Estimating Exposure Risk to Guide Behaviour During the SARS-COV2 Pandemic.

The end of 2020 and the beginning of 2021 was a challenging time for many countries in Europe, as the combination of colder weather, holiday celebrations, and the emergence of more transmissible virus variants conspired to create a perfect storm for virus transmission across the continent. At the same time lockdowns appeared to be less effective than they were earlier in the pandemic. In this paper we argue that one contributing factor is that existing ways of communicating risk-case numbers, test positivity rates, hospitalisations etc.-are difficult for individuals to translate into a level of personal risk, thereby limiting the ability of individuals to properly calibrate their own behaviour. We propose an new more direct measure of personal risk, exposure risk, to estimate the likelihood that an individual will come into contact with an infected person, and we argue that it can play an important role, alongside more conventional statistics, to help translate complex epidemiological data into a simple measure to guide pandemic behaviour. We describe how exposure risk can be calculated using existing data and infection prediction models, and use it to evaluate and compare the exposure risk associated with 39 European countries.

How do firms learn? Evidence from corporate cash holdings during the COVID‐19 pandemic

We examine the impact of COVID‐19 on US corporate cash holdings. Our findings suggest that greater pandemic exposure is associated with higher corporate cash holdings and that firms learn from prior experiences as they manage their cash policies. More specifically, the level of cash holdings in firms that experienced severe financial constraints during the 2008 credit crisis and firms with prior severe acute respiratory syndrome (SARS) and H1N1 exposure is significantly lower than that of firms with no prior epidemic or financial constraints experience. Overall, our findings support the learning behaviour of cash and contribute to corporate cash holdings literature by providing insights on the extent to which firms learn from prior experiences to manage their liquidity.

Modelling the impact of non-pharmaceutical interventions on COVID-19 exposure in closed-environments using agent-based modelling

Businesses can play a key role in reducing exposure to COVID-19 in closed environments. This is possible by assessing the impact of Non-Pharmaceutical Interventions (NPIs) in mitigating disease exposure. This study aims to assess the impact of NPIs on COVID-19 exposure in closed environments. This is achieved by proposing an innovative COVID-19 exposure prediction framework. The developed framework consists of three modules: Agent-Based Modelling (ABM) approach, Clustering Module (CM), and Decision Tree (DT) technique. The framework also integrates these modules considering the exposure time factor to identify the level of exposure to COVID-19 in closed environments. A supermarket based in Jordan is considered a case study to test the applicability of the proposed framework in predicting exposure levels and numbers. The impact of Individual and combined NPIs application in closed environment facilities is assessed based on the exposure level and other OIs such as opening time, body temperature measurement, and the number of people inside the supermarket. Key results show that wearing Mask, Face Shield and leaving Social Distance guarantees no exposure to COVID-19 and increases the safety level to 61.9% in a closed environment such as supermarkets with a potential exposure rate of up to 28.5% if otherwise. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

The social scar of the pandemic: Impacts of COVID-19 exposure on interpersonal trust.

This paper employs a difference-in-differences strategy to examine the causal effect of exposure to the COVID-19 pandemic on interpersonal trust amidst zero-COVID policies in China. Using a nationally representative panel survey, we find that COVID-19 exposure leads to a decrease in the levels of generalized trust. We also show that the change in interpersonal trust varies across domains. Specifically, COVID-19 exposure significantly decreases trust in parents, neighbors, and local government officials, but has small and insignificant effects on trust in doctors, strangers, and Americans. Empirical tests suggest that changes in income and physical health status are not likely to be potential channels. We provide some evidence for the mechanism of deteriorated mental health status and pessimistic expectations.

Caregiver Perceptions of Children's and Adolescents' Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families' daily lives, including the mental health of children and adolescents. OBJECTIVE: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. METHODS: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. RESULTS: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children's interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. CONCLUSIONS: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers' parenting and psychosocial functioning of children and adolescents.

