Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives.

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Mechanisms influencing the factors of urban built environments and coronavirus disease 2019 at macroscopic and microscopic scales: The role of cities.

In late 2019, the coronavirus disease 2019 (COVID-19) pandemic soundlessly slinked in and swept the world, exerting a tremendous impact on lifestyles. This study investigated changes in the infection rates of COVID-19 and the urban built environment in 45 areas in Manhattan, New York, and the relationship between the factors of the urban built environment and COVID-19. COVID-19 was used as the outcome variable, which represents the situation under normal conditions vs. non-pharmacological intervention (NPI), to analyze the macroscopic (macro) and microscopic (micro) factors of the urban built environment. Computer vision was introduced to quantify the material space of urban places from street-level panoramic images of the urban streetscape. The study then extracted the microscopic factors of the urban built environment. The micro factors were composed of two parts. The first was the urban level, which was composed of urban buildings, Panoramic View Green View Index, roads, the sky, and buildings (walls). The second was the streets' green structure, which consisted of macrophanerophyte, bush, and grass. The macro factors comprised population density, traffic, and points of interest. This study analyzed correlations from multiple levels using linear regression models. It also effectively explored the relationship between the urban built environment and COVID-19 transmission and the mechanism of its influence from multiple perspectives.

Dynamics of Microbial Community and Potential Microbial Pollutants in Shopping Malls.

Shopping malls offer various niches for microbial populations, potentially serving as sources and reservoirs for the spread of microorganisms of public health concern. However, knowledge about the microbiome and the distribution of human pathogens in malls is largely unknown. Here, we examine the microbial community dynamics and genotypes of potential pathogens from floor and escalator surfaces in shopping malls and adjacent road dusts and greenbelt soils. The distribution pattern of microbial communities is driven primarily by habitats and seasons. A significant enrichment of human-associated microbiota in the indoor environment indicates that human interactions with surfaces might be another strong driver for mall microbiomes. Neutral community models suggest that the microbial community assembly is strongly driven by stochastic processes. Distinct performances of microbial taxonomic signatures for environmental classifications indicate the consistent differences of microbial communities of different seasons/habitats and the strong anthropogenic effect on homogenizing microbial communities of shopping malls. Indoor environments harbored higher concentrations of human pathogens than outdoor samples, also carrying a high proportion of antimicrobial resistance-associated multidrug efflux genes and virulence genes. These findings enhanced the understanding of the microbiome in the built environment and the interactions between humans and the built environment, providing a basis for tracking biothreats and communicable diseases and developing sophisticated early warning systems. IMPORTANCE Shopping malls are distinct microbial environments which can facilitate a constant transmission of microorganisms of public health concern between humans and the built environment or between human and human. Despite extensive investigation of the natural environmental microbiome, no comprehensive profile of microbial ecology has been reported in malls. Characterizing microbial distribution, potential pathogens, and antimicrobial resistance will enhance our understanding of how these microbial communities are formed, maintained, and transferred and help establish a baseline for biosurveillance of potential public health threats in malls.

Evaluation of Satisfaction with the Built Environment of University Buildings under the Epidemic and Its Impact on Student Anxiety.

Anxiety on college campuses has increased due to the COVID-19 epidemic's profound effects on society. Much research has been conducted on how the built environment influences mental health; however, little has been undertaken on how it affects student mental health in the context of the epidemic from the architectural scale perspective of academic buildings. Based on online survey data, this study develops multiple linear regression and binary logistic regression models to investigate students' satisfaction ratings of the academic buildings' physical environments during the epidemic and how these satisfaction ratings affect students' anxiety tendencies. According to the study's findings regarding the natural exposure perspective, students who perceived the academic building's poor semi-open space view (p = 0.004, OR = 3.22) as unsatisfactory factors were more likely to show anxiety tendencies. In terms of the physical conditions, students who were dissatisfied with the noise level in the classroom (p = 0.038, OR = 0.616) and the summer heat in semi-open spaces (p = 0.031, OR = 2.38) were more likely to exhibit anxiety tendencies. Additionally, even after controlling for confusing distractions, the general satisfaction rating of the academic building's physical environments (p = 0.047, OR = 0.572) was still able to significantly and negatively affect students' anxiety tendencies. The study's findings can be used in the architectural and environmental planning of academic buildings focusing on mental health.

