Unintended consequences of implementing non-pharmaceutical interventions for the COVID-19 response in Africa: experiences from DRC, Nigeria, Senegal, and Uganda.

INTRODUCTION: The coronavirus (COVID 19) pandemic is one of the most terrifying disasters of the twenty-first century. The non-pharmaceutical interventions (NPIs) implemented to control the spread of the disease had numerous positive consequences. However, there were also unintended consequences-positively or negatively related to the nature of the interventions, the target, the level and duration of implementation. This article describes the unintended economic, Psychosocial and environmental consequences of NPIs in four African countries. METHODS: We conducted a mixed-methods study in the Democratic Republic of Congo (DRC), Nigeria, Senegal and Uganda. A comprehensive conceptual framework, supported by a clear theory of change was adopted to encompass both systemic and non-systemic interventions. The data collection approaches included: (i) review of literature; (ii) analysis of secondary data for selected indicators; and (ii) key informant interviews with policy makers, civil society, local leaders, and law enforcement staff. The results were synthesized around thematic areas. RESULTS: Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. CONCLUSION: Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children. Noticeable efforts, including measures to avoid forced into marriage, increasing inequities, economic support to urban poor; those living with disabilities, migrant workers, and refugees, had been conducted to mitigate the negative effects of the NIPs.

Mitigating the "Cobra Effect" when pursuing organizational resilience

This paper is a systematic literature review of organizational resilience. It aims to identify the reasons for the unintended consequences that may occur when organizations pursue resilience and how these unintended consequences could be mitigated. The analysis of 68 articles published between 2017 and 2022 indicates that organizations could have unintended consequences when pursuing organizational resilience, resulting from the organizational resilience conceptualization, models, practices, levels and the paradox of change. Consequently, several unintended consequences may arise when implementing a resilience strategy. This includes lessened leadership effectiveness, the pursuit of unrealistic objectives, low organizational creativity and innovation, overreliance on a single strategy, compromised values, fragile relationships, a short-term focus and organizational culture. Therefore, the overall construct aspects of organizational resilience should be researched and analyzed further by gathering additional empirical data that sheds more light on these issues. Aside from the challenge of defining and measuring organizational resilience, there is variability in how organizational resilience is developed. It has also been operationalized in various ways, with limited insight into empirical methods to identify resilience against future hardships. Although the notion is promising, it has been criticized for being ambiguous and lacking a uniform explanation, diminishing its relevance for practice.

Unlearning in crisis: Forces of change in unlearning

The study of unlearning continues to be important, not only due to the relevance of the concept itself, but in light of current strong, unforeseen forces, knowledge change opportunities have been created beyond our prediction. A knowledge exchange is often needed to revise processes, use new technologies, or due to forces that stem from catastrophic situations. Examples include economic, such as in business failures or the recent public health concerns from the COVID-19 pandemic. Building from new insights using the typological model from Rushmer and Davies (2004), deep unlearning may the end result of catastrophic forces of change. First, deep unlearning occurs with striking events, or yield change that adds anxiety, psychological, or technological upset. Second, inherent in many catastrophic changes are rapid interruptions in the trajectory of "previous” actions and unique processes toward recovery where knowledge base may be forever altered. We address the following question: "Is Rushmer and Davies' deep unlearning typology exhibited during catastrophic situations?” This theoretical paper examines the concept of deep unlearning, the process of replacement or lack of use of a belief, action, or process in a context of an emergency situation where little is currently known. What type of agent for change would be needed? Will unintended consequences not be identified by individuals and organizations;what may be the cost to future learning skills when deep unlearning of current tasks occurs? Third, some insights and directions for future research are presented. © 2022 IEEE Computer Society. All rights reserved.

Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities.

