"It all goes back to trust": a qualitative exploration of extension professionals' perceptions of COVID-19 vaccines in rural Florida

While urban communities experienced high levels of infection at the onset of the COVID-19 pandemic, rural communities experienced an increase of confirmed cases during the fall months of 2020. Rural Americans were also among the most hesitant to receive the COVID-19 vaccine. The purpose of this study was to explore the perceptions of [State] extension professionals related to the COVID-19 vaccines in rural communities. Qualitative methods were utilized to gather data from extension professionals in rural area of [State], where vaccine uptake was below average. Results revealed frustration with the vaccine process, vaccine norms, and skepticism and mistrust to all be contributing factors to vaccine hesitancy in rural communities. Extension professionals discussed not feeling comfortable discussing topics related to public health with their clientele, citing the topic being outside their expertise. Practical recommendations from this study included utilizing a grassroots approach rather than relying on mass media, providing messages related to the COVID-19 vaccine that focus on education, rather than promotion, and testing new messages before they are disseminated.

Occupational health and safety trainees reflect on their education and future careers during COVID-19

Background: The National Institute for Occupational Safety and Health (NIOSH) funded Education and Research Centers (ERCs), located at 18 universities, with the mission to train occupational safety and health (OSH) leaders. The Florida Sunshine ERC has trained hundreds of students since its inception in 1997 through seven programs that collaboratively foster interdisciplinary education and applied research and practice. The COVID-19 pandemic has presented practical challenges for educators, students, and trainees, forcing institutions to move to remote learning. The pandemic also magnifies the importance of public health and OSH. Purpose: This evaluation elicited feedback from ERC trainees early in the pandemic (2020) and again in 2021 on how the pandemic affected their training, professional development, career plans, and wellbeing. Methods: Open-ended surveys were collected and focus groups were held with currently enrolled trainees from seven Sunshine ERC programs. Descriptive statistics were calculated, and qualitative transcripts were analyzed using MAXQDA software. Results: Through survey responses (45 respondents) and focus group discussions (9 participants), ERC trainees shared their perspectives on pandemic impacts in their performance and wellbeing, transition to remote learning, their respective OSH fields, and career plans during the pandemic. Programs should consider enhancing OSH curricula to respond to training needs and issues related to occupational stress and well-being, pragmatism and disaster response, and even more interdisciplinary training to prepare for emerging population-wide threats. Conclusions: OSH training will require shifts in teaching modalities and content to prepare OSH professionals for the future. Evaluation results informed teaching and training modifications to ensure that ERC objectives continue to be met and that trainees are well-prepared and supported.

Programmatic impacts of utilizing various staffing options for COVID-19 contact tracers: recommendations and lessons learned

Background: The rapidly expanding COVID-19 pandemic created an immediate demand for the Department of Health in Hillsborough County (DOH-Hillsborough) Epidemiology Program to supplement its contact tracing workforce;and, because of the long duration of the response, a sustained workforce was needed. The DOH-Hillsborough Epidemiology Program's COVID-19 response, broadly referred to as "contact tracing", included case investigations, outbreaks, and identification and notifications to exposed individuals. To meet contact tracing staffing needs, several staffing options were utilized, including Core Epidemiology Staff, Reassigned DOH-Hillsborough staff (Reassigned Staff), Contracted staffing agency hires (Contract Staff), State of Florida hires (State Level Hires), County hires (DOH-Hillsborough Hires), and college and university faculty and students (University Partners). Purpose: To understand the differences in work output and efficiency across staffing groups (quantitative analysis) and to understand Core Epidemiology Staff recommendations when hiring temporary staff as contact tracers (qualitative analysis). Methods: A mixed-methods approached was used to assess each staffing group hired in Hillsborough County. Quantitative data was analyzed from 3/1/2020 through 1/31/2021, and included data from the state's personnel management system and the state's reportable disease database to represent work output. Qualitative interviews with DOH-Hillsborough Core Epidemiology Staff were conducted and analyzed to understand Core Epidemiology Staff recommendations when hiring surge staffing in the future. Results: During the evaluation period, 199 staff across the staffing groups worked a collective 132,252.50 hours. The number of hours worked per case and contact ranged from 10.16 in Core Epidemiology Staff to 0.67 in University Partners. During qualitative interviews with the Core Epidemiology Staff, five common themes emerged as ideal characteristics for temporary contact tracing staff. These included: communication skills, professionalism, public health knowledge, following official guidance, and flexibility. Two groups who emerged as the "best hires" for their seamless transition into their roles included University Partners and the State Level hires. Discussion: These mixed methods data can be used to develop best practices to inform future surge staffing needs.