Users' Expectations, Experiences, and Concerns With COVID Alert, an Exposure-Notification App

We conducted semi-structured interviews with 20 users of Canada's exposure-notification app, COVID Alert. We identified several types of users' mental models for the app. Participants' concerns were found to correlate with their level of understanding of the app. Compared to a centralized contact-tracing app, COVID Alert was favored for its more efficient notification delivery method, its higher privacy protection, and its optional level of cooperation. Based on our findings, we suggest decision-makers rethink the app's privacy-utility trade-off and improve its utility by giving users more control over their data. We also suggest technology companies build and maintain trust with the public. Further, we recommend increasing diagnosed users' motivation to notify the app and encouraging exposed users to follow the guidelines. Last, we provide design suggestions to help users with Unsound and Innocent mental models to better understand the app. © 2022 ACM.

How do firms learn? Evidence from corporate cash holdings during the COVID‐19 pandemic

We examine the impact of COVID-19 on US corporate cash holdings. Our findings suggest that greater pandemic exposure is associated with higher corporate cash holdings and that firms learn from prior experiences as they manage their cash policies. More specifically, the level of cash holdings in firms that experienced severe financial constraints during the 2008 credit crisis and firms with prior severe acute respiratory syndrome (SARS) and H1N1 exposure is significantly lower than that of firms with no prior epidemic or financial constraints experience. Overall, our findings support the learning behaviour of cash and contribute to corporate cash holdings literature by providing insights on the extent to which firms learn from prior experiences to manage their liquidity.

JUE Insight: The determinants of the differential exposure to COVID-19 in New York city and their evolution over time.

We argue that occupations are a key explanatory variable for understanding the early transmission of COVID-19 in New York City, finding that they play a larger role than other key demographics such as race or income. Moreover, we find no evidence that commuting patterns are significant after controlling for occupations. On the other hand, racial disparities still persist for Blacks and Hispanics compared with Whites, although the disparities' magnitudes are economically small. We perform our analysis over a range of several weeks to evaluate how different channels interact with the progression of the pandemic and the stay-at-home order. While the coefficient magnitudes of many occupations and demographics decrease, we find evidence consistent with higher intra-household contagion over time. Finally, our results also suggest that crowded spaces play a more important role than population density in the spread of COVID-19.

Equity and Accessibility of Washington State's COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders.

BACKGROUND: In November 2020, WA Notify, Washington State's COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity-triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations. OBJECTIVE: We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities. METHODS: We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13). RESULTS: Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify. CONCLUSIONS: As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention.

COVID-19 Infection During Pregnancy Induces Differential Gene Expression in Human Cord Blood Cells From Term Neonates.

Background: The COVID-19 pandemic continues worldwide with fluctuating case numbers in the United States. This pandemic has affected every segment of the population with more recent hospitalizations in the pediatric population. Vertical transmission of COVID-19 is uncommon, but reports show that there are thrombotic, vascular, and inflammatory changes in the placenta to which neonates are prenatally exposed. Individuals exposed in utero to influenza during the 1918 pandemic had increased risk for heart disease, kidney disease, diabetes, stomach disease and hypertension. Early exposure of COVID-19 during fetal life may lead to altered gene expression with potential long-term consequences. Objective: To determine if gene expression is altered in cord blood cells from term neonates who were exposed to COVID-19 during pregnancy and to identify potential gene pathways impacted by maternal COVID-19. Methods: Cord blood was collected from 16 term neonates (8 exposed to COVID-19 during pregnancy and 8 controls without exposure to COVID-19). Genome-wide gene expression screening was performed using Human Clariom S gene chips on total RNA extracted from cord blood cells. Results: We identified 510 differentially expressed genes (374 genes up-regulated, 136 genes down-regulated, fold change ≥1.5, p-value ≤ 0.05) in cord blood cells associated with exposure to COVID-19 during pregnancy. Ingenuity Pathway Analysis identified important canonical pathways associated with diseases such as cardiovascular disease, hematological disease, embryonic cancer and cellular development. Tox functions related to cardiotoxicity, hepatotoxicity and nephrotoxicity were also altered after exposure to COVID-19 during pregnancy. Conclusions: Exposure to COVID-19 during pregnancy induces differential gene expression in cord blood cells. The differentially expressed genes may potentially contribute to cardiac, hepatic, renal and immunological disorders in offspring exposed to COVID-19 during pregnancy. These findings lead to a further understanding of the effects of COVID-19 exposure at an early stage of life and its potential long-term consequences as well as therapeutic targets.

