Kiwis and COVID-19: The Aotearoa New Zealand Response to the Global Pandemic

This fast-moving global COVID-19 pandemic caught many nations unprepared and has exposed numerous flaws in global health, public health, and economic and social welfare infrastructures. It may seem premature to write about responses, but there are lessons to be learned from the response of Aotearoa New Zealand. Although its geopolitical situation as an island nation meant that it had late exposure to COVID-19, NZ has been commended because it closed its borders (to non-nationals);lockdown;traced;tested contacts;told people to pick a ‘bubble' (immediate and usual family or household) and stay within that bubble;and promoted clear public messages. Government assistance was available for employers to retain staff, and additional support was provided for businesses and individuals. A strong and empathetic prime minister communicated regularly with the public and developed a sense of common national purpose. However, COVID-19 still exposed the impact of social inequalities. Implications for the next steps of recovery are considered in the paper.

Emotional response patterns, mental health, and structural vulnerability during the COVID-19 pandemic in Canada: a latent class analysis.

BACKGROUND: The COVID-19 pandemic has contributed to increases in negative emotions such as fear, worry, and loneliness, as well as changes in positive emotions, including calmness and hopefulness. Alongside these complex emotional changes has been an inequitable worsening of population mental health, with many people experiencing suicidal ideation and using substances to cope. This study examines how patterns of co-occurring positive and negative emotions relate to structural vulnerability and mental health amid the pandemic. METHODS: Data are drawn from a cross-sectional monitoring survey (January 22-28, 2021) on the mental health of adults in Canada during the pandemic. Latent class analysis was used to group participants (N = 3009) by emotional response pattern types. Descriptive statistics, bivariate cross-tabulations, and multivariable logistic regression were used to characterize each class while quantifying associations with suicidal ideation and increased use of substances to cope. RESULTS: A four-class model was identified as the best fit in this latent class analysis. This included the most at-risk Class 1 (15.6%; high negative emotions, low positive emotions), the mixed-risk Class 2 (7.1%; high negative emotions, high positive emotions), the norm/reference Class 3 (50.5%; moderate negative emotions, low positive emotions), and the most protected Class 4 (26.8% low negative emotions, high positive emotions). The most at-risk class disproportionately included people who were younger, with lower incomes, and with pre-existing mental health conditions. They were most likely to report not coping well (48.5%), deteriorated mental health (84.2%), suicidal ideation (21.5%), and increased use of substances to cope (27.2%). Compared to the norm/reference class, being in the most at-risk class was associated with suicidal ideation (OR = 2.84; 95% CI = 2.12, 3.80) and increased use of substances to cope (OR = 4.64; 95% CI = 3.19, 6.75). CONCLUSIONS: This study identified that adults experiencing structural vulnerabilities were disproportionately represented in a latent class characterized by high negative emotions and low positive emotions amid the COVID-19 pandemic in Canada. Membership in this class was associated with higher risk for adverse mental health outcomes, including suicidal ideation and increased use of substances to cope. Tailored population-level responses are needed to promote positive coping and redress mental health inequities throughout the pandemic and beyond.