Since the start of the COVID-19 pandemic in early 2020, governments around the world have adopted an array of measures intended to control the transmission of the SARS-CoV-2 virus, using both pharmaceutical and non-pharmaceutical interventions (NPIs). NPIs are public health interventions that do not rely on vaccines or medicines and include policies such as lockdowns, stay-at-home orders, school closures, and travel restrictions. Although the intention was to slow viral transmission, emerging research indicates that these NPIs have also had unintended consequences for other aspects of public health. Hence, we conducted a narrative review of studies investigating these unintended consequences of NPIs, with a particular emphasis on mental health and on lifestyle risk factors for non-communicable diseases (NCD): physical activity (PA), overweight and obesity, alcohol consumption, and tobacco smoking. We reviewed the scientific literature using combinations of search terms such as 'COVID-19', 'pandemic', 'lockdowns', 'mental health', 'physical activity', and 'obesity'. NPIs were found to have considerable adverse consequences for mental health, physical activity, and overweight and obesity. The impacts on alcohol and tobacco consumption varied greatly within and between studies. The variability in consequences for different groups implies increased health inequalities by age, sex/gender, socioeconomic status, pre-existing lifestyle, and place of residence. In conclusion, a proper assessment of the use of NPIs in attempts to control the spread of the pandemic should be weighed against the potential adverse impacts on other aspects of public health. Our findings should also be of relevance for future pandemic preparedness and pandemic response teams.

Unintended consequences of knowledge management during the COVID-19 pandemic in 2021: the case of Netflix

Purpose: Unintended consequences of knowledge management (KM) can be harmful if they are calamitous. However, they can occasionally be advantageous during catastrophes. The purpose of this study is to investigate how KM can be accidentally propitious during the COVID-19 pandemic using the case of Netflix. Design/methodology/approach: Explanatory factor analysis, multilevel and multiple regressions were used with a sample of 45 countries. Findings: In the authors' sample, the hypothesized direct relationship between culture (i.e. individualism, power distance and indulgence) and collective pandemic resilience (CPR) was found. In addition, the hypothesized moderating effect of Netflix KM on the relationship between culture and CPR was partially confirmed. The findings suggest that KM during the pandemic can generate an unintended consequence of intensifying the degree of CPR. Research limitations/implications: Small sample size, data paucity and the constructed variable of CPR might limit the generalizability of this study's results. Nonetheless, one important research implication is that KM qua unintended consequences can have a significant moderating effect on the relationship between culture and resilience. Practical implications: This paper highlights how organizations and society can cocreate the value of KM accidentally for the benefit of a larger public during calamities. Also, firms should proactively search for a wider application of their KM beyond their original intention. Originality/value: This paper initiates a new discussion of positive consequences of unintended KM. Unlike individual-level studies of collective resilience in the past, to the best of the authors' knowledge, this study generates country-level implications for the first time. © 2022, Emerald Publishing Limited.

Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications.

During the COVID-19 pandemic, several priority diseases were not getting sufficient attention. Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients' conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient's mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.

Trade policies, firm strategies, and adaptive reconfigurations of global value chains

The recent U.S.–China trade conflicts cast new light on the role of trade policies in global value chains (GVCs). Contrary to the expectation that trade restrictions lead to the shrinking or disruption of GVCs, our article posits that the unintended consequences of trade policies (both restrictions and trade agreements) are amplified by the prevalence and organizational complexity of GVCs. We anchor our argument in the historical evolution of three classic GVCs – apparel, automobiles, and electronics – from the 1970s to the present. Our framework highlights the dynamic interaction between GVC-oriented trade policies and firm strategies, which often has counterintuitive implications in terms of upgrading outcomes for the countries and companies involved in these GVCs. While trade policies often provide momentum for an adaptive reconfiguration of GVCs, firms’ strategic actions are crucial in modifying the geographic and organizational features of GVCs in ways that support their longevity. Firm strategies can mediate the effect of trade policies on GVC configurations in two ways: (1) firms can accommodate trade restrictions and trade agreements by altering supply and demand locations and by switching supply-chain partners;and (2) firms pursue diverse strategies to upgrade their value chain activities, leveraging the shifting geographies associated with new trade rules.

