ABSTRACT
Food insecurity in the United States is not a new challenge, but the coronavirus pandemic has revealed that the current system to sup-port Food Assistance Providers (FAPs) is incredibly brittle and vul-nerable to supply chain disruptions. Many FAPs use just-in-time models to support their operations, relying heavily on donations from restaurants and grocers. However, COVID-19 has demon¬strated that when a disaster causes increased food demand and widespread destabilization of food supply chains, jurisdictions are severely constrained from obtaining and delivering food to pop¬ulations in need. Recent events have further amplified a potential danger to current food security strategies in terms of regions expe¬riencing multiple events, such as a pandemic coupled with hurri¬canes, wildfires, or other catastrophes. After exploring the current governmental food security measures, their long-term deficiencies, and other lessons learned through the COVID-19 response, we call for a major policy shift in how the country addresses food insecurity following a disaster. Rather than relying on after-the-fact spending and hastily created infrastruc¬ture, the nation should proactively stockpile shelf-stable food. To this end, we propose establishing a national stockpile of shelf-sta¬ble foods to help protect against future food supply destabilization. © 2020, Policy Studies Organization. All rights reserved.
ABSTRACT
Objective: To describe the utilization of a popular online forum, subreddit r/ AskDocs, for the diagnosis of urinary tract infections (UTI) in 2020 and explore whether COVID was associated with increased utilization of online forum health care. Methods: The Reddit Pushshift API and Python were used to search for genitourinary infections in the subreddit r/AskDocs between the dates of January 1 2015-December 31 2020 to describe the trend in utilization over 5 years. The year 2020 and the diagnosis of UTI was then chosen for further analysis as the most queried diagnosis in the most utilized year. Posts, responses, and their associated URL were pooled into Microsoft Excel for manual review. Posts flagged by the forum moderators for insufficient information, duplicate requests, viral posts (>50 comments), and posts made on another's behalf were excluded. Manual review was performed to collect the original poster's self-reported age and sex, as well as responder classification. The forum classifies responders as unverified (not a doctor, or 'NAD') and verified medical professionals. Posts in April 2020 (peak timing of COVID19 restrictions in the US) were further analyzed and coded according to themes identified by manual qualitative review. Results: Over 5 years, UTI was the most frequently mentioned diagnosis, with 8100 posts written with an average annual growth rate of 205%. 3275 (40%) of posts for UTI were placed in 2020, of which 2738 met inclusion criteria. The majority of posts came from females (69%) with a mean (±SD) age of 24.4 ± 6. 86%of posts received a response from 'NAD', while 27%of requests received a response from verified medical professionals, 41% of whom identified as physicians. During April 2020, 248 posts for UTI were made which was not different than during other months in 2020 (p = 0.38). The median (IQR) duration of symptoms was 21 (4-90) days. 31% of requests were made for the purpose of receiving a new diagnosis and 35% were requesting a second opinion. Another 16% mentioned plans of seeing a doctor or wanted advice on whether their symptoms warranted a visit. The remainder of requests (9%) requested clarification on medications or other advice. Of all UTI posts in April 2020, 50 (21%) mentioned COVID19 as a barrier to receiving/seeking care. Several requests described concerning symptoms of hematuria (18%) and back pain (30%). 12% of individuals self-identified as having recurrent/ chronic UTI and 9% described the use of over the counter medications or supplements to prevent UTI. Conclusions: These data demonstrate that requests for online support for the diagnosis and management of UTIs are growing annually and that patients who received care in a medical office still go online to receive verification of the medical plan.Many users post in the hopes of getting a new diagnosis from a medical professional, however, they were more likely to get a response from a non-verified user. Additionally, COVID19 delays/closures were identified by many users as a barrier to seeking medical care in April 2020.