"It reflects the society in which we live, except now everything is accentuated": youth, social inequities, and the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has been an extraordinary moment of uncertainty and rapid transformation. The effects lockdowns had on youths' mental and physical health, as well as the challenges they posed for young peoples' learning, were of great concern. It quickly became clear that government responses to COVID-19, in particular regarding the social determinants of health, were not equally experienced across all social groups. This paper adopts an interdisciplinary lens at the intersection of health and education and uses Max Weber's lifestyle theory to analyze the inequitable experience of the COVID-19 pandemic. We examine most directly social inequities in education during the first wave of COVID-19 and explore long-term effects on youths' educational opportunities, health, and well-being. METHODS: We use focus group materials collected from our Spring 2020 study. This study explored how youth were differentially experiencing the pandemic. Participants included 18 youth between the ages of 13 and 18 (11 girls, 7 boys). Participants were stratified by private and public secondary schools and we ran focus groups in which experiences of the pandemic were discussed. RESULTS: Our results show (1) clear differences in early access to education for youth who attended public and private institutions in Quebec during the COVID-19 pandemic; (2) access to the internet and computers offset learning opportunities for students across Quebec throughout the COVID-19 pandemic; and (3) few of the differences experienced during the pandemic were based on youth's behaviours, or life choices, but rather stemmed from differences in material and structural opportunities, based largely, but not solely, on what type of school the youth attended (public or private). CONCLUSION: The way in which the COVID-19 pandemic was handled by the Quebec education system deepened existing social inequities in education between private and public school attendees. Given the importance of education as one of the main determinants of health, particularly during transition periods such as adolescence, we must ensure that future policies do not repeat past mistakes.

RéSUMé: OBJECTIFS: La pandémie de la COVID-19 a été un moment d'incertitude et de transformation rapide hors du commun, soulevant des questions inédites sur les effets du confinement sur la santé mentale et physique des jeunes ainsi que sur les défis engendrés en termes d'apprentissage chez les jeunes. Il s'est rapidement avéré que les réponses du gouvernement à la COVID-19, en particulier en ce qui concerne les déterminants sociaux de la santé, n'étaient pas vécues de la même manière dans tous les groupes sociaux. Cet article adopte une optique interdisciplinaire à l'intersection de la santé et de l'éducation et utilise la théorie du mode de vie de Max Weber pour analyser l'expérience inéquitable de la pandémie de COVID-19. Nous examinons plus directement les inégalités sociales dans l'éducation pendant la première vague de COVID-19 et explorons les effets à long terme sur la santé et le bien-être des jeunes. MéTHODES: Nous utilisons les données recueillies lors de notre étude du printemps 2020 qui a exploré comment les jeunes vivaient différemment la pandémie. Les participants sont 18 jeunes âgés de 13 à 18 ans (11 filles, 7 garçons). Les participants ont été stratifiés par écoles secondaires privées et publiques et nous avons organisé des groupes de discussion dans lesquels les expériences de la pandémie ont été discutées. RéSULTATS: Nos résultats montrent 1) de nouvelles et profondes inégalités sociales dans le système d'éducation qui ont été créées par les mesures de confinement gouvernementales au Québec et 2) un accès inéquitable aux ressources mobilisées pour s'adapter aux mesures gouvernementales. CONCLUSION: L'étude du cas des inégalités sociales en contexte d'éducation pendant la pandémie offre d'importants apprentissages sur les inégalités sociales en général. Nous concluons cette étude en réfléchissant à l'espace intersectoriel important entre l'éducation et la santé pour les jeunes.

Social Determinants of Health and Distance Learning in Italy in the Era of the SARS-CoV-2 Pandemic.

OBJECTIVES: To investigate the experiences by distance learning (DL) method during the first wave of the SARS-CoV-2 pandemic in Italy, and to search for correlations with purported experiences and respective levels of social determinants of health (SDH). STUDY DESIGN AND METHODS: Cross-sectional online survey, investigating various SDH and parents' attitude towards DL, proposed 6 months after the beginning of the pandemic to a sample population of parents with school-aged children throughout Italy. RESULTS: A total of 3791 questionnaires were analyzed. Non-Italian parents complained more frequently of difficulties in providing support to their children in DL due to poor digital skills (p = 0.01), lack of good-quality digital equipment (p = 0.01), problems with the Italian language (p < 0.001), and a lower level of education (p < 0.001). When parents lived apart, greater difficulties in concentration in children using DL (p = 0.05) and a lower parental capacity to support DL (p = 0.002) were reported. Adequate digital structures appeared related to living in owned compared to rented property, higher levels of parental education, and better familial financial situations. CONCLUSIONS: Students from families with financial difficulties and low levels of parental education, or even those living in houses for rent or having separated parents, may be disadvantaged in an educational context since the introduction of DL.

