Alcohol dependence during COVID-19 lockdowns.

To determine whether the past half-year of COVID-19-related lockdowns, stay-at-home orders, and social isolation were associated with changes in high-risk alcohol use, a total of 5,931 individuals completed the Alcohol Use Disorders Identification Test (AUDIT) at one of six time points from April through September 2020. Over the 6-month period, hazardous alcohol use and likely dependence increased month-by-month for those under lockdowns compared to those not under restrictions. This increase in harmful alcohol use and related behaviors is likely to have prolonged adverse psychosocial, interpersonal, occupational, and health impacts as the world attempts to recover from the pandemic crisis.

Demographic and technological factors influencing virtual seizure clinic visit satisfaction before and during the Covid-19 pandemic in rural Hawaii.

BACKGROUND: Telemedicine clinic visits traditionally originated from spoke clinic sites, but recent trends have favored home-based telemedicine, particularly in the time of Covid-19. Our study focused on identification of barriers and factors influencing perceptions of care with use of home-based telemedicine in patients with seizures living in rural Hawaii. We additionally compared characteristics of patients using telemedicine versus in-person clinic visits prior to the Covid-19 pandemic. METHODS: For the retrospective portion of our study, we queried charts of adult outpatients treated by the two full-time epileptologists at a Level 4 epilepsy center accredited by the National Association of Epilepsy Centers between November 2018 and December 2019. We included patients who live on the neighbor islands of Hawaii but not on Oahu, i.e., patients who would require air travel to see an epileptologist. There had been no set protocol at the epilepsy center for telemedicine referral; our practice had been to offer telemedicine visits to all neighbor island patients when felt to be appropriate. We collected demographic and clinic visit data. For the prospective portion we surveyed neighbor island patients or their caregivers, seen via home-based telemedicine between March 2020 and December 2020. We obtained verbal consent for study participation. Survey questions addressed satisfaction with clinical care, visit preferences, and potential barriers to care. RESULTS: In a 14-month period prior to the Covid-19 pandemic, 75 (61%) neighbor island patients were seen exclusively in-person in seizure clinic while 47 (39%) had at least one telemedicine visit. 39% of patients seen only in-person were female whereas 38% of patients seen by telemedicine were female. Patients seen in-person had an older median age (47.2 years) compared to those seen at least once by telemedicine (42.4 years). The no-show rate was 13% for in-person visits versus 4% for telemedicine visits. Among patients seen in person, 17% were Asian, 32% Native Hawaiian, and 47% White, whereas patients seen by telemedicine were 15% Asian, 23% Native Hawaiian, and 57% White. Patients who were seen in person lived in zip codes with median household income of $68,516 and patients who were seen by telemedicine lived in zip codes with median household income of $67,089. Patients who were seen in person lived in zip codes in which 78% of the population had access to broadband internet, whereas patients who were seen by telemedicine lived in zip codes in which 79% of the population had access to broadband internet. During the Covid-19 pandemic, we surveyed 47 consecutive patients seen by telemedicine, 45% female with median age of 33 years. Telemedicine connection was set up by the patient in 74% of cases, or by the patient's mother (15%), other family member (9%), or other caregiver (2 %). Median patient satisfaction score was 5 ("highly satisfied") on a 5-point Likert scale with mean score of 4.6. Telemedicine visit was done using a smartphone by 62% of patients, a computer by 36% of patients, and a tablet by 2% of patients. A home WiFi connection was used in 83% of patients. CONCLUSIONS: Home-based telemedicine visits provide a high-satisfaction method for seizure care delivery despite some obstacles. Demographic disparities may be an obstacle to telemedicine care and seem to relate to race and possibly age, rather than to sex/gender, household income, or access to broadband internet. Additionally, despite high satisfaction overall, more patients felt the physical exam was superior at in-person clinic visits and more patients expressed a preference for in-person visits. During the Covid-19 pandemic when there may be barriers to in-person clinic visits, home-based telemedicine is a feasible alternative.

Co-ordinating critical care transfers: creation of an ICU Transfer Hub

COVID-19 hit North West London (NWL) early, placing unprecedented and uneven demand on its Intensive Care Units (ICUs). It became clear that high volume inter-hospital transfers would be required to dissipate capacity pressures across the region and prevent units from becoming overwhelmed. However, ICU transfers are highly complex, requiring specialist teams and intensive coordination – resources that individual units could not spare - and to perform this at scale presented a real challenge.In response, the North West London Critical Care Network (NWLCCN) rapidly created an ICU ‘Transfer Hub’ to coordinate the strategy and logistics of capacity transfers. It was staffed by three doctors who communicated closely with ICU leads for real-time metrics on the fluctuating capacity pressures to plan the volume and destinations of patient transfers. An emergency bank of stand-by transfer volunteers was created, consisting of 69 critical care clinicians from across London, and the Hub partnered with a staff-bank management app to create a bespoke digital platform to facilitate shift scheduling and payment. This automation provided a way to onboard new staff swiftly and scale the bank with ease.Between 17 March - 6 May 2020, the Hub coordinated the transfer of 238 patients, at its peak organising 13 patient transfers in a single day - the highest frequency of ICU transfers ever carried out in NWL.These inter-hospital transfers were essential for NWL to cope with pandemic-driven ICU admission pressures and created greater equity of access to critical care for patients. The strengths of a network uniting to deliver mutual aid were maximised by having a single hub as the conduit to support information flow and co-ordinate decision making. Partnering with a tech platform and having access to key decision-makers were other enablers that allowed the Hub to innovate at pace and their experience has informed discussions about developing a pan-London ICU transfers service.

