Tackling Challenges of COVID-19: An Assessment of the Convergence- Divergence Debates from the Global South-India

The World Health Organization (WHO) officially announced COVID-19 as a global pandemic in March 2020 which in effect transformed the society, economy, the politics and indeed our everyday life. Such a transformation of power geometries across all manner of spaces and their geographies disrupted the finite balance and wellbeing and continues to displace norms of equanimity, sanity, and hope amidst the catalogue of errors, blunders and inactivity. In India the first COVID-19 case was registered on January 30, 2020. The response of 29 States and 7 Union Territories of India has varied depending on their health, community, law and order and legislative infrastructure. This chapter will attempt to situate an analysis of coronavirus pandemic within the demographic transition framework of India. We examine the critical role of civil societies across the states, divergence of policies and practices relating to social distancing, contact tracing, and differential Public Health Agency infrastructures in operation across the States of India. What began as a stigma, followed by populist rhetoric quickly faded into intense struggle for survival even as oxygen, essential medicines and of course hospital beds became a premium in the most affluent parts of any given city. The grim reaper became a great leveller cutting across socially constructed boundaries of class, gender, age, caste and religion. The management of this pandemic and the established protocols for treatment remain tentative even as we learn lessons from yet another mutant strain. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

The effect of the healthcare system's structure on COVID-19 dynamics in Ecuador

To manage the COVID-19 pandemic, governments established certain stringency measures, such as lockdowns and traffic light systems. However, the response to the pandemic depended on the regions' preexisting capacities and underlying conditions. This study aims to determine the relationship between the COVID-19 pandemic dynamics and the underlying regional healthcare system's structure in Ecuador, using three dependent variables-the number of COVID-19 cases, the COVID-19 prevalence rate at the cantonal level, and the daily deaths resulting from COVID-19 at the provincial level-for three phases: isolation, social distancing, and contingency. Using daily COVID-19 data and cantonal (provincial) level variables, a negative binomial model and a tobit model were estimated to analyze the determinants of the number of COVID-19 cases and the prevalence rate, respectively. The results show a positive relationship between primary and secondary health centers and the number of infected people, implying that it is possible to make more diagnoses when the health infrastructure is more developed. As for COVID-19 deaths, primary health centers are associated with a low number of daily deaths whereas secondary health centers are associated with a higher number of daily deaths, implying the transfer of severe COVID-19 cases to cantons with secondary health centers. More affluent cantons had more COVID-19 cases and deaths. Stringency measures, such as the traffic light system, were effective in managing the pandemic. The geographical proximity between cantons and the nature of economic activities (essential versus non-essential) also impacted the spread of the virus.

Israel's national HIE network Ofek: a robust infrastructure for clinical and population health

The national health information exchange (HIE) network in Israel is perhaps the world's best kept HIE secret. Few Israelis even know the network exists, yet this HIE network has broad adoption across Israel's health system, and it has facilitated many landmark studies on HIE in the biomedical literature. This case study highlights the development, implementation, and evolution of Israel's national HIE network. What began as a vision within one health maintenance organization (HMO) about 20 years ago now connects most hospitals in the country as well as many ambulatory care facilities. At its center is a focus on using a de-centralized, federated network to deliver comprehensive, virtual medical records to clinicians on demand within their electronic medical record system for use in supporting patient care. The network evolved to support COVID-19 and other national priorities. Moving forward, the Israeli national HIE network will play a critical role in supporting the nation's digital health strategy, and will focus on advanced functionalities, including common clinical terminologies and advanced analytics. © 2023 Elsevier Inc. All rights reserved.