Unintended consequences of knowledge management during the COVID-19 pandemic in 2021: the case of Netflix

Purpose: Unintended consequences of knowledge management (KM) can be harmful if they are calamitous. However, they can occasionally be advantageous during catastrophes. The purpose of this study is to investigate how KM can be accidentally propitious during the COVID-19 pandemic using the case of Netflix. Design/methodology/approach: Explanatory factor analysis, multilevel and multiple regressions were used with a sample of 45 countries. Findings: In the authors’ sample, the hypothesized direct relationship between culture (i.e. individualism, power distance and indulgence) and collective pandemic resilience (CPR) was found. In addition, the hypothesized moderating effect of Netflix KM on the relationship between culture and CPR was partially confirmed. The findings suggest that KM during the pandemic can generate an unintended consequence of intensifying the degree of CPR. Research limitations/implications: Small sample size, data paucity and the constructed variable of CPR might limit the generalizability of this study’s results. Nonetheless, one important research implication is that KM qua unintended consequences can have a significant moderating effect on the relationship between culture and resilience. Practical implications: This paper highlights how organizations and society can cocreate the value of KM accidentally for the benefit of a larger public during calamities. Also, firms should proactively search for a wider application of their KM beyond their original intention. Originality/value: This paper initiates a new discussion of positive consequences of unintended KM. Unlike individual-level studies of collective resilience in the past, to the best of the authors’ knowledge, this study generates country-level implications for the first time. © 2022, Emerald Publishing Limited.

Understanding Urban Green Space Usage through Systems Thinking: A Case Study in Thamesmead, London

Urban green spaces provide environmental, economic, societal and health benefits to cities. However, policy and planning interventions aiming to improve usage have often led to unintended consequences, including, in some circumstances, an actual decline in usage. Previous research has identified factors influencing the use of urban green space, more often with a focus on the ‘quality’ and physical features of the space, rather than on the broader social factors. This study aims to unpack the complexity of factors that influence the use of urban green space through the application of Systems Thinking. A qualitative mixed-method approach integrating System Dynamics with rapid ethnography was adopted to elicit the views of local residents in Thamesmead, London. A thematic analysis of interviews was undertaken to systematically map the causal relations between factors, which were compared to wider stakeholders’ views. Our findings highlight the relevance of dynamics and social influences on the use of green space, which include social interactions and stewardship, health conditions, availability of services and amenities. These are factors that are underexplored in the literature and, sometimes, overlooked in urban green space policy by decision-makers. We infer that attendance of urban green spaces requires time, which may be occupied in other practices determined by local conditions and needs. Expanding the spatial and temporal boundaries of investigation, wider than debates on ‘quality’, should, in our view, increase the chances of identifying critical influences and foster an increased use of green space.

Unintended socio-economic and health consequences of COVID-19 among slum dwellers in Kampala, Uganda.

BACKGROUND: To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-economic and health consequences due to the COVID-19 pandemic and the mitigation measures among slum dwellers in Kampala to inform the on-going and future pandemic response strategies. METHODS: This was a mixed methods cross-sectional study conducted in Bwaise I and Bwaise III slums of Kawempe division, Kampala Uganda from October to December 2020. We used systematic sampling to randomly select 425 household heads for the face-to-face quantitative interviews. We also conducted six focus group discussions (FGDs) with slum dwellers and used photovoice among eight Community Health Workers (CHWs) to document unintended socio-economic and health consequences. Quantitative data were imported into STATA version 14.0 for analysis, while qualitative data were analysed thematically using NVivo version 12. Modified Poisson regression analysis was conducted to establish factors associated with impact on access to food. RESULTS: Most respondents reported limited access to food (71.1%; 302/425); disruption in education (77.1%; 270/350); drop in daily income and wages (86.1%; 329/382) and loss of employment (63.1; 125/198). Twenty five percent of the respondents (25.4%; 86/338) reported domestic violence as one of the challenges. Seven themes emerged from the qualitative findings on the impact of COVID-19 including: limited access to food; negative impact on children's rights (child labour and teenage pregnancies) and education; poor housing and lack of accommodation; negative social behaviours; negative impact on family and child care; reduced income and employment; and negative impact on health and access to health care services. CONCLUSION: The slum dwellers of Bwaise I and Bwaise III experienced several negative socio-economic and health consequences of COVID-19 and its prevention measures that severely affected their wellbeing. Children experienced severe consequences such as child labour and teenage pregnancies among the girls. Response activities should be contextualised to different settings and protocols to protect the vulnerable groups in the community such as children and women should be developed and mainstreamed in response activities.

