The COVID-19 Pandemic in Ukraine: A Mosaic of Regional Patterns and Voices of Social Disparity

The chapter analyzes the features of effects and responses to the coronavirus in Ukraine. The three most important issues related to the pandemic are highlighted. First, we focus on the national level of the emergencies in terms of the efficacy of responses. The second issue is the geographical mosaic pattern of COVID-19 threats. We explain these patterns with reference to the regional integration into the global economy. In the search for local responses to the global challenges of the pandemic, it is necessary to consider the well-being of people and the restoration of the state's social responsibility. Coronavirus and certain measures to counter the pandemic not only led to a number of negative economic side effects but also deepened existing inequalities between residents of different cities and villages, as well as between poor and affluent households. The most vulnerable groups in contemporary neoliberal Ukraine need effective protection during the pandemic;they are the homeless, the elderly, the low-income persons, the informally employed, minorities, migrants, and internally displaced persons. The third issue relates to the glaring social disparities emerging from the COVID-19 pandemic. We survey the open resources and analyze the cases of personal accounts of survival and instant wealth of different focus groups in Ukrainian society. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Social Disparities and Social Distancing During the Covid Pandemic.

According to Putnam (2000) and Bourdieu (1986), social disparities may result in the formation of narrow social bonds that exacerbate existing social cleavages and impede collective action. Motivated by this insight, we examine the relationship between social disparities and social distancing during the pre-vaccine Covid pandemic in the US. Using a panel of weekly, county-level observations, we find that income, educational and racial disparities are associated with a statistically significant decrease in the social distancing. This result is robust to controls for a wide variety of socioeconomic variables, the Covid infection rate, and a measure of social capital.

Assessing the Impact of COVID-19 on IBD Outcomes Among Vulnerable Patient Populations in a Large Metropolitan Center.

BACKGROUND: With the onset of COVID-19, there were rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to determine the impact of changes in healthcare delivery during the COVID-19 pandemic on patients with inflammatory bowel disease (IBD), in both well-resourced and vulnerable populations. METHODS: Using a mixed methods, observational study design, patients receiving IBD care at a university or a safety-net hospital were identified by the electronic health record. Patient demographics, IBD history, and disease activity were acquired from the electronic health record. IBD-related outcomes were compared from the onset of the pandemic in the United States until December 2020 (COVID-19 pandemic year 1) and compared with outcomes in the previous year. A subset of participants provided their perspective on how changes in healthcare delivery and financial stability impacted their IBD through a standardized questionnaire and semi-structured interview. RESULTS: Data from a total of 1449 participants were captured, 1324 at the tertiary care university hospital and 125 at the safety-net hospital. During COVID-19, there was a decrease in healthcare utilization at both sites. Race/ethnicity and primary language were not associated with IBD-related hospitalizations or admissions. Patients that were employed and those with insurance had a higher number of IBD-related emergency department visits at both the university and safety-net hospitals (P = .03 and P = .01, respectively). Patients who did not speak English were more likely to report challenges using technology with telehealth and difficulty contacting IBD providers. CONCLUSIONS: For IBD populations, during COVID-19, in both hospital settings, emergency department visits, hospitalizations, outpatient surgery, and clinic visits were reduced compared with the year prior. Patients with lower socioeconomic status and limited English proficiency reported facing more challenges with changes to healthcare delivery, healthcare access, and conveying changes in IBD activity. These results highlight the need for payors and providers to specifically attend to those populations most susceptible to these systemic and lasting changes in care delivery and promote greater equity in healthcare.

Critical Care Among Disadvantaged Minority Groups Made Equitable: Trends Throughout the COVID-19 Pandemic.

BACKGROUND: US racial and ethnic minorities have well-established elevated rates of comorbidities, which, compounded with healthcare access inequity, often lead to worse health outcomes. In the current COVID-19 pandemic, it is important to understand existing disparities in minority groups' critical care outcomes and mechanisms behind these-topics that have yet to be well-explored. OBJECTIVE: Assess for disparities in racial and ethnic minority groups' COVID-19 critical care outcomes. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 2125 adult patients who tested positive for COVID-19 via RT-PCR between March and December 2020 and required ICU admission at the Cleveland Clinic Hospital Systems were included. MAIN MEASURES: Primary outcomes were mortality and hospital length of stay. Cohort-wide analysis and subgroup analyses by pandemic wave were performed. Multivariable logistic regression models were built to study the associations between mortality and covariates. KEY RESULTS: While crude mortality was increased in White as compared to Black patients (37.5% vs. 30.5%, respectively; p = 0.002), no significant differences were appraised after adjustment or across pandemic waves. Although median hospital length of stay was comparable between these groups, ICU stay was significantly different (4.4 vs. 3.4, p = 0.003). Mortality and median hospital and ICU length of stay did not differ significantly between Hispanic and non-Hispanic patients. Neither race nor ethnicity was associated with mortality due to COVID-19, although APACHE score, CKD, malignant neoplasms, antibiotic use, vasopressor requirement, and age were. CONCLUSIONS: We found no significant differences in mortality or hospital length of stay between different races and ethnicities. In a pandemic-influenced critical care setting that operated outside conditions of ICU strain and implemented standardized protocol enabling equitable resource distribution, disparities in outcomes often seen among racial and ethnic minority groups were successfully mitigated.