The impact of the COVID-19 pandemic on regional inequalities in Romania. Spotlight on unemployment and health conditions

For a long time, inequalities have existed across the population and between different communities and groups. Although regional inequality is a topic of interest among scholars and policy makers, only recently have they been increasingly investigated at local territorial units. The economic shock related to the COVID-19 crisis, which resulted from the lockdown and significant decline in economic activity in many sectors, has affected all regions, but not in the same way or with a similar intensity. Assessing some regional indicators available in the first period of the ongoing COVID-19 crisis depicting the quality of life, it is becoming evident that new regional disparities emerge and interact with many of the pre-existing inequalities. This paper aims to provide new insights on the impact of the COVID-19 pandemic on inequalities across two dimensions, namely employment and health conditions, with relevance for the standard of living. By investigating past and current evolutions of some indicators, as reflected at the NUTS3 territorial level in Romania and the use of spatial analysis, our study shows that new fissures generated by the health crisis have deepened the existing inequalities at the regional level along various key dimensions such as gender, age, education, and rural–urban and local geography. This empirical study, considering traditional measurements of inequality and relevant spatial investigation, evaluates the intensity of inequalities across all Romanian counties. © 2023 The Authors. Regional Science Policy & Practice © 2023 Regional Science Association International.

Expanding Vulnerability Indices for Pandemic Effects

In this study, our goal is to identify potentially vulnerable communities that could be subject to ongoing or compounding impacts from the pandemic and/or that may experience a slower recovery due to sociodemographic factors. For this purpose, we compiled information from multiple databases related to sociodemographic and health variables. We used a ranking-based method to integrate them and develop new combined indices. We also investigated a time-dependent correlation between vulnerability components and COVID-19 statistics to understand their time-dependent relationship. We ultimately developed pandemic vulnerability indices by combining CDC's social vulnerability index, our newly developed composite health vulnerability index, and COVID-19 impact indices. We also considered additional assessments include expected annual loss due to natural hazards and community resilience. Potential hot spots (at the county level) were identified throughout the United States, and some general trends were noted. Counties with high COVID-19 impact indices and higher values of the pandemic vulnerability indices were primarily located in the southern United States or coastal areas in the Eastern and Southwestern United States at the beginning of the COVID-19 pandemic. Over time, the computed pandemic vulnerability indices shifted to higher values for counties in the southern and north-central United States, while values calculated for the northwestern and northeastern communities tended to decrease.

Expanding Vulnerability Indices for Pandemic Effects

In this study, our goal is to identify potentially vulnerable communities that could be subject to ongoing or compounding impacts from the pandemic and/or that may experience a slower recovery due to sociodemographic factors. For this purpose, we compiled information from multiple databases related to sociodemographic and health variables. We used a ranking-based method to integrate them and develop new combined indices. We also investigated a time-dependent correlation between vulnerability components and COVID-19 statistics to understand their time-dependent relationship. We ultimately developed pandemic vulnerability indices by combining CDC's social vulnerability index, our newly developed composite health vulnerability index, and COVID-19 impact indices. We also considered additional assessments include expected annual loss due to natural hazards and community resilience. Potential hot spots (at the county level) were identified throughout the United States, and some general trends were noted. Counties with high COVID-19 impact indices and higher values of the pandemic vulnerability indices were primarily located in the southern United States or coastal areas in the Eastern and Southwestern United States at the beginning of the COVID-19 pandemic. Over time, the computed pandemic vulnerability indices shifted to higher values for counties in the southern and north-central United States, while values calculated for the northwestern and northeastern communities tended to decrease.

Lessons from the frontline: Documenting the pandemic emergency care experience from the Pacific region - Infrastructure and equipment.

Background: The COVID-19 pandemic highlighted challenges for all health systems worldwide. This research aimed to explore the impact of COVID-19 across the Pacific especially with regards to emergency care (EC) and clinicians' preparations and responses. Methods: A collaboration of Australia and Pacific researchers conducted prospective qualitative research over 18 months of the pandemic. In this three phase study data were gathered from Emergency Clinicians and stakeholders through online support forums, in-depth interviews and focus groups. A phenomenological methodological approach was employed to explore the lived experience of participants. This paper discusses the findings of the study regarding the EC building block of 'Infrastructure and Equipment.' Findings: Pre-existing infrastructure and equipment were not sufficient to help control the pandemic. Adequate space and correct equipment were essential needs for Pacific Island emergency clinicians, with donations, procurement and local ingenuity required for suitable, sustainable supplies and facilities. Adequate personal protective equipment (PPE) conferred a sense of security and increased Health Care Workers willingness to attend to patients. Interpretation: Investing in adequate infrastructure and appropriate equipment is crucial for an effective response to the COVID-19 pandemic. The sustainability of such investments in the Pacific context is paramount for ongoing EC and preparation for future surge responses and disasters. Funding: Phases 1 and 2A of this study were part of an Epidemic Ethics/World Health Organization (WHO) initiative, supported by Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding for this research was received from the Australasian College for Emergency Medicine Foundation via an International Development Fund Grant.