Increasing aggression during the COVID-19 lockdowns.

BACKGROUND: To combat the spread of COVID-19, many communities implemented restrictions on personal movement, often referred to as "lockdowns." We hypothesized that continued lockdowns might be associated with increased feelings of aggression. METHODS: Over the first six months of the COVID-19 pandemic, the Buss-Perry Aggression Questionnaire (BPAQ) was administered to a total of 5,928 adults distributed proportionally from across the United States during independent online cross-sectional surveys collected each month. Data across the 6-month period were compared between those under lockdown versus those not under such restrictions. RESULTS: BPAQ Total Aggression scores showed a significant main effect for both month and lockdown status as well as a significant interaction effect, with increasing scores evident for those reporting that they were under lockdown relative to those reporting no restrictions. This same pattern was evident for all four subscales of the BPAQ, including Physical Aggression, Verbal Aggression, Anger, and Hostility. LIMITATIONS: Random sampling of the entire population was not possible, so generalization of the results should be made with caution. Additionally, data were collected cross-sectionally and cannot be considered to reflect longitudinal change within individuals. Finally, the cross-sectional survey design means that it is impossible to infer that the lockdowns caused the increase in aggression. CONCLUSIONS: Lockdowns were associated with elevated levels of aggression that were higher in later months of the national pandemic response.

Mental Health During the First Weeks of the COVID-19 Pandemic in the United States.

Background: By March 2020, the World Health Organization declared the COVID-19 crisis as a worldwide pandemic and many local governments instituted stay-at-home orders and closed non-essential businesses. Within the United States, tens of millions of workers lost their jobs and financial security during the first few weeks of the national response, in an attempt to slow the global pandemic. Because of the enormity of the pandemic and its potential impact on mental health, the objective of the present study was to document the prevalence of mental health problems and their association with pandemic-related job loss during the third week of the nationwide shutdown. Methods: Mental health was assessed via online questionnaires among a representative sample of 1,013 U.S. adults on April 9-10, 2020. Rates of clinically significant mental health outcomes were compared between participants who lost their job as a result of COVID-19 restrictions (17.4%) vs. those who did not (82.6%). Bivariate multiple logistic regression identified factors that were predictive of, and protective against, mental health problems. Results: The prevalence of clinically significant symptoms was significantly higher than prior population estimates, ranging from 27 to 32% for depression, 30 to 46% for anxiety disorders, 15 to 18% for acute/post-traumatic stress, 25% for insomnia, and 18% for suicidal ideation. Prevalence estimates were 1.5-1.7 times higher for those who reported job loss due to COVID-19 restrictions than those who did not. Mental health problems were predicted by worry over financial instability, insomnia, social isolation, and alcohol consumption, while getting outside more often, perceived social support, and older age were protective against these problems. Conclusions: During the first 3 weeks of lockdowns/stay-at-home restrictions, mental health problems, including depression, anxiety, insomnia, and acute stress reactions were notably elevated relative to prior population estimates. Job loss related to the nationwide shutdown was particularly associated with poorer mental health. These findings provide a baseline of mental health functioning during the first weeks of the national emergency and lockdown orders in response to COVID-19.

Three months of loneliness during the COVID-19 lockdown.

The majority of the U.S. population has been under stay-at-home restrictions to reduce the spread of COVID-19 since March 2020. Over the first three months of restrictions, 3,121 U.S. adults completed the UCLA Loneliness Scale-3 and Patient Health Questionnaire-9 (PHQ-9). Despite relaxation of lockdowns and shelter-in-place orders over that time, loneliness scores increased significantly, particularly from April to May 2020, and appear to have plateaued by June. Loneliness was correlated with depression and suicidal ideation at all time points and was most prevalent among individuals who reported that they were still under community restrictions to socially isolate due to the novel coronavirus. Loneliness remains elevated despite the reopening of many communities.

Critical care transfers and COVID-19: Managing capacity challenges through critical care networks.

The intensive care units in North West London are part of one of the oldest critical care networks in the UK, forming a mature and established strategic alliance to share resources, experience and knowledge for the benefit of its patients. North West London saw an early surge in COVID-19 admissions, which urgently threatened the capacity of some of its intensive care units even before the UK government announced lockdown. The pre-existing relationships and culture within the network allowed its members to unite and work rapidly to develop agile and innovative solutions, protecting any individual unit from becoming overwhelmed, and ultimately protecting its patients. Within a short 50-day period 223 patients were transferred within the network to distribute pressures. This unprecedented number of critical care transfers, combined with the creation of extra capacity and new pathways, allowed the region to continue to offer timely and unrationed access to critical care for all patients who would benefit from admission. This extraordinary response is a testament to the power and benefits of a regionally networked approach to critical care, and the lessons learned may benefit other healthcare providers, managers and policy makers, especially in regions currently facing new outbreaks of COVID-19.