Disparities in COVID-19 case counts and incidence in Florida by race and ethnicity at the county and state level

Background: In 2020, as COVID-19 spread across the United States, reports of disparities in COVID-19 incidence and mortality by race and ethnicity soon followed. This study assessed COVID-19 case counts and incidence by race and ethnicity at county and state levels focusing on Florida. Methods: Counts of COVID-19 were collected from June through December 2020. Chi square analyses assessed disparities in case distribution and linear regressions assessed disparities in incidence and potential interaction between predictors. Results: Race and ethnicity were significant predictors of COVID-19 incidence. Mean incidence was 4.9, 6.6, and 14.3 per 1,000 people among White, Black, and Other populations and 10.9 and 5.0 per 1,000 people among Hispanic and non-Hispanic populations. Incidence was greatest among the Other population (P=0.3825), and greater among Hispanic than non-Hispanic populations (P=0.0057). Conclusion: This study illustrates the disproportionate impact of COVID-19 upon racial and ethnic minorities and highlights the need to improve race and ethnicity data collection in disease reporting.

Failure to respond to a coral disease epizootic in Florida: causes and consequences

Stony coral tissue loss disease (SCTLD) was first observed in September 2014 near Virginia Key, Florida. In roughly six years, the disease spread throughout Florida and into the greater Caribbean basin. The high prevalence of SCTLD and high resulting mortality in coral populations, and the large number of susceptible species affected, suggest that this outbreak is one of the most lethal ever recorded. The initial recognition and management response to this catastrophic disease in Florida was slow, which delayed the start of monitoring programs and prevented coordinated research programs by at least two years. The slow management response was a result of several factors that operated concurrently. First, the Port Miami dredging project was ongoing during the coral disease epidemic and dredging rather than SCTLD was blamed by some managers and local environmental groups for the extreme coral losses reported in the project's compliance monitoring program. Second, this blame was amplified in the media because dredging projects are intuitively assumed to be bad for coral reefs. Third, during this same time State of Florida policy prohibited government employees to acknowledge global warming in their work. This was problematic because ocean warming is a proximal cause of many coral diseases. As a result, the well-known links between warming and coral disease were ignored. A consequence of this policy was that the dredging project provided an easy target to blame for the coral mortality noted in the monitoring program, despite convincing data that suggested otherwise. Specifically, results from the intensive compliance monitoring program, conducted by trained scientific divers, were clear. SCTLD that was killing massive numbers of corals throughout Florida was also killing corals at the dredge site - and in the same proportions and among the same suite of species. While eradication of the disease was never a possibility, early control measures may have slowed its spread or allowed for the rescue of significant numbers of large colonies of iconic species. This coral disease outbreak has similarities to the COVID-19 pandemic in the United States and there are lessons learned from both that will improve disease response outcomes in the future, to the benefit of coral reefs and human populations.

Social determinants of health and COVID-19 infection in North Carolina: a geospatial analysis

Study Objectives: The COVID-19 pandemic has demonstrated that social determinants of health (SDOH) are profoundly linked to the spread and outcomes of COVID-19. However, the relationships between these SDOH and COVID-19 spatial outbreaks have yet to be determined. We conducted spatial analyses with geographic information systems (GIS) mapping of county-level SDOH and regional COVID-19 infection outbreaks to demonstrate the most impactful SDOH and to provide a pragmatic visual guide to prevent future outbreaks.