ASSESSING THE VULNERABILITY INDEX OF COVID-19 PANDEMIC IN INDIA

The coronavirus (COVID-19) outbreak has created havoc all across the States and Union Territories (UTs) of India since its beginning on 30th January 2020. As of 1st January 2021, India has recorded 10,305,788 cases and 149,218 deaths from this deadly pandemic. It has been observed through the data;across states and UTs, the trend and pattern of this disease are not similar at all. There are many reasons for these dissimilarities which are categorized into indicators to assess the vulnerability in this study. We have examined vulnerabilities in 28 states and 8 UTs of India. Livelihood Vulnerability Index (LVI) has been applied with certain modifications to calculate the Vulnerability Index ( VI). The figure resulting from the vulnerability assessment corresponds that the factors involved in the three-section exposure, sensitivity, and adaptive capacity had a significant impact on deciding the vulnerability of the population. The result identified the states and UTs which are more vulnerable and need more attention from the government and policymakers. The proposed method of study is unique in its sense as vulnerability index calculation is purely based on a secondary source of data and therefore has an expectation of a higher degree of practical application. © 2021, Russian Geographical Society. All rights reserved.

COVID-19 exposure in SARS-CoV-2-seropositive hospital staff members during the first pandemic wave at Strasbourg University Hospital, France.

OBJECTIVES: Strasbourg University Hospital faced an important COVID-19 first wave from early March 2020. We performed a longitudinal prospective cohort study to describe clinical and virological data, exposure history to COVID-19, and adherence to strict hygiene standards during the first pandemic wave in 1497 workers undergoing a SARS-CoV-2 serological test at our hospital, with a follow up of serology result three months later. PATIENTS AND METHODS: A total of 1497 patients were enrolled from April 6 to May 7, 2020. Antibody response to SARS-CoV-2 was measured, and COVID-19 exposure routes were analyzed according to SARS-CoV-2 serological status. RESULTS: A total of 515 patients (34.4%) were seropositive, mainly medical students (13.2%) and assistant nurses (12.0%). A history of COVID-19 exposure in a professional and/or private setting was mentioned by 83.1% of seropositive subjects (P<0.05; odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.8-3.4). COVID-19 exposure factors associated with seropositive status were non-professional exposure (OR: 1.9, 95% CI: 1.3-2.7), especially outside the immediate family circle (OR: 2.2, 95% CI: 1.2-3.9) and contact with a COVID-19 patient (OR: 1.6; 95% CI: 1.1-2.2). Among professionally exposed workers, systematic adherence to strict hygiene standards was well observed, except for the use of a surgical mask (P<0.05, OR: 1.9, 95% CI: 1.3-2.8). Of those who reported occasionally or never wearing a surgical mask, nurses (25.7%), assistant nurses (16.2%), and medical students (11.7%) were predominant. CONCLUSION: Infection of staff members during the first pandemic wave in our hospital occurred after both professional and private COVID-19 exposure, underlining the importance of continuous training in strict hygiene standards.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and During COVID-19 Pandemic: A Longitudinal Mediation Model.

