Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias.

BACKGROUND: Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. METHODS: Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed. RESULTS: Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. CONCLUSIONS: Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19.

The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.

Geographical and Temporal Analysis of Tweets Related to COVID-19 and Cardiovascular Disease in the US

The COVID-19 pandemic has resulted in more than 600 million confirmed cases worldwide since December 2021. Cardiovascular disease (CVD) is both a risk factor for COVID-19 mortality and a complication that many COVID-19 patients develop. This study uses Twitter data to identify the spatiotemporal patterns and correlation of related tweets with daily COVID-19 cases and deaths at the national, regional, and state levels. We collected tweets mentioning both COVID-19 and CVD-related words from February to July 2020 (Eastern Time) and geocoded the tweets to the state level using GIScience techniques. We further proposed and validated that the Twitter user registration state can be a feasible proxy of geotags. We applied geographical and temporal analysis to investigate where and when people talked about COVID-19 and CVD. Our results indicated that the trend of COVID-19 and CVD-related tweets is correlated to the trend of COVID-19, especially the daily deaths. These social media messages revealed widespread recognition of CVD's important role in the COVID-19 pandemic, even before the medical community started to develop consensus and theory supports about CVD aspects of COVID-19. The second wave of the pandemic caused another rise in the related tweets but not as much as the first one, as tweet frequency increased from February to April, decreased till June, and bounced back in July. At the regional level, four regions (Northeast, Midwest, North, and West) had the same trend of related tweets compared to the country as a whole. However, only the Northeast region had a high correlation (0.8–0.9) between the tweet count, new cases, and new deaths. For the second wave of confirmed new cases, the major contributing regions, South and West, did not ripple as many related tweets as the first wave. Our understanding is that the early news attracted more attention and discussion all over the U.S. in the first wave, even though some regions were not impacted as much as the Northeast at that time. The study can be expanded to more geographic and temporal scales, and with more physical and socioeconomic variables, with better data acquisition in the future.

Utilization of telehealth services in low- and middle-income countries amid the COVID-19 pandemic: a narrative summary.

BACKGROUND: During the current period of the pandemic, telehealth has been a boon to the healthcare system by providing quality healthcare services at a safe social distance. However, there has been slow progress in telehealth services in low- and middle-income countries with little to no evidence of the cost and effectiveness of such programmes. OBJECTIVE: To provide an overview of the expansion of telehealth in low- and middle-income countries amid the COVID-19 pandemic and identify the challenges, benefits, and costs associated with implementing telehealth services in these countries. METHODS: We performed a literature review using the search term: '*country name* AND ((telemedicine[Title][Abstract]) OR (telehealth[Title][Abstract] OR eHealth[Title][Abstract] OR mHealth[Title][Abstract]))'. Initially, we started with 467 articles, which were reduced to 140 after filtering out duplicates and including only primary research studies. Next, these articles were screened based on established inclusion criteria and 44 articles were finalised to be used in the review. RESULTS: We found telehealth-specific software being used as the most common tool to provide such services. Nine articles reported patient satisfaction of greater than 90% with telehealth services. Moreover, the articles identified the ability to make a correct diagnosis to resolve the condition, efficient mobilisation of healthcare resources, increased accessibility for patients, increased service utilisation, and increased satisfaction as benefits of telehealth services, whereas inaccessibility, low technological literacy, and lack of support, poor security standards and technological concerns, loss of interest by the patients, and income impacts on physicians as challenges. The review could not find articles that explored the financial information on telehealth programme implementation. CONCLUSION: Although telehealth services are growing in popularity, the research gap on the efficacy of telehealth is high in low- and middle-income countries. To better guide the future development of telehealth services, rigorous economic evaluation of telehealth is needed.

Associations of racial and ethnic discrimination with adverse changes in exercise and screen time during the COVID-19 pandemic in the United States.