Suicidal ideation during the COVID-19 pandemic: The role of insomnia.

There is growing concern over the potential for increased suicide risk in vulnerable populations as the COVID-19 pandemic unfolds. To contextualize this risk during the first weeks of the nationwide lockdown efforts, we had 1,013 U.S. adults complete questionnaires assessing worries over COVID-19, insomnia severity, and suicidal ideation. Anxiety about COVID-19 correlated positively with insomnia severity and suicidal ideation. Analysis revealed that the statistical association between pandemic fears and suicidal thinking was fully accounted for by insomnia severity, suggesting that interventions aimed at improving sleep may be useful in reducing suicide risk during the current pandemic.

Follow the Money: How the Online Advertising Ecosystem Funds COVID-19 Junk News and Disinformation

From the Abstract: "As people around the world turn towards search engines to access information about COVID-19 [coronavirus disease 2019], it is important to understand why and how users are being exposed to junk news content. In this memo, we examine the role of search engines and their optimization processes in directing traffic towards junk news & disinformation about COVID-19, and how these sites, in turn, monetize that traffic through digital advertising. We ask: [1] How do the search engine optimization strategies of professional news sources compare to those of junk news & disinformation sources? [2] In what way do third party sites boost the online reputation of junk news and disinformation on COVID-19 through backlinks? [3] How and to what extent do major advertising platforms monetize junk news & disinformation around COVID-19? Comparing professional versus junk news & disinformation sources, our analysis draws from a sample of 830 sources of news and information that are reporting on COVID-19. We review key search engine optimization (SEO) metrics, as a means of assessing sites' online reputation, and their reliance on advertising. We find that: (1) The top junk news & disinformation sources achieve outstandingly high key SEO factors and are slightly better optimised for distribution on search and social media. (2) Major high-prestige, high-trust sites inadvertently boost junks news & disinformation promoting their online reputation and visibility. (3) The overwhelming majority of junk news & disinformation domains rely on major advertising platforms to monetize their pages and 61 percent of junk news & disinformation sources used Google ads."

Loneliness during the first half-year of COVID-19 Lockdowns.

During the first 6-months of the COVID-19 pandemic, the primary weapons against the spread of the virus have included local government orders for restriction of movement and broad implementation of face masks and social distancing policies. While some early reports suggested increases in loneliness during the pandemic restrictions, others reported no changes. Here, we provide an update on self-reported loneliness over the first 6-months of community lockdown restrictions from a nationwide sample of 6,186 U.S. adults who completed the UCLA Loneliness Scale-3 and Public Health Questionnaire-9 during the pandemic. Loneliness scores increased significantly from April through September 2020 and were significantly higher for those reporting they were under stay-at-home, shelter-in-place, or lockdown orders compared to those reporting no restrictions. Greater loneliness was positively correlated with depression and suicidal ideation. Loneliness has increased over the first half-year of the pandemic, particularly for those under lockdown restrictions, and remains a significant mental health concern.

Trends in suicidal ideation over the first three months of COVID-19 lockdowns.

To reduce viral spread during the first months of the COVID-19 pandemic, most communities across the U.S. engaged in some form of stay-at-home restrictions or lockdowns that limited social interaction and movement outside the home. To determine the effect of these restrictions on suicidal ideation, a total of 3,120 individuals completed the Patient Health Questionnaire (PHQ-9) at one of three time points from April through June 2020. The percentage of respondents endorsing suicidal ideation was greater with each passing month for those under lockdown or shelter-in-place restrictions due to the novel coronavirus, but remained relatively stable and unchanged for those who reported no such restrictions. Public health policy and routine clinical care need to address the potential for increased suicidal thinking among those experiencing prolonged restrictions of normal social contact.

Psychological resilience during the COVID-19 lockdown.

Some individuals are more psychologically resilient to adversity than others, an issue of great importance during the emerging mental health issues associated with the COVID-19 pandemic. To identify factors that may contribute to greater psychological resilience during the first weeks of the nation-wide lockdown efforts, we asked 1,004 U.S. adults to complete assessments of resilience, mental health, and daily behaviors and relationships. Average resilience was lower than published norms, but was greater among those who tended to get outside more often, exercise more, perceive more social support from family, friends, and significant others, sleep better, and pray more often. Psychological resilience in the face of the pandemic is related to modifiable factors.

Loneliness: A signature mental health concern in the era of COVID-19.

In response to the COVID-19 pandemic, most communities in the United States imposed stay-at-home orders to mitigate the spread of the novel coronavirus, potentially leading to chronic social isolation. During the third week of shelter-in-place guidelines, 1,013 U.S. adults completed the UCLA Loneliness Scale-3 and Public Health Questionnaire (PHQ-9). Loneliness was elevated, with 43% of respondents scoring above published cutoffs, and was strongly associated with greater depression and suicidal ideation. Loneliness is a critical public health concern that must be considered during the social isolation efforts to combat the pandemic.