Background: The outbreak of the COVID-19 pandemic has had a profound influence on the mental health and well-being of individuals across the globe. Emotional competence, defined as one's ability to recognize, understand, and manage their emotions, has been found linked with mental health problems (e.g., depression and anxiety) in previous studies. However, there is limited knowledge about the direction of the association between these factors among populations exposed to COVID-19. This study examined the possible mediation relationships between depression, anxiety, emotional competence, and COVID-19 exposure among Chinese adolescents. Methods: Responses from 7,958 Chinese adolescents who had previously taken part in a two-wave study before (December 23, 2019-January 13, 2020) and during COVID-19 (June 16, 2020-July 8, 2020) were analyzed (51.67% males, mean age = 11.74, SD = 2.15). Structural equation modeling with three covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal mediation relationships between COVID-19 exposure and depression, anxiety via emotional competence. Results: Results indicated that the prevalence of depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 to Time 2. The T2 emotional competence significantly mediated the relationship between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 [0.004-0.019], p < 0.05). T2 emotional competence also significantly mediated the relationship between T2 COVID-19 exposure and T2 depression (indirect effect [95% CI] = 0.013 [0.005-0.022], p < 0.05). The results indicated that T2 emotional competence had a significant and negative influence on T2 anxiety (ß = -0.266, SE = 0.005, p < 0.001), and T2 depression (ß = -0.326, SE = 0.029, p < 0.001). Conclusions: This longitudinal research study demonstrated the crucial role of emotional competence in influencing the severity of long-term mental health problems, and suggested that emotional competence interventions can be conducted to improve mental well-being among Chinese adolescents exposed to COVID-19.

Strategizing COVID-19 lockdowns using mobility patterns.

During the COVID-19 pandemic, governments have attempted to control infections within their territories by implementing border controls and lockdowns. While large-scale quarantine has been the most successful short-term policy, the enormous costs exerted by lockdowns over long periods are unsustainable. As such, developing more flexible policies that limit transmission without requiring large-scale quarantine is an urgent priority. Here, the dynamics of dismantled community mobility structures within US society during the COVID-19 outbreak are analysed by applying the Louvain method with modularity optimization to weekly datasets of mobile device locations. Our networks are built based on individuals' movements from February to May 2020. In a multi-scale community detection process using the locations of confirmed cases, natural break points from mobility patterns as well as high risk areas for contagion are identified at three scales. Deviations from administrative boundaries were observed in detected communities, indicating that policies informed by assumptions of disease containment within administrative boundaries do not account for high risk patterns of movement across and through these boundaries. We have designed a multi-level quarantine process that takes these deviations into account based on the heterogeneity in mobility patterns. For communities with high numbers of confirmed cases, contact tracing and associated quarantine policies informed by underlying dismantled community mobility structures is of increasing importance.

Impact of COVID-19 exposure on working capital management: The moderating effect of investment opportunities and government incentives.

This study examines the impact of the COVID-19 pandemic on firms' working capital management (WCM) covering 2,542 US-publicly traded firms for the period 2019Q1-2021Q2. Proxying WCM as cash conversion cycle (CCC), I find that COVID-19-exposed firms operate with higher levels of CCC. I show that firms with more investment opportunities and firms that receive government incentives (deferred taxes and investment tax credit (DT_ITC)) operate with lower levels of CCC. Overall, I provide evidence of the significant adverse impact of COVID-19 on WCM and show that the effect could be mitigated with an increase in investment opportunities and government incentives.

Infection prevention strategies are highly protective in COVID-19 units while main risks to healthcare professionals come from coworkers and the community.