The spatial and temporal distribution of SARS-CoV-2 from the built environment of COVID-19 patient rooms: A multicentre prospective study.

BACKGROUND: SARS-CoV-2 can be detected from the built environment (e.g., floors), but it is unknown how the viral burden surrounding an infected patient changes over space and time. Characterizing these data can help advance our understanding and interpretation of surface swabs from the built environment. METHODS: We conducted a prospective study at two hospitals in Ontario, Canada between January 19, 2022 and February 11, 2022. We performed serial floor sampling for SARS-CoV-2 in rooms of patients newly hospitalized with COVID-19 in the past 48 hours. We sampled the floor twice daily until the occupant moved to another room, was discharged, or 96 hours had elapsed. Floor sampling locations included 1 metre (m) from the hospital bed, 2 m from the hospital bed, and at the room's threshold to the hallway (typically 3 to 5 m from the hospital bed). The samples were analyzed for the presence of SARS-CoV-2 using quantitative reverse transcriptase polymerase chain reaction (RT-qPCR). We calculated the sensitivity of detecting SARS-CoV-2 in a patient with COVID-19, and we evaluated how the percentage of positive swabs and the cycle threshold of the swabs changed over time. We also compared the cycle threshold between the two hospitals. RESULTS: Over the 6-week study period we collected 164 floor swabs from the rooms of 13 patients. The overall percentage of swabs positive for SARS-CoV-2 was 93% and the median cycle threshold was 33.4 (interquartile range [IQR]: 30.8, 37.2). On day 0 of swabbing the percentage of swabs positive for SARS-CoV-2 was 88% and the median cycle threshold was 33.6 (IQR: 31.8, 38.2) compared to swabs performed on day 2 or later where the percentage of swabs positive for SARS-CoV-2 was 98% and the cycle threshold was 33.2 (IQR: 30.6, 35.6). We found that viral detection did not change with increasing time (since the first sample collection) over the sampling period, Odds Ratio (OR) 1.65 per day (95% CI 0.68, 4.02; p = 0.27). Similarly, viral detection did not change with increasing distance from the patient's bed (1 m, 2 m, or 3 m), OR 0.85 per metre (95% CI 0.38, 1.88; p = 0.69). The cycle threshold was lower (i.e., more virus) in The Ottawa Hospital (median quantification cycle [Cq] 30.8) where floors were cleaned once daily compared to the Toronto hospital (median Cq 37.2) where floors were cleaned twice daily. CONCLUSIONS: We were able to detect SARS-CoV-2 on the floors in rooms of patients with COVID-19. The viral burden did not vary over time or by distance from the patient's bed. These results suggest floor swabbing for the detection of SARS-CoV-2 in a built environment such as a hospital room is both accurate and robust to variation in sampling location and duration of occupancy.

Neighborhood-Built Environment and Ageism in Later Life.

Ageism is a global challenge and a public health concern that the recent COVID-19 pandemic has further exacerbated. Existing research has mainly focused on individual factors, overlooking the association between the neighborhood-built environment and ageism. This study examined this association and whether its effect varied among areas possessing different socioeconomic characteristics. We conducted a cross-sectional survey of 1278 older people in Hong Kong and merged this with the built environment factors derived from geographical information system data. We used multivariable linear regression to examine the association. Findings revealed that more parks were significantly associated with a lower level of ageism, an impact that remained significant in low-income or low-education areas. Conversely, more libraries in high-income areas were associated with a lower level of ageism. Our findings provide urban planners and policymakers insight into planning for the built environment that reduces ageism enabling older people to achieve a better life.

Disentangling the rhythms of human activity in the built environment for airborne transmission risk: An analysis of large-scale mobility data.