OBJECTIVES: During the coronavirus disease 2019 (COVID-19) pandemic, a growing prevalence of racial and ethnic discrimination occurred when many Americans struggled to maintain healthy lifestyles. This study investigated the associations of racial and ethnic discrimination with changes in exercise and screen time during the pandemic in the United States. METHODS: We included 2,613 adults who self-identified as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic from the Health, Ethnicity, and Pandemic study, a cross-sectional survey conducted among a nationally representative sample of United States adults between October and November 2020. We assessed self-reported racial and ethnic discrimination by measuring COVID-19-related racial and ethnic bias and examined its associations with changes in exercise and screen time using multivariable logistic regression models. We analyzed data between September 2021 and March 2022. RESULTS: COVID-19-related racial and ethnic bias was associated with decreased exercise time among non-Hispanic Asian (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.13 to 1.89) and Hispanic people (OR, 1.91; 95% CI, 1.32 to 2.77), and with increased screen time among non-Hispanic Black people (OR, 1.94; 95% CI, 1.33 to 2.85), adjusting for age, sex, education, marital status, annual household income, insurance, and employment status. CONCLUSIONS: Racial and ethnic discrimination may have adversely influenced exercise and screen time changes among racial and ethnic minorities during the COVID-19 pandemic in the United States. Further studies are needed to investigate the mechanisms through which racial and ethnic discrimination can impact lifestyles and to develop potential strategies to address racial and ethnic discrimination as a barrier to healthy lifestyles.

Geographical and Temporal Analysis of Tweets Related to COVID-19 and Cardiovascular Disease in the US.

The COVID-19 pandemic has resulted in more than 600 million confirmed cases worldwide since December 2021. Cardiovascular disease (CVD) is both a risk factor for COVID-19 mortality and a complication that many COVID-19 patients develop. This study uses Twitter data to identify the spatiotemporal patterns and correlation of related tweets with daily COVID-19 cases and deaths at the national, regional, and state levels. We collected tweets mentioning both COVID-19 and CVD-related words from February to July 2020 (Eastern Time) and geocoded the tweets to the state level using GIScience techniques. We further proposed and validated that the Twitter user registration state can be a feasible proxy of geotags. We applied geographical and temporal analysis to investigate where and when people talked about COVID-19 and CVD. Our results indicated that the trend of COVID-19 and CVD-related tweets is correlated to the trend of COVID-19, especially the daily deaths. These social media messages revealed widespread recognition of CVD's important role in the COVID-19 pandemic, even before the medical community started to develop consensus and theory supports about CVD aspects of COVID-19. The second wave of the pandemic caused another rise in the related tweets but not as much as the first one, as tweet frequency increased from February to April, decreased till June, and bounced back in July. At the regional level, four regions (Northeast, Midwest, North, and West) had the same trend of related tweets compared to the country as a whole. However, only the Northeast region had a high correlation (0.8-0.9) between the tweet count, new cases, and new deaths. For the second wave of confirmed new cases, the major contributing regions, South and West, did not ripple as many related tweets as the first wave. Our understanding is that the early news attracted more attention and discussion all over the U.S. in the first wave, even though some regions were not impacted as much as the Northeast at that time. The study can be expanded to more geographic and temporal scales, and with more physical and socioeconomic variables, with better data acquisition in the future.

Racism Experience Among American Adults During COVID-19: A Mixed-Methods Study.

Purpose: Despite escalating racism in the United States during COVID-19, few studies have identified correlates of racism experience among Americans using nationally representative data. This study seeks to quantitatively identify correlates of racism experience and qualitatively categorize racism experience and its coping using nationally representative survey data. Methods: Based on data from the "Health, Ethnicity and Pandemic Survey" (N=2,506), a nationally representative survey conducted in October 2020, multivariable logistic regression was estimated to examine the association between self-reported racism experience and selected correlates. Thematic analysis was conducted to qualitatively classify types of racism experience and related coping strategies. Results: When asked whether they had been discriminated or unfairly treated during COVID-19 because of their racial/ethnic background, 19% non-Hispanic Asian and Black respondents said yes, followed by 15% among Hispanics and 3% among non-Hispanic Whites. Besides significant correlates of racism experience identified at the individual and household level, three contextual factors at the neighborhood or state level were associated with lower odds of racism experience, including living in a blue state (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]: 0.50-0.95; reference category: red state), living in the top third of the neighborhoods in the sample in terms of racial diversity (AOR=0.65%, 95% CI: 0.42-0.99; reference: bottom third), and coming from neighborhoods with a median population age of 35-39 (AOR=0.67, 95% CI: 0.46-0.98; reference: younger than 35). Prevailing coping strategies against experienced racism included social avoidance, direct confrontation, seeking social and religious support, resorting to hobbies for relief, and taking legal actions. Conclusion: Racism experience is not only correlated with factors at individual level, it is also associated with contextual factors such as political climate, neighborhood diversity, and population age structure. Future efforts in supporting victims of racism might be more cost-effective by focusing on the identified vulnerable groups and related contextual factors.