Social Determinants of Health and Distance Learning in Italy in the Era of the SARS-CoV-2 Pandemic

Objectives: To investigate the experiences by distance learning (DL) method during the first wave of the SARS-CoV-2 pandemic in Italy, and to search for correlations with purported experiences and respective levels of social determinants of health (SDH). Study design and methods: Cross-sectional online survey, investigating various SDH and parents’ attitude towards DL, proposed 6 months after the beginning of the pandemic to a sample population of parents with school-aged children throughout Italy. Results: A total of 3791 questionnaires were analyzed. Non-Italian parents complained more frequently of difficulties in providing support to their children in DL due to poor digital skills (p = 0.01), lack of good-quality digital equipment (p = 0.01), problems with the Italian language (p < 0.001), and a lower level of education (p < 0.001). When parents lived apart, greater difficulties in concentration in children using DL (p = 0.05) and a lower parental capacity to support DL (p = 0.002) were reported. Adequate digital structures appeared related to living in owned compared to rented property, higher levels of parental education, and better familial financial situations. Conclusions: Students from families with financial difficulties and low levels of parental education, or even those living in houses for rent or having separated parents, may be disadvantaged in an educational context since the introduction of DL.

Progression of COVID-19 Among Black Pregnant Women: Population-Based Study.

The aim of this study was to evaluate the evolution of COVID-19 related to race/skin color among Brazilian pregnant women registered on the Sistema de Informação de Vigilância da Gripe (SIVEP Gripe). This is a population-based study, based on the data from SIVEP Gripe, with data collected at two time points, August 2020 and February 2021. From the complete database (575,935 cases on August 8, 2020 and 1,048,576 cases on January 2, 2021), the weeks 13 to 32 (563,851 cases) and 33 to 53 (469,241 cases) were selected. We selected cases of pregnant women with white, brown and black skin color and final evolution (1,884 and 1,286 cases). The final sample (939 and 858 cases) was defined by including participants who had all the targeted information recorded. The outcome variables were hospitalization, Intensive Care Unit (ICU) admission and COVID-19 deaths. The present study identified that there was a drop of approximately two-thirds in the proportion of pregnant women who required ICU care or died, when comparing the first and second periods. In the second period, black pregnant women had approximately five times higher risk of death compared to white and brown women.

Kiwis and COVID-19: The Aotearoa New Zealand Response to the Global Pandemic

This fast-moving global COVID-19 pandemic caught many nations unprepared and has exposed numerous flaws in global health, public health, and economic and social welfare infrastructures. It may seem premature to write about responses, but there are lessons to be learned from the response of Aotearoa New Zealand. Although its geopolitical situation as an island nation meant that it had late exposure to COVID-19, NZ has been commended because it closed its borders (to non-nationals);lockdown;traced;tested contacts;told people to pick a ‘bubble’ (immediate and usual family or household) and stay within that bubble;and promoted clear public messages. Government assistance was available for employers to retain staff, and additional support was provided for businesses and individuals. A strong and empathetic prime minister communicated regularly with the public and developed a sense of common national purpose. However, COVID-19 still exposed the impact of social inequalities. Implications for the next steps of recovery are considered in the paper. © 2020 SAGE Publications.