Background: Since the outset of the COVID-19 pandemic, substantial public attention has focused on the role of seasonality in impacting transmission. Misconceptions have relied on seasonal mediation of respiratory diseases driven solely by environmental variables. However, seasonality is expected to be driven by host social behavior, particularly in highly susceptible populations. A key gap in understanding the role of social behavior in respiratory disease seasonality is our incomplete understanding of the seasonality of indoor human activity. Methods: We leverage a novel data stream on human mobility to characterize activity in indoor versus outdoor environments in the United States. We use an observational mobile app-based location dataset encompassing over 5 million locations nationally. We classify locations as primarily indoor (e.g. stores, offices) or outdoor (e.g. playgrounds, farmers markets), disentangling location-specific visits into indoor and outdoor, to arrive at a fine-scale measure of indoor to outdoor human activity across time and space. Results: We find the proportion of indoor to outdoor activity during a baseline year is seasonal, peaking in winter months. The measure displays a latitudinal gradient with stronger seasonality at northern latitudes and an additional summer peak in southern latitudes. We statistically fit this baseline indoor-outdoor activity measure to inform the incorporation of this complex empirical pattern into infectious disease dynamic models. However, we find that the disruption of the COVID-19 pandemic caused these patterns to shift significantly from baseline and the empirical patterns are necessary to predict spatiotemporal heterogeneity in disease dynamics. Conclusions: Our work empirically characterizes, for the first time, the seasonality of human social behavior at a large scale with a high spatiotemporal resolutio and provides a parsimonious parameterization of seasonal behavior that can be included in infectious disease dynamics models. We provide critical evidence and methods necessary to inform the public health of seasonal and pandemic respiratory pathogens and improve our understanding of the relationship between the physical environment and infection risk in the context of global change. Funding: Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under award number R01GM123007.

Associations of the built environment with type 2 diabetes in Asia: a systematic review.

OBJECTIVES: Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia. DESIGN: Systematic review of the literature. DATA SOURCES: Online databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023. ELIGIBILITY CRITERIA: Eligible studies included cohort, cross-sectional and case-control studies that explored associations of built environment characteristics with T2D among adults 18 years and older in Asia. DATA EXTRACTION AND SYNTHESIS: Covidence online was used to remove duplicates and perform title, abstract and full-text screening. Data extraction was carried out by two independent reviewers using the OVID database and data were imported into MS Excel. Out of 5208 identified studies, 28 studies were included in this systematic review. Due to heterogeneity in study design, built environment and outcome definitions, a semiqualitative analysis was conducted, which synthesised results using weighted z-scores. RESULTS: Five broad categories of built environment characteristics were associated with T2D in Asia. These included urban green space, walkability, food environment, availability and accessibility of services such as recreational and healthcare facilities and air pollution. We found very strong evidence of a positive association of particulate matter (PM2.5, PM10), nitrogen dioxide and sulfur dioxide (p<0.001) with T2D risk. CONCLUSION: Several built environment attributes were significantly related to T2D in Asia. When compared with Western countries, very few studies have been conducted in Asia. Further research is, therefore, warranted to establish the importance of the built environment on T2D. Such evidence is essential for public health and planning policies to (re)design neighbourhoods and help improve public health across Asian countries. PROSPERO REGISTRATION NUMBER: CRD42020214852.

Modelling Impact of High-Rise, High-Density Built Environment on COVID-19 Risks: Empirical Results from a Case Study of Two Chinese Cities.

Characteristics of the urban environment (e.g., building density and road network) can influence the spread and transmission of coronavirus disease 2019 (COVID-19) within cities, especially in high-density high-rise built environments. Therefore, it is necessary to identify the key attributes of high-density high-rise built environments to enhance modelling of the spread of COVID-19. To this end, case studies for testing attributes for modelling development were performed in two densely populated Chinese cities with high-rise, high-density built environments (Hong Kong and Shanghai).The investigated urban environmental features included 2D and 3D urban morphological indices (e.g., sky view factor, floor area ratio, frontal area density, height to width ratio, and building coverage ratio), socioeconomic and demographic attributes (e.g., population), and public service points-of-interest (e.g., bus stations and clinics). The modelling effects of 3D urban morphological features on the infection rate are notable in urban communities. As the spatial scale becomes larger, the modelling effect of 2D built environment factors (e.g., building coverage ratio) on the infection rate becomes more notable. The influence of several key factors (e.g., the building coverage ratio and population density) at different scales can be considered when modelling the infection risk in urban communities. The findings of this study clarify how attributes of built environments can be applied to predict the spread of infectious diseases. This knowledge can be used to develop effective planning strategies to prevent and control epidemics and ensure healthy cities.