Gender difference in working from home and psychological distress - A national survey of U.S. employees during the COVID-19 pandemic.

The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work. While the general subject of working from home has recently drawn increased attention, few studies have assessed gender differences in vulnerability to the potential mental health effects of working from home. Using data from 1,585 workers who participated in the Health, Ethnicity, and Pandemic (HEAP) study, a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020, associations of working from home with psychological distress were examined with weighted logistic regression among 1,585 workers and stratified by gender. It was found that workers who worked from home had higher odds of psychological distress (aOR and 95% CI = 2.62 [1.46, 4.70]) compared to workers who did not work from home, adjusting for demographic factors, socioeconomic status, and health behaviors. In gender-stratified analyses, this positive association between working from home and psychological distress was significant in women (aOR and 95% CI = 3.68 [1.68, 8.09]) but not in men. These results have implications for female workers' mental health in the transition towards working from home in the COVID-19 pandemic era.

Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic.

Racial discrimination has intensified in the U.S. during the COVID-19 pandemic, but how it disrupted healthcare is largely unknown. This study investigates the association of racial discrimination with delaying or forgoing care during the pandemic based on data from a nationally representative survey, the Health, Ethnicity and Pandemic (HEAP) study (n = 2552) conducted in October 2020 with Asians, Hispanics and non-Hispanic Blacks oversampled. Racial discrimination during the pandemic was assessed in three domains: experienced racial discrimination, race-related cyberbullying, and Coronavirus racial bias beliefs. Respondents answered whether they had delayed or forgone any type of healthcare due to the pandemic. Overall, 63.7% of respondents reported delaying or forgoing any healthcare during the pandemic. About 20.3% East/Southeast Asians, 18.6% non-Hispanic Blacks and 15.9% Hispanics reported experiences of racial discrimination, compared with 2.8% of non-Hispanic Whites. Experienced racial discrimination was associated with delaying/forgoing care among non-Hispanic Blacks (Adjusted odds ratios[AOR] = 4.58, 95% confidence interval[CI]: 2.22-9.45), Hispanics (AOR = 3.88, 95%CI: 1.51-9.98), and East/Southeast Asians (AOR = 2.14, 95%CI: 1.22-3.77). Experiencing race-related cyberbullying was significantly associated with delaying/forgoing care among non-Hispanic Blacks (AOR = 1.34, 95%CI: 1.02-1.77) and East/Southeast Asians (AOR = 1.51, 95%CI: 1.19-1.90). Coronavirus racial bias was significantly associated with delaying/forgoing care among East/Southeast Asians (AOR = 1.55, 95%CI: 1.16-2.07). The three domains of racial discrimination were consistently associated with delayed or forgone health care among East/Southeast Asians during the COVID-19 pandemic; some of the associations were also seen among non-Hispanic Blacks and Hispanics. These results demonstrate that addressing racism is important for reducing disparities in healthcare delivery during the pandemic and beyond.

Differences in Mental Health Status Among Asian Americans During the COVID-19 Pandemic: Findings from the Health, Ethnicity, and Pandemic Study.

Purpose: This study aims to explore the differences in mental health status among Asian Americans during the COVID-19 pandemic. Methods: Data from the 2020 Health, Ethnicity, and Pandemic (HEAP) Study were used to explore the psychological distress of 2672 adults, using the Standard Kessler Psychological Distress Scale. Results: We observed that among Asian American subgroups, South Asian Americans had significantly higher odds of experiencing psychological distress than non-Hispanic White Americans (odds ratio = 1.82, 95% confidence interval = 1.00-3.31), after controlling for covariates. Conclusion: The study identified differences in mental health status among Asian American subgroups. We recommend the implementation of culturally appropriate interventions to help Asian Americans cope with mental health challenges.

Racial Discrimination, Mental Health and Behavioral Health During the COVID-19 Pandemic: a National Survey in the United States.