A spatiotemporal decay model of human mobility when facing large-scale crises.

A common feature of large-scale extreme events, such as pandemics, wildfires, and major storms is that, despite their differences in etiology and duration, they significantly change routine human movement patterns. Such changes, which can be major or minor in size and duration and which differ across contexts, affect both the consequences of the events and the ability of governments to mount effective responses. Based on naturally tracked, anonymized mobility behavior from over 90 million people in the United States, we document these mobility differences in space and over time in six large-scale crises, including wildfires, major tropical storms, winter freeze and pandemics. We introduce a model that effectively captures the high-dimensional heterogeneity in human mobility changes following large-scale extreme events. Across five different metrics and regardless of spatial resolution, the changes in human mobility behavior exhibit a consistent hyperbolic decline, a pattern we characterize as "spatiotemporal decay." When applied to the case of COVID-19, our model also uncovers significant disparities in mobility changes-individuals from wealthy areas not only reduce their mobility at higher rates at the start of the pandemic but also maintain the change longer. Residents from lower-income regions show a faster and greater hyperbolic decay, which we suggest may help account for different COVID-19 rates. Our model represents a powerful tool to understand and forecast mobility patterns post emergency, and thus to help produce more effective responses.

Carrying the Burden Into the Pandemic - Effects of Social Disparities on Elementary Students' Parents' Perception of Supporting Abilities and Emotional Stress During the COVID-19 Lockdown.

The COVID-19 pandemic has posed many challenges, especially for families. Both the public and the scientific community are currently discussing the extent to which school closings have worsened existing social differences, especially with regard to children's academic and socio-emotional development. At the same time, parents have had to manage childcare and home schooling alongside their jobs and personal burdens posed by the pandemic. Parents' possibilities for meeting these cognitive and emotional challenges might also depend on the different conditions in families. For this reason, the present paper investigates the structural and process characteristics of the family as well as children's and parents' psychological characteristics that predict how parents assess their ability to support their child's learning during homeschooling as well as parents' perceived emotional stress caused by school closure. The study analyses data of the Newborn Cohort Study of the German National Educational Panel Study. The two dependent variables (self-assessment of abilities, perceived stress) were measured during the COVID-19 pandemic after the first school closure in Germany, at a time when the children of this cohort were attending second grade. Besides a number of control variables (including the child's struggle with home schooling), families' structural characteristics [socioeconomic status (SES), education], process characteristics (home learning environment, HLE), parents' psychological characteristics (preceding psychological stress), and the child's psychological characteristics (self-regulation, school-related independence) from earlier waves were included as predictors. The results of structural equation models show that perceived stress was associated with structural factors and the preceding psychological stress of parents. Parents with higher preceding stress reported higher perceived stress. Interestingly, higher-educated parents also reported more stress than lower educated parents during the pandemic. The effect was the other way around for SES - parents with lower SES reported more stress than parents with higher SES. The self-reported abilities to support the learning of the child seemed to be mainly predicted by the parent's education as well as preceding psychological stress. To sum up, the results identify important aspects that determine how parents handle the challenges of the school closures. Especially, socially disadvantaged families carry their burden into the pandemic.

Social Disparities in Benign Lung Diseases.

The many socioeconomic disparities in the myriad of diagnoses that make up benign lung diseases are unfortunately a global issue that was most recently highlighted by the COVID-19 pandemic of 2020. In this chapter, we will be reviewing the socioeconomic disparities in benign lung disease from both a United States perspective as well as a global perspective. We will cover the spectrum of infectious, obstructive, and restrictive lung disease and review the evidence on how social disparities affect these populations and their access to medical care.

Rethinking the Role of Advance Care Planning in the Context of Infectious Disease.

Advance care planning (ACP) for medical decision-making at the end of life has developed around the expectation of death from long-term, progressive chronic illnesses. We reexamine advance care planning in light of the increased probability of death from COVID-19, an exemplar of death that occurs relatively quickly after disease onset. We draw several conclusions about ACP in the context of infectious diseases: interpersonal and sociostructural barriers to ACP are high; ACP is not well-oriented toward decision-making for treatment of an acute illness; and the U.S. health care system is not well positioned to fulfill patients' end of life preferences in a pandemic. Passing the peak of the crisis will reduce, but not eliminate, these problems.

COVID-19: risk accumulation among biologically and socially vulnerable older populations.

Emerging data show that the health and economic impacts of COVID-19 are being disproportionately borne by individuals who are not only biologically, but also socially vulnerable. Based on preliminary data from Sweden and other reports, in this paper we propose a conceptual framework whereby different factors related to biological and social vulnerability may explain the specific COVID-19 burden among older people. There is already some evidence showing large social disparities in the prevention, treatment, prognosis and/or long-term consequences of COVID-19. The remaining question is to what extent these affect older adults specifically. We provide the rationale to address this question with scientific methods and proper study designs, where the interplay between individuals' biomedical status and their social environment is the focus. Only through interdisciplinary research integrating biological, clinical and social data will we be able to provide new insights into the SARS-CoV-2 pandemic and inform actions aimed at reducing older adults' vulnerability to COVID-19 or other similar pandemics in the future.