Anxiety symptoms among extension professionals' during the COVID-19 pandemic with the GAD-2. (Special Issue: Space, place, and COVID-19.)

According to the National Institute of Mental Health, anxiety disorders are a common mental health disorder but often remain undetected and undertreated. During the COVID-19 pandemic, Extension professionals have worked hard to address emerging issues that communities face, possibly impacting the amount of anxiety they experience. This study determined the prevalence of anxiety symptoms among Extension professionals in the United States. Participants from 24 states completed a survey containing the Generalized Anxiety Disorder 2-item (GAD-2) screener. Almost one-quarter of Extension professionals had a GAD-2 score greater than three, an indicator of anxiety with a possibility of generalized anxiety disorder, which is similar to that of the general population. Also, female and male Extension professionals were about equal in the prevalence of anxiety symptoms, which is contrary to the literature. Extension administrators should consider ways to help their employees with this anxiety, especially during and after traumatic events.

Summary of the 31st meeting of the international task force for disease eradication, 20-21 October 2020

This article provides a brief overview of the 31st meeting of the International TaskForce for Disease Eradication (ITFDE) that was convened at The Carter Center in Atlanta, GA, USA on 20-21 October 2020 to discuss "The impact of the COVID-19 pandemic on eradication and elimination programmes and the way forward." It highlights the results of 7 eradication programmes, with specific conclusions and recommendations for each: Guinea Worm Eradication Programme(dracunculiasis;GWEP);Global Polio Eradication Initiative (GPEI);elimination programmes for measles and rubella (MR), malaria, river blindness (onchocerciasis;RB), and lymphatic filariasis (LF);and the program for the Global Elimination of Trachoma.

Proceedings from the 25th Annual Injury Free Coalition for KidsR Conference: Forging New Frontiers: Changing the Conversation on Gun Safety, Fort Lauderdale, Florida, USA, 4-6 December 2020

These proceedings contain 12 articles discussing how the COVID-19 pandemic has both impacted the epidemiology of childhood injury and uncovered health care disparities in childhood injury. The papers also highlight the research, education and advocacy efforts of the Injury Free Coalition for Kids in youth injury prevention.

Sharing Black trauma as COVID-19 crisis communication tactic: assessing communications from a regional hospital system in Albany, Georgia. (Special Issue: COVID-19 and health inequities: insights from communication research and practice.)

Background: The predominantly Black city of Albany, Georgia, and its metropolitan region, was hard hit during the first wave of COVID-19. In the midst of the wave, the local hospital produced a video of a Black man dying from COVID-19 as a part of its crisis communication strategy. The purpose of this study is to critically interrogate a crisis communications tactic used by one healthcare delivery system during the COVID-19 pandemic.

Shifting tides: lessons learned from virtual plant clinics

Monroe County contains an archipelago of islands, which extend more than 110 miles offshore from the mainland of Florida. There is only one main coastal highway, the Overseas Highway (U.S. Route 1) that connects all of the islands from Key Largo to Key West. Traveling from the southernmost part of the county, where the main extension office is located, to the northern limits can take up to three hours. Due to these geographical restrictions, shifting programming efforts and plant clinics online in response to COVID-19 has presented new opportunities and opened extension's educational opportunities to a new and diverse audience. Through clientele feedback, we have been able to adapt our services and continue to see increases in participation for online events.

COVID connections: lessons from adaptations to COVID-19 as strategies for building food system resilience. (Special Issue: More than disaster: creativity in growing, distributing, and accessing food during covid-19.)

To identify elements of crisis response that might hold lessons for resilience beyond the current moment, we studied a central North Carolina food system during the COVID-19 pandemic. Based on ethnographic interviews with farmers, employees and volunteers of food access organizations, and local government employees, our work found that connection, networking, innovation, and technology adoption were sources of strength and growth. Lessons: food system actors found that their social connections helped them to exchange information and resources, meet increased food needs among SNAP (Supplemental Nutrition Assistance Program) participants and Latina/os immigrants, and combine efforts to adopt technologies and learn from new labor pools. Challenges: while navigating COVID-19, food system actors faced challenges spanning labor, safety, information, government policies, supply shortages, weather, and unreliable information. In addition to lessons and challenges, we offer a series of future research directions that we identified in our study findings. Our study shows that small-scale production and local food organization and government responses are important and dynamic parts of a resilient food system. Regional systems' actors were able to pivot more quickly than large-scale systems and presented a more flexible, locally suitable model that will likely prove adaptive beyond the pandemic.