BACKGROUND: Early evaluations of healthcare professional (HCP) COVID-19 risk occurred during insufficient personal protective equipment and disproportionate testing, contributing to perceptions of high patient-care related HCP risk. We evaluated HCP COVID-19 seropositivity after accounting for community factors and coworker outbreaks. METHODS: Prior to universal masking, we conducted a single-center retrospective cohort plus cross-sectional study. All HCP (1) seen by Occupational Health for COVID-like symptoms (regardless of test result) or assigned to (2) dedicated COVID-19 units, (3) units with a COVID-19 HCP outbreak, or (4) control units from 01/01/2020 to 04/15/2020 were offered serologic testing by an FDA-authorized assay plus a research assay against 67 respiratory viruses, including 11 SARS-CoV-2 antigens. Multivariable models assessed the association of demographics, job role, comorbidities, care of a COVID-19 patient, and geocoded socioeconomic status with positive serology. RESULTS: Of 654 participants, 87 (13.3%) were seropositive; among these 60.8% (N = 52) had never cared for a COVID-19 patient. Being male (OR 1.79, CI 1.05-3.04, p = 0.03), working in a unit with a HCP-outbreak unit (OR 2.21, CI 1.28-3.81, p < 0.01), living in a community with low owner-occupied housing (OR = 1.63, CI = 1.00-2.64, p = 0.05), and ethnically Latino (OR 2.10, CI 1.12-3.96, p = 0.02) were positively-associated with COVID-19 seropositivity, while working in dedicated COVID-19 units was negatively-associated (OR 0.53, CI = 0.30-0.94, p = 0.03). The research assay identified 25 additional seropositive individuals (78 [12%] vs. 53 [8%], p < 0.01). CONCLUSIONS: Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission. Prior to universal masking, HCP COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission.

Exposure of community pharmacists to COVID-19: A multinational cross-sectional study.

OBJECTIVES: Community pharmacists (CPs) are among the frontline healthcare providers who have been exposed to a high risk of being infected with SARS-CoV-2 during the pandemic. Unfortunately, there have been limited studies in the Middle East that provide an occupational risk analysis among CPs. Therefore, this study aims to evaluate the risk of COVID-19 exposure among Middle Eastern CPs and to identify the infection predictors. METHODS: A cross-sectional survey was conducted using an online, self-administered questionnaire that was distributed to CPs across KSA, Lebanon, and Jordan between November and December 2020. The bivariate logistic regression test was used to analyse the predictors associated with COVID-19. RESULTS: CPs were more susceptible to acquiring SARS-CoV-2 than the general public (12.9% vs. 1.5%). The significant predictors of infection included a family member with confirmed COVID-19 infection, age <40 years, encountering patients in pharmacy without a protective glass-barrier, and contact with confirmed COVID-19 patients or colleagues with confirmed COVID-19 during practice. Additionally, the mean level of the respondents' expected rate of infection was 3.27 ± 1.04 (out of 5). This level was significantly higher among female pharmacists and Lebanese pharmacists. CONCLUSIONS: This study demonstrates that CPs are at a higher risk of acquiring COVID-19 compared with the general public. This is attributed to several occupational factors that increase the risk of exposure to COVID-19. Therefore, healthcare authorities are advised to enforce strict occupational guidelines for CPs.

Fear and depression linked to COVID-19 exposure A study of adult twins during the COVID-19 pandemic.

Millions of people have been impacted by the novel coronavirus (COVID-19) pandemic worldwide. High infection rates and death tolls, combined with social distancing measures, may have unintended psychological consequences on individuals. The goal of this study was to examine the interrelations between COVID-19 exposure, fear of COVID-19, and depression among a community-based sample of adult twins. We further explored whether fear of COVID-19 mediated the association between COVID-19 exposure and depression. 732 same-sex adult twin pairs (78.1% MZ, 21.9% DZ) completed an online survey examining their feelings in May 2020. About one-fifth of the participants reported having any COVID-19 exposure. Most participants (>80%) were somewhat concerned about themselves or their household members being infected by COVID-19. The average depression level was relatively low (M = 0.9 out of 6). We found that COVID-19 exposure was related to increased fears of COVID-19 and depression, and that depressive feelings increased with fear of COVID-19. The correlation between COVID-19 exposure and depression was partially mediated by fear of COVID-19. However, these associations were confounded by familial influences. As society navigates through the pandemic, it is essential to implement public health strategies to help individuals cope with the concerns and fears about COVID-19.