Syrian Refugees' Experiences of Housing Stability during the COVID-19 Pandemic: Barriers to Integration and Just Solutions

Research has shown high levels of housing precarity among government assisted refugees (GARs) connected to difficult housing markets, limited social benefits, and other social and structural barriers to positive settlement (Lumley-Sapanski, 2021). The COVID-19 pandemic has likely exacerbated this precarity. Research to date demonstrates the negative consequences of the COVID-19 pandemic for refugees and low-income households, including both health-related issues and economic challenges, that may exacerbate their ability to obtain affordable, suitable housing (Jones & Grigsby-Toussaint, 2020;Shields & Alrob, 2020). In this context, we examined Syrian government-assisted refugees' experiences during the pandemic, asking: how the COVID-19 pandemic has impacted Syrian refugees' experiences of housing stability. To examine this issue, we interviewed 38 families in Calgary, London, and Fredericton. Using a qualitative descriptive methodology for analysis and interpretation (Thorne et al., 1997), we found the liminality of settling as a GAR has been compounded by isolation, further economic loss, and new anxieties during the pandemic. Ultimately, for many participants, the pandemic has thwarted their housing stability goals and decreased their likelihood of improving their housing conditions. Based on our findings, we discuss potential policy and practice relevant solutions to the challenges faced by refugees in Canada during the pandemic and likely beyond.

Social inequalities and their impact on children's health: a current and global perspective.

OBJECTIVE: To describe the consequences of social inequalities on children's health as a global and persistent problem, demonstrating its historical and structural roots in different societies. DATA SOURCES: Relevant articles in the PubMed/MEDLINE database, in addition to those found in a manual search and in the bibliographic references of selected studies and consultation to the websites of international organizations to obtain relevant data and documents. DATA SYNTHESIS: To understand how inequities affect health, it is necessary to know the unequal distribution of their social determinants among population groups. In the case of children, the parental pathway of determinants is central. The non-equitable way in which many families or social groups live, determined by social and economic inequalities, produces unequal health outcomes, particularly for children. This is observed between and within countries. Children from the most vulnerable population groups consistently have worse health conditions. Interventions aimed at children's health must go beyond care and act in an integrated manner on poverty and on social and economic inequalities, aiming to end systematic and unfair differences. CONCLUSIONS: Despite the considerable advances observed in children's health in recent decades at a global level, the inequalities measured by different indicators show that they persist. This scenario deserves attention from researchers and decision-makers, especially in the context of the global health crisis caused by the COVID-19 pandemic, which has further intensified the situation of vulnerability and social inequalities in health around the world.

County-Level Social Determinants of Health and COVID-19 in Nursing Homes, United States, June 1, 2020-January 31, 2021.

OBJECTIVES: Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home-associated COVID-19 infection rates and county-level and nursing home attributes. METHODS: We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis. RESULTS: Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (-0.007) or state-owned (-0.025) and nonprofit (-0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home-associated COVID-19 infection rates early in the study. High median annual personal income (-0.002) at the county level correlated with lower nursing home-associated COVID-19 infection rates. CONCLUSIONS: Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.

A case of acquired immunodeficiency syndrome-related Kaposi sarcoma in a patient with COVID-19 - A brief review of HIV-COVID Co-infection and its Therapeutic challenges!

Barriers posed by the COVID-19 pandemic have led to reduced access to Human Immunodeficiency virus (HIV) care, leaving untreated patients at risk for various superimposed infections and malignancies such as Kaposi sarcoma (KS). We recently encountered a 37-year-old African-American male with a past medical history of HIV who tested positive for SARS-CoV-2 and was diagnosed with AIDS-related disseminated KS, representing the first reported case of COVID-19 infection with a newly diagnosed concomitant KS. The patient experienced multi-organ failure requiring tracheostomy, renal replacement therapy, and a prolonged intensive care unit (ICU) stay. Goals of care were changed to comfort measures and the patient passed away shortly afterwards. He was made comfort measures and passed away shortly afterwards. AIDS-related KS is a vascular tumor seen in association with Human Herpes Virus-8 (HHV-8). Management of limited AIDS-related KS typically includes combined antiretroviral therapy (ART) while multi-organ KS disease demands systemic chemotherapy. Immunosuppression should be avoided in patients with AIDS-related KS as it can lead to progression of KS. This recommendation is in conflict with the usual standard of care for patients with COVID-19 pneumonia, requiring clinical judgment and a customized approach based on the stage and severity of both the KS and the COVID-related disease. We briefly review HIV-COVID-19 coinfection, AIDS related KS and challenges associated with their management.

Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study.

BACKGROUND: Chronic pain affects about 20 % of the Canadian population and can lead to physical, psychological and social vulnerabilities. However, this condition remains poorly recognized and undertreated. During 2020, as the COVID-19 pandemic disrupted daily living and health care systems, the situation of people with chronic pain has drawn little public attention. METHODS: This qualitative study was part of a pan-Canadian mixed-methods project and aimed to understand the experiences and challenges of people living with chronic pain during the COVID-19 pandemic in Canada. Between May and August 2020, we conducted in-depth semi-structured interviews with 22 individuals living with chronic pain across the country. We used reflexive thematic analysis to interpret data. RESULTS: Our findings underscored four dimensions of the chronic pain experience during the pandemic: (1) Reinforced vulnerability due to uncertainties regarding pain and its management; (2) Social network as a determinant of pain and psychological condition; (3) Increasing systemic inequities intermingling with the chronic pain experience; (4) More viable living conditions due to confinement measures. Though several participants reported improvements in their quality of life and reduced social pressure in the context of stay-at-home orders, participants from socio-economically deprived groups and minorities reported more challenges in accessing pain relief, health care services, and psychosocial support. CONCLUSIONS: The COVID-19 pandemic has revealed and intensified pre-existing disparities and challenges among people living with chronic pain in terms of material resources, psychosocial condition, social support, and access to care. In post-pandemic times, it will be essential to address flaws in health and welfare policies to foster equity and social inclusiveness of people with chronic pain.

Unpacking the health and social consequences of COVID-19 through a race, migration and gender lens.

The ongoing COVID-19 pandemic has emerged as an unprecedented challenge for healthcare systems across the world. To date, there has been little application of a race, migration and gender lens to explore the long-term health and social consequences of COVID-19 in African, Caribbean and Black (ACB) communities in Canada, who have been disproportionately impacted by this pandemic. The evidence presented in this commentary suggests that recovery strategies need to adopt an intersectional lens taking into account race, migration and gender since ACB women and ACB immigrant women have been among the populations most impacted both personally and economically. To do so, there is an urgent need to incorporate variables capturing race, beyond "visible minority" status; gender, beyond looking at differences between women and men; and factors to help understand the complexities of migration trajectories (i.e., beyond the dichotomy of born in Canada versus not born in Canada categories) in Canadian datasets. We provide examples of policy and practice initiatives that will be urgently required to address the needs of these population groups as these race-based data become available.

RéSUMé: La pandémie de COVID-19 en cours se révèle être un défi sans précédent pour les systèmes de santé du monde entier. Jusqu'à maintenant, on a très peu appliqué le prisme de la race, de la migration et du genre pour explorer les conséquences sociosanitaires à long terme de la COVID-19 dans les communautés africaines, caribéennes et noires (ACN) du Canada, qui ont été démesurément touchées par cette pandémie. Selon les données probantes présentées dans notre commentaire, les stratégies de rétablissement doivent adopter un prisme intersectionnel qui tient compte de la race, de la migration et du genre, car les femmes ACN et les immigrantes ACN sont parmi les populations les plus touchées, personnellement et économiquement. Pour cela, il faut de toute urgence intégrer dans les jeux de données canadiens des variables qui saisissent la race, au-delà du statut de « minorité visible ¼; le genre, au-delà des différences entre femmes et hommes; et les facteurs qui aident à comprendre les trajectoires de migration dans toute leur complexité (c.-à-d. au-delà de la dichotomie des catégories « né au Canada ¼ et « né à l'étranger ¼). Nous donnons des exemples d'initiatives stratégiques et pratiques qui seront nécessaires à très court terme pour répondre aux besoins de ces segments démographiques à mesure que les données fondées sur la race deviendront disponibles.