease 2019 and acute ischemic stroke. Design/Methods: We analyzed the data from 54 healthcare facilities using the Cerner deidentified Coronavirus disease 2019 dataset. The dataset included patients with an emergency department or inpatient encounter with a discharge diagnoses codes that could be associated to suspicion of or exposure to Coronavirus disease 2019, or confirmed Coronavirus disease 2019. Results: A total of 103 (1.3%) patients developed acute ischemic stroke among 8,163 patients with Coronavirus disease 2019. Among all Coronavirus disease 2019 patients, the proportion of patients with hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk 2.1, 95% confidence interval 1.7-2.4, p<.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19,513 patents without Coronavirus disease 2019. Among all ischemic stroke patients, Coronavirus disease 2019 was associated with discharge to destination other than home or death (relative risk 1.2, 95% confidence interval 1.0- 1.3, p=.03) after adjusting for potential confounders Conclusions: Acute ischemic stroke was infrequent in patients with Coronavirus disease 2019 and usually occurs in presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased two folds with occurrence of acute ischemic stroke in patients with Coronavirus disease 2019.