BACKGROUND: While hate crimes rose during the COVID-19 pandemic, few studies examined whether this pandemic-time racial discrimination has led to negative health consequences at the population level. OBJECTIVE: We examined whether experienced and perceived racial discrimination were associated with mental or behavioral health outcomes during the pandemic. DESIGN: In October 2020, we conducted a national survey with minorities oversampled that covered respondents' sociodemographic background and health-related information. PARTICIPANTS: A total of 2709 participants responded to the survey (response rate: 4.2%). MAIN MEASURES: The exposure variables included (1) experienced and encountered racial discrimination, (2) experienced racial and ethnic cyberbullying, and (3) perceived racial bias. Mental health outcomes were measured by psychological distress and self-rated happiness. Measures for behavioral health included sleep quality, change in cigarette smoking, and change in alcohol consumption. Weighted logistic regressions were performed to estimate the associations between the exposure variables and the outcomes, controlling for age, gender, race and ethnicity, educational attainment, household income, eligibility to vote, political party, COVID-19 infection, and geographic region. Separate regressions were performed in the six racial and ethnic subgroups: non-Hispanic White, non-Hispanic Black, Hispanic, East Asian, South Asian, and Southeast Asian respondents. KEY RESULTS: Experienced racial discrimination was associated with higher likelihood of psychological distress (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [95% CI]: 1.34-3.55). Experienced racial discrimination (AOR = 2.31, 95% CI: 1.34-3.99) and perceived racial bias (AOR = 1.05, 95% CI: 1.00-1.09) were both associated with increased cigarette smoking. The associations between racial discrimination and mental distress and substance use were most salient among Black, East Asian, South Asian, and Hispanic respondents. CONCLUSIONS: Racial discrimination may be associated with higher likelihood of distress, and cigarette smoking among racial and ethnic minorities. Addressing racial discrimination is important for mitigating negative mental and behavioral health ramifications of the pandemic.

The Impact of Expanding Telehealth-Delivered Dietary Interventions on Long-Term Cardiometabolic Health.

A healthy diet is an important protective factor to prevent cardiometabolic disease. Traditional face-to-face dietary interventions are often episodic, expensive, and may have limited effectiveness, particularly among older adults and people living in rural areas. Telehealth-delivered dietary interventions have proven to be a low-cost and effective alternative approach to improve dietary behaviors among adults with chronic health conditions. In this study, we developed a validated agent-based model of cardiometabolic health conditions to project the impact of expanding telehealth-delivered dietary interventions among older adults in the state of Georgia, a state with a large rural population. We projected the incidence of major cardiometabolic health conditions (type 2 diabetes, hypertension, and high cholesterol) with the implementation of telehealth-delivered dietary interventions versus no intervention among all older adults and 3 subpopulations (older adults with diabetes, hypertension, and high cholesterol, separately). The results showed that expanding telehealth-delivered dietary interventions could avert 22,774 (95% confidence interval [CI]: 22,091-23,457) cases of type 2 diabetes, 19,732 (19,145-20,329) cases of hypertension, and 18,219 (17,672-18,766) cases of high cholesterol for 5 years among older adults in Georgia. The intervention would have a similar effect in preventing cardiometabolic health conditions among the 3 selected subpopulations. Therefore, expanding telehealth-delivered dietary interventions could substantially reduce the burden of cardiometabolic health conditions in the long term among older adults and those with chronic health conditions.

Negative Employment Changes During the COVID-19 Pandemic and Psychological Distress: Evidence From a Nationally Representative Survey in the U.S.

OBJECTIVE: We examined associations of negative employment changes during the COVID-19 pandemic with mental health in a national sample of U.S. workers, and whether the associations differed by race. METHODS: Data were from the Health, Ethnicity, and Pandemic Study, a cross-sectional survey. The effects of negative employment changes on psychological distress in 1510 workers were examined via linear regression, and stratified analyses were conducted across racial subgroups. RESULTS: After adjustment for covariates, compared to workers with no change in employment, those who experienced permanent job loss had the highest psychological distress (ß and 95% CI = 3.27 [1.89, 4.65]). Permanent job loss had the greatest effect on psychological distress in Blacks and Asians. CONCLUSION: Negative employment changes related to the pandemic may have deleterious impacts on workers' mental health, with disproportionate effects on racial minorities.

Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States.

Telehealth is an important source of health care during the COVID-19 pandemic. Evidence is scarce regarding disparities in telehealth utilization in the United States. We aimed to investigate the prevalence and factors associated with telehealth utilization among US adults. Our data came from the Health, Ethnicity, and Pandemic Study, a nationally representative survey conducted in October 2020, with 2554 adults ≥ 18 and an oversample of racial/ethnic minorities. Telehealth utilization was measured as self-reported teleconsultation with providers via email, text message, phone, video, and remote patient monitoring during the pandemic. Logistic regressions were performed to examine the association between telehealth use and factors at the individual, household, and community levels. Overall, 43% of the sample reported having used telehealth, representing 114.5 million adults in the nation. East and Southeast Asians used telehealth less than non-Hispanic Whites (OR = 0.5, 95% CI: 0.3-0.8). Being uninsured (compared with private insurance: OR = 0.4, 95% CI: 0.2-0.8), and those with limited broadband coverage in the community (OR = 0.5, 95% CI: 0.3-0.8) were less likely to use telehealth. There is a need to develop and implement more equitable policies and interventions at both the individual and community levels to improve access to telehealth services and reduce related disparities.