Leveraging COVID-19 pandemic response for improved health system financing: Lessons from Ghana.

The COVID-19 pandemic has exposed health system funding challenges across many developing countries. The needed infrastructure to effectively respond to the pandemic was absent in many developing countries. This has resulted in policymakers resorting to various strategies to mobilise sufficient resources in response to the pandemic, especially in the early stages. This paper reviewed Ghana's efforts to mobilise domestic and external resources for the health sector in response to the pandemic. The paper also assessed lessons from these strategies and highlights how these lessons could be leveraged to sustain financing for the health sector. Using evidence from desk reviews, we demonstrate the existence of fiscal space through external sources, partnership with non-state actors, and effective public financial management (budget space). We also show that the COVID-19 pandemic presents an important momentum to drive future investment in health infrastructure across developing countries.

Determinants of COVID-19 pandemic in India: an exploratory study of Indian states and districts.

The countries across the globe are facing one of the worst infectious diseases in modern times in the form of COVID-19 pandemic. Different measures have been taken to control and manage the outbreak of COVID-19 in these countries. There are two propositions in context of effective control and management of a pandemic like COVID-19. First, a strong and effective public health care system is essential for managing the public health crisis and the uneven responses to COVID-19 are mainly because of inadequate health infrastructure. Second, the spread of COVID-19 depends on the interplay of other social determinants at local level, and therefore, addressing the gaps in social determinants of COVID-19 at local level is critical to control and manage this pandemic. The present paper attempts to examine these two propositions in Indian context at states and districts level, respectively. Using the cross-sectional data and constructing composite indices of COVID-19 intensity and level of health infrastructure at state level, the results show that there is no robust relationship between level of health infrastructure and management of COVID-19 at state level as the states with better health infrastructure are also struggling to combat against COVID-19. The district-level analysis indicates a significant relationship between concentration of COVID-19 and social determinants as majority of the districts with higher concentration of COVID-19 are those which have social determinants below national average.

Analyzing Cyberchondriac Google Trends Data to Forecast Waves and Avoid Friction: Lessons From COVID-19 in India

This article examines the Google Trends data related to the second COVID-19 wave in India. We investigate the phenomenon of cyberchondria, which potentially causes individuals to avoid getting tested and quarantined directly upon experiencing symptoms for fear of losing their salaries or jobs. We utilize Google Trends data to predict future disease statistics, like the pandemic's impact on human activities and health-related issues in India. By means of a bootstrapped Pearson correlation, a time-lead correlation, and a quantile regression, we found a strong relationship between Google Trend searches and COVID-19 cases. Contextualizing the second COVID-19 wave in India through the lenses of cyberchondria and protection motivation theory, our article notes that, when people develop COVID-19 symptoms, they turn to Google for confirmation and treatment, rather than getting themselves checked early, only getting medically tested, and treated when their health deteriorates. At that stage, given the patients’critical conditions, hospitalization is the only option. This places an unsustainable burden on hospitals, resulting in capacity constraints and increased mortality rates. We suggest using Google Trends data to forecast COVID-19 waves and mobilize the health infrastructure to save lives and facilitate friction-free growth. IEEE

Integrating health planning and primary care infrastructure for COVID-19 and tuberculosis care in India: Challenges and opportunities.

Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The COVID-19 pandemic has overburdened healthcare services around the world especially in resource constrained settings. It has shaken already unstable foundation of TB control programs in India and other high burden states. A 25% decline is expected in TB detection while estimates suggest 13% increase in TB deaths due to the impact of the pandemic. However, the significant intersections between the two diseases perhaps offer potential opportunities for consolidating the efforts to tackle both. The widespread implementation and acceptance of universal masking and social distancing in India has helped limit transmission of both diseases. Integrating the capacity building strategies for the two diseases, optimizing the existing the surveillance and monitoring systems which have been achieved over the years will result in a single vertically integrated national program addressing both, rather than multiple parallel program which utilize the already sparse primary care manpower and infrastructure. In this article, we explore the impact of the COVID-19 pandemic on tuberculosis in India and offer suggestions on how effective health planning can efficiently integrate infrastructure and manpower at primary level to provide care for both COVID-19 and tuberculosis.

Syndemic Framework Evaluation of Severe COVID-19 Outcomes in the United States: Factors Associated With Race and Ethnicity.

Socially and economically disadvantaged racial and ethnic minorities have experienced comparatively severe clinical outcomes from the coronavirus disease (COVID-19) pandemic in the United States. Disparities in health outcomes arise from a myriad of synergistic biomedical and societal factors. Syndemic theory provides a useful framework for examining COVID-19 and other diseases that disproportionately affect vulnerable populations. Syndemic models ground research inquiries beyond individual clinical data to include non-biological community-based drivers of SARS-CoV-2 infection risk and severity of disease. Given the importance of such economic, environmental, and sociopolitical drivers in COVID-19, our aim in this Perspective is to examine entrenched racial and ethnic health inequalities and the magnitude of associated disease burdens, economic disenfranchisement, healthcare barriers, and hostile sociopolitical contexts-all salient syndemic factors brought into focus by the pandemic. Systemic racism persists within long-term care, health financing, and clinical care environments. We present proximal and distal public policy strategies that may mitigate the impact of this and future pandemics.

Public Health Crises In Comparison: China's Epidemic Response Policies From SARS To COVID-19.

The rate of infectious disease outbreaks has been accelerating over the past two decades, from the SARS epidemic in 2003 to COVID-19 in 2020. Termed by some as the twenty-first century's first pandemic, SARS originated in China and alerted the country to the importance of public health and epidemic response. After SARS, China improved its health infrastructure and reformed its political and legal health governance system. The emergence of COVID-19 from Wuhan in late 2019 put those reforms to the test. This paper analyses China's public health and epidemic response policies from a historical perspective, tracing the evolution of Chinese public health policies after the SARS outbreak in 2003. This paper assesses China's response to COVID-19 and how post-SARS policy reforms, particularly in epidemic response, played out on the ground in Wuhan. What policies worked well? What were the challenges faced? Based on the policy analysis, this paper presents recommendations for how China can improve its epidemic response through strengthened infectious disease surveillance, more transparent political coordination, and expanded public health infrastructure.

A Holistic View of Health Infrastructure Resilience before and after COVID-19.

BACKGROUND: Large-scale events such as COVID-19 show that there are situations that can lead to huge stress on health infrastructure systems (HIS). The pandemic reveals that it is very difficult to protect HIS from all kinds of possible hazards. They can be unpredictable and spread rapidly; hence, it is hard to find an effective mitigation strategy to completely protect society and its important HIS. METHODS: An often raised central question is what we should do if we cannot protect HIS from these types of hazards. To answer this question, the focus should move from HIS protection to HIS resilience. Therefore, in this paper, the Critical Infrastructure Resilience Index (CIRI) is used to estimate the resilience of health infrastructure systems. RESULTS: The results of the case study show that HIS resilience was enhanced significantly after the implementation of measures. The results indicate that among the resilience phases the learning phase of resilience is the weakest part. This requires a root cause analysis, which should be prioritized by HIS managers and stakeholders. CONCLUSION: This paper discusses how the resilience concept will help decision- and policy-makers to have a clear view of HIS performance before, during, and after the disaster. An easy-to-use and applicable methodology for HIS assessment and evaluation was employed. It can be concluded that resilience and its identified phases can help HIS managers to allocate available resources accordingly in the phases during and post-crisis.