Gis-based vulnerability analysis of the United States to COVID-19 occurrence. (Special Issue: COVID-19 one year on.)

The outbreak of COVID-19 in the United States has resulted in over 11.2 million cases and over 240 thousand deaths. COVID-19 has affected the society in unprecedented way with its socioeconomic impact yet to be determined. This study aimed at assessing the vulnerability of the US at the county-level to COVID-19 using the pandemic data from January to June of the year 2020. The study considered the following critical factors: population density, elderly population, racial/ethnic minority population, diabetics, income, and smoking adults. Pearson's correlation analysis was performed to validate the independence of the factors. Spatial correlations between the COVID-19 occurrence and the factors were examined using Jaccard similarity analysis, which revealed relatively high correlation. A vulnerability to COVID-19 map with a five-level Likert scale was created using Logistic Regression Analysis in ArcGIS. The map showed close agreement in seven representative states, which were selected based on COVID-19 cases including NY, CA, FL, TX, OH, NC, and MT with R2 values between 0.684 and 0.731 with Root Mean Squared Error (RMSE) values between ..0.033 and ..0.057. Furthermore, vulnerability levels from 'High' to 'Very High' were obtained for the top ten counties with the highest COVID-19 cases with residual values less than or equal to 0.04. The method and resulted vulnerability map can aid in COVID-19 response planning, prevention programs and devising strategies for controlling COVID-19 and similar pandemics in the future.

Different media, same relationships: what the Iris piano trio learned from the COVID-19 pandemic. (Special Issue: Art-based research in health and well-being during the pandemic.)

The Iris Music Project is a non-profit dedicated to reimagining residential and healthcare communities as spaces of creative exchange. By February 2020, our chamber music group, the Iris Piano Trio, had developed a model for music programming at Charles E. Smith Life Communities (CESLC) in Rockville, Maryland (United States), that emphasized collaborative relationships between professional musicians and community members. The COVID-19 pandemic severely disrupted the Trio's work and tested its model. In this article, the researchers describe how the Trio remained connected and relevant to CESLC residents by experimenting with virtual programmes that adapted our model to a digital setting. The researchers argue that our prior relationships with residents and staff enabled us to impact their lives throughout the pandemic despite the isolation created by COVID-19 closures. The pandemic strained, but did not fundamentally change, the Trio's ensemble-in-residence model, suggesting its potential as a generalized model in the field of music and health.

Inequalities in accessing healthcare in the United States of America: a major contributor to the increasing COVID-19 morbidity and mortality

Introduction: Many COVID-19 cases and deaths have been reported from the United States (US). This study aimed to assess the health system inequalities as a determinant of COVID-19 case morbidity and mortality in the US.

Health care capacity surge strategies: Florida's health care regulation during the novel coronavirus pandemic

While streamlining emergency powers might offer some advantages, recent events demonstrate how Florida's Department of Health worked collaboratively to address the Novel Coronavirus Disease 2019 (COVID-19) pandemic. As Florida began experiencing a need for increased health care capacity, Division of Medical Quality Assurance (MQA) officials reviewed health care practitioners' licensing and regulatory framework to identify mitigation strategies to boost staffing of front-line responders where needed. Florida officials responded quickly to the spread of COVID-19 and adopted health care workforce strategies that were grouped into three categories: (1) those involving licensed practitioners, (2) those involving soon-to-be licensed practitioners, and (3) those involving an expansion of practitioners' authority. While Florida's "two declaration" process for addressing emergencies may appear complex, in reality the Florida Department of Health, including the regulatory boards, was able to respond promptly and employ a number of health care workforce strategies to address health care capacity needs.