Changes of Exercise, Screen Time, Fast Food Consumption, Alcohol, and Cigarette Smoking during the COVID-19 Pandemic among Adults in the United States.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on multiple lifestyle changes among adults in the United States (USA). METHODS: We conducted a survey, the Health, Ethnicity, and Pandemic (HEAP) Study, in October 2020 among USA adults. Participants were selected from the United States using 48 sampling strata, including age, race, ethnicity, education, and gender, and were asked to report five lifestyle behaviors (i.e., exercise time, screen time, fast-food meal consumption, alcohol drinking, and cigarette smoking) before and during the COVID-19 pandemic. The associations of sociodemographic factors with each lifestyle change were estimated using weighted multivariable logistic regression models. RESULTS: All 2709 HEAP participants were included in this study. Compared to pre-pandemic, the time spent on exercise decreased (32.06 vs. 38.65 min/day; p < 0.001) and screen time increased (6.79 vs. 5.06 h/day; p < 0.001) during the pandemic. The percentage of individuals who reported consuming fast-food meals ≥3 times/week decreased from 37.7% before the pandemic to 33.3% during the pandemic. The percentage of heavy drinkers (≥5 times/week) increased from 20.9% before the pandemic to 25.7% during the pandemic. Among smokers, heavy smoking (≥11 cigarettes/day) increased from 5.8% before the pandemic to 7.9% during the pandemic. We also identified subgroups who were more vulnerable to adverse influences from the pandemic, including racial/ethnic minority groups and young adults. CONCLUSIONS: The COVID-19 pandemic had negative impacts on multiple lifestyle behaviors among Americans. Mitigating such negative impacts of COVID-19 requires effective interventions, particularly for some vulnerable subgroups.

The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study.

BACKGROUND: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. OBJECTIVE: The goal of this study was to assess the change in children's and adolescents' prevention and vaccination behaviors amid China's COVID-19 epidemic. METHODS: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children's and adolescents' prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents' characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. RESULTS: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2% (638/776) of children or adolescents always wore masks when going out compared with 31.5% (521/1655) before the epidemic; in addition, 25.0% (414/1655) and 79.8% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9% (776/1655) went out during the epidemic. Meanwhile, 56.1% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8% (468/626) delaying scheduled vaccinations and 80.9% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. CONCLUSIONS: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders.

Disease Burden Attributable to the First Wave of COVID-19 in China and the Effect of Timing on the Cost-Effectiveness of Movement Restriction Policies.

OBJECTIVES: Movement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transmission but are associated with high societal cost. This study aims to estimate the health burden of the first wave of COVID-19 in China and the cost-effectiveness of early versus late implementation of MRPs to inform preparation for future waves. METHODS: The SEIR (susceptible, exposed, infectious, and recovered) modeling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (January 23, the real-world scenario), delayed by 1 week, delayed by 2 weeks, and delayed by 4 weeks. The end point was set as the day when newly confirmed cases reached zero. Two costing perspectives were adopted: healthcare and societal. Input data were obtained from official statistics and published literature. The primary outcomes were disability-adjusted life-years, cost, and net monetary benefit. Costs were reported in both Chinese renminbi (RMB) and US dollars (USD) at 2019 values. RESULTS: The first wave of COVID-19 in China resulted in 38 348 disability adjusted life-years lost (95% CI 19 417-64 130) and 2639 billion RMB losses (95% CI 1347-4688). The rapid implementation strategy dominated all other delayed strategies. This conclusion was robust to all scenarios tested. At a willingness-to-pay threshold of 70 892 RMB (the national annual GDP per capita) per disability-adjusted life-year saved, the probability for the rapid implementation to be the optimal strategy was 96%. CONCLUSIONS: Early implementation of MRPs in response to COVID-19 reduced both the health burden and societal cost and thus should be used for future waves of COVID-19.