Inequality-Related Health and Social Factors and Their Impact on Well-Being during the COVID-19 Pandemic: Findings from a National Survey in the UK.

Background: Lower socioeconomic groups and disadvantaged populations across the world suffer disproportionately from the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the impact of health- and social-inequality-related factors on well-being in order to further distinguish each of their effects during the pandemic. Methods: A nationally-representative sample of 5077 UK respondents aged 18 years or older was recruited through an online survey panel during the COVID-19 pandemic. Their subjective well-being was measured using the 11-point Cantril Ladder of Life Scale. The impact of inequality-related health and social factors (pre-existing medical conditions, household size and occupation), as well as COVID-19-related risk factors (symptoms, confirmed infections, and social distancing behaviours) on well-being were analysed using multiple linear regression models. The associations between the COVID-19-related risk factors and well-being according to the respondents' household size and occupation were modelled in order to test the differences by their socioeconomic profile. Results: We identified inverted V-shaped associations between household size and subjective well-being during the COVID-19 pandemic. Compared to single-person households, respondents from households of two to four persons showed better well-being (ß = 0.57; CI (0.44, 0.72)), whereas living in crowded households of five persons or more was associated with decreased well-being (ß = -0.48; CI (-0.71, -0.25)). Furthermore, lower-skilled occupations (elementary occupations: ß = -0.31; CI (-0.58, -0.03); logistics and transport services: ß = -0.37; CI (-0.74, -0.01)) and chronic medical conditions (cardiometabolic or respiratory diseases: ß = -0.25; CI (-0.41, -0.1); and mental health conditions: ß = -1.12; CI (-1.28, -0.96)) were factors associated with reduced well-being during the pandemic. Interactions between a positive COVID-19 diagnosis, symptoms, and crowded households were identified (ß = -0.95; CI (-1.76, -0.14) and ß = -4.74; CI (-9.87, -1.61), respectively). Conclusions: In a national sample, the levels of general subjective well-being during the COVID-19 pandemic and lockdowns were disproportionately distributed across different groups within society. Preventive policies should explicitly focus on reaching lower socioeconomic groups; more emphasis should be placed on the coordination of multisectoral support in order to tackle existing health and social inequalities.

Smartphone-Enabled, Telehealth-Based Family Conferences in Palliative Care During the COVID-19 Pandemic: Pilot Observational Study.

BACKGROUND: In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. OBJECTIVE: We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. METHODS: Family conferences comprised three phases designed according to telehealth implementation guidelines-the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: "team talk," "option talk," and "decision talk." The model has been implemented at a national cancer treatment center in Taiwan since February 2020. RESULTS: From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients' mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). CONCLUSIONS: Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic.

First COVID-19 mortality case in Taiwan with bacterial co-infection by national surveillance of critically ill patients with influenza-negative pneumonia.

A 63-year-old diabetic smoker with alcoholism was the first mortality case of coronavirus disease 2019 (COVID-19) in Taiwan. As concurrently infected with Klebsiella pneumoniae and subsequently with Klebsiella aerogenes, he was exposed by a national survey of patients with critically influenza-negative pneumonia. We recommend COVID-19 screening for patients with severe flu-like syndrome and protecting health-care workers from being infected.