COVID-19 and face masks - To use or not to use! (Special Issue: The epidemiologist and the pandemic.)

COVID-19 has evolved into a pandemic in quick time and being a droplet infection, it was quickly understood that prevention is the key. People started to use all types of masks and there was a panic as stocks started running out. Health care workers must use a triple layered surgical mask and those exposed to aerosol generating procedures must use an N 95 mask and these should be kept reserved for them, especially in a resource limited setting. Though initial advice from experts to the general public was not to use a mask in community settings unless they are sick or taking care of someone sick, the advice had to be later modified. Though CDC Atlanta currently advices everyone with no symptoms to wear cloth masks in the community, WHO opines there is no clear evidence to advise for or against mask use in the community. However, WHO encourages countries advising community mask use as it can generate useful evidence. Along with mask use, practicing all other preventive measures such as hand washing, cough etiquette, social distancing, quarantine and isolation are of utmost importance, without which, using surgical masks or even N95 masks, will not be much effective in the community setting.

Tools for quickly adapting during pandemics, disasters, and other unique events

Amid the current COVID-19 pandemic, Cooperative Extension personnel across the nation are quickly adapting to daily changes while continuing to respond to the needs of clients. This article provides examples of how we in North Carolina State Extension Forestry have responded to the challenges we have faced thus far. The solutions and tools described can be used in the current situation and for future pandemics, disasters, and other unique events that require "alternative" arrangements. The needs of landowners, farmers, youths, and the public at large will not diminish during this unprecedented time;therefore, we should continue to innovate to ensure that our impact is not diminished.

Provider perception and office practices of the initial prenatal visit pre - Coronavirus 2019 pandemic

Background: Prenatal Care is a critical aspect of women's health and current literature shows adequate care significantly reduces risk of adverse outcomes. With scientific advancement, the initial prenatal visit is increasingly tasked with more objectives that leave providers with barriers to provide appropriate and adequate care. Purpose: The aim of this survey study was to determine clinical practices of the initial prenatal visit - regarding history taking, counseling, lab work and screening prior to the onset of COVID-19 Pandemic.

Epidemiology of enforcing travel restrictions in US peninsular regions during the COVID-19 pandemic

This study evaluated the effectiveness of enforced travel restrictions on COVID-19 case burden and deaths, epidemiologic data from Barnstable and Monroe County. As of 25 May, 2020, Barnstable County, MA had 1277 reported cases of COVID-19 and 110 related deaths. Barnstable County had a case rate of 600 infections per 100,000 population. For the same period, Monroe County, FL had 107 cases and four deaths. Monroe County had a case rate of 144 infections per 100,00 population. In Florida, the Monroe County Emergency Manager established a travel ban to the Florida Keys on 20 March, 2020. Phase 1 of Florida re-opening, the "Safe, Smart, Step-by-Step Plan for Recovery" was implemented 4 May, 2020;travel restrictions within the Florida Keys were lifted but travel to the Florida Keys remains restricted at time of this report. While local citizen organizations pushed for the closure of bridges to Cape Cod in Barnstable County, no transportation-limiting quarantine measures were put into effect. Although no policy statement for why travel restrictions were not in place in Barnstable but were for Monroe, it was suspected that the differences in policy stem from the feasibility of implementation and existing infrastructure. While a travel ban has been disruptive to the Keys economy, heavily reliant on tourism, the normalization of emergency measures likely lowered barriers to the implementation of travel restrictions. In Cape Cod, such restrictions may have been seen as a much more extreme measure due to the infrequency of severe natural disasters. In the beginning of the pandemic, Barnstable COVID-19 cases were not at elevated as those in nearby Massachusetts counties, likely limiting the perceived need for restricted access. Additionally, the perceived risk of population influx following COVID-19's pandemic designation may have been different in the two locations. In Monroe County, this timing corresponded with the beginning of Spring Break tourist season and implementing a peninsular lockdown may have seemed more critical. However, in Barnstable County, March and April are typically low tourism months and the risk of peninsular traffic may have seemed lower as a result.