Application Strategy of Big Data in Enterprise Financial Management from the Perspective of Risk Society Coupling

Risk society is closely related to the natural and social environment in which human beings live and the unintended consequences of human social actions. It has the characteristics of suddenness, uncertainty, urgency, complexity and harm. The “COVID-19” is a huge test in the process of human beings toward a risk society. In the face of public health emergencies, the company's response level is a reflection of its comprehensive financial management capabilities. The application of big data technology has brought great changes to people's traditional thinking and behavior, and also brought great challenges to the traditional business model of enterprises. The article analyzes the impact of the “COVID-19” on corporate financial management, uses big data technology to find effective response ideas, measures and methods, and prospects the process of financial management informatization, automation, intelligence, and digitalization. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Power, paradox and pessimism: On the unintended consequences of digital health technologies in primary care.

We consider what might be learned from the unintended, apparently unanticipated, consequences of the use of digital health (including alternatives to face to face consultations, electronic medical records, use of apps and online monitoring) in primary care. We chose a conceptual literature review method, to seek a higher order understanding of the nuanced patterning of unintended consequences of digital health technologies (for people, relationships, organisations and ways of working) which are rarely simply positive or negative. The approach is informed by realist review, which recognises that experiences and outcomes of interventions work (or fail) in different ways in particular contexts. We present three higher order themes to illuminate underpinning mechanisms for unintended consequences in digital health technologies in primary care. These themes are illustrated by case examples, with particular focus on those that have been little discussed in the literature. Following Merton's (1936) differentiation between consequences for the actor(s) and others, which are mediated through the culture and social structure, we discuss consequences that i) disrupt power relations between patients and health professionals or between different groups of health professions, ii) contribute to paradoxical outcomes and iii) result in a potentially corrosive sub-culture of pessimism about digital health. We conclude that when implementing or evaluating digital technologies in primary care, it is wise to consider the 'dark logic' of the intervention (Bonell et al., 2015). Attention to issues of power relations, the potential for paradoxical outcomes, and impacts on the expectations of staff in relation to digital innovation are particularly salient in relation to the dramatic changes in primary care delivery initiated during the Covid-19 pandemic. Fostering a sense of ownership and interest in monitoring the effects that matter to the organisation will likely help counter pessimism and renew interest in deploying those digital innovations that show promise.

Pathways between COVID-19 public health responses and increasing overdose risks: A rapid review and conceptual framework.

BACKGROUND: Emerging evidence indicates that illicit drug overdoses are increasing throughout the COVID-19 pandemic. There is a paucity of evidence on the causative pathways for this trend, but expert opinions, commentaries, and some reviews offer theoretical underpinnings. METHODS: In this rapid review, we collate the available published evidence, expert opinions, commentaries, and reviews on the unintended pathways between COVID-19 public health responses and increasing illicit drug overdoses. Using tenets of thematic analyses and grounded theory, we also offer a visual conceptual framework for these unintended pathways. RESULTS: Our framework focuses on five particular public health responses, namely social isolation/physical distancing/quarantine; staff/resource reallocations and reductions; closures of businesses and other places of employment; border closures and transportation restrictions; and the early release of people from prisons. As argued in the literature reviewed here, these public health responses have unintentionally created increased overdose risks by producing high risk use scenarios; increased risks of relapsing; disrupted addictions services and treatment; an increasingly toxic supply of drugs; and the risk of using with lowered tolerance. CONCLUSIONS: Health care systems should respond to these pathways to mitigate the unintended consequences. Furthermore, the COVID-19 pandemic may represent an opportunity to enact proactive, progressive, and innovative solutions to an overdose crisis that will surely outlast the current pandemic.

The political economy of drug and alcohol regulation during the COVID-19 pandemic.

States tightly regulate access to alcohol and other substances. During the pandemic and related state of emergency, state and federal governments adopted a variety of regulations affecting this access. State shelter-in-place orders included decisions about whether liquor stores and marijuana dispensaries are essential businesses. Decisions about telehealth access to medical marijuana or treatments for substance use disorders were made at the state and federal levels. This article examines the political economy behind these decisions, focusing on deviations from the norm including Pennsylvania's decision to close state-run liquor stores. Interest groups and other political considerations help explain state and federal policy changes affecting access to alcohol and other substances.

The unintended consequences of COVID-19 mitigation measures matter: practical guidance for investigating them.

BACKGROUND: COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT: Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION: Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future.

BACKGROUND: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.