Associations Between Built Environment Factors and SARS-CoV-2 Infections at the Neighbourhood Level in a Metropolitan Area in Germany.

COVID-19-related health outcomes displayed distinct geographical patterns within countries. The transmission of SARS-CoV-2 requires close spatial proximity of people, which can be influenced by the built environment. Only few studies have analysed SARS-CoV-2 infections related to the built environment within urban areas at a high spatial resolution. This study examined the association between built environment factors and SARS-CoV-2 infections in a metropolitan area in Germany. Polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infections of 7866 citizens of Essen between March 2020 and May 2021 were analysed, aggregated at the neighbourhood level. We performed spatial regression analyses to investigate associations between the cumulative number of SARS-CoV-2 infections per 1000 inhabitants (cum. SARS-CoV-2 infections) up to 31.05.2021 and built environment factors. The cum. SARS-CoV-2 infections in neighbourhoods (median: 11.5, IQR: 8.1-16.9) followed a marked socially determined north-south gradient. The effect estimates of the adjusted spatial regression models showed negative associations with urban greenness, i.e. normalized difference vegetation index (NDVI) (adjusted ß = - 35.36, 95% CI: - 57.68; - 13.04), rooms per person (- 10.40, - 13.79; - 7.01), living space per person (- 0.51, - 0.66; - 0.36), and residential (- 0.07, 0.16; 0.01) and commercial areas (- 0.15, - 0.25; - 0.05). Residential areas with multi-storey buildings (- 0.03, - 0.12; 0.06) and green space (0.03, - 0.05; 0.11) did not show a substantial association. Our results suggest that the built environment matters for the spread of SARS-CoV-2 infections, such as more spacious apartments or higher levels of urban greenness are associated with lower infection rates at the neighbourhood level. The unequal intra-urban distribution of these factors emphasizes prevailing environmental health inequalities regarding the COVID-19 pandemic.

Designing for the post-pandemic era: Trends, focuses, and strategies learned from architectural competitions based on a text analysis.

The COVID-19 pandemic has made the built environment an important source of prevention and control, architects and scholars have thus been seeking countermeasures since the beginning of the outbreak. As design and construction cycles are long, only a few completed cases and evidence-based studies are available for reference. However, massive architectural competition works have emerged, which always been the soil for discussion and practice of cutting-edge design issues. These contain a vast number of ideas for solutions from various design dimensions-including cities, buildings, and facilities-and provide a great deal of materials worth analyzing and summarizing. Therefore, the exploration of competitions will provide us with public health intervention directions, strategies and a rethinking of the built environment. Using a text-mining approach, we analyzed 558 winning entries in architectural competitions related to the pandemic response, exploring specific issues, populations involved, coping strategies, and trends that emerged as the pandemic evolved. Our results show that the strategies proposed can be grouped into 17 keywords, with modularization being the most frequent strategy and related strategies like rapid assembly, flexible space, etc. are also took a significant percentage of the use. Further, we explored the technical orientation, year, territory, target groups, and target problems of the works which lead to a series of cross-comparison relationships. The results indicate that indirect impacts caused by the pandemic gained more attention and flexible Solutions were used more often highlighted the consensus when adapting to the uncertainties. The focus on the spiritual dimension is increasing year by year reflected the spiritual influences were gaining traction and the indirect impacts gradually showed up over time. The research will provide a strategy reference for the design response to the pandemic, as well as help understand the influence and significance of social factors behind the divergence of issue focuses and strategic tendency in different regions and times.

Decline in older adults' daily mobility during the COVID-19 pandemic: the role of individual and built environment factors.

BACKGROUND: Extensive research has shown that the COVID-19 pandemic dramatically impacted the daily mobility of older adults. However, very little attention has been paid to the role of individual and built environmental factors in decline in older adults' daily mobility during the pandemic. METHODS: Based on a cohort survey of 741 older adults in Hong Kong, we conducted a one-way ANOVA to explore the differences in determinants (individual or environmental factors) of older adults' daily mobility between before and during the COVID-19 pandemic. Further, multilevel linear regression was performed to examine how individual characteristics and built environment factors are associated with changes in older adults' daily mobility during the pandemic. RESULTS: Results show that the duration of active travel declined from 174.72 to 76.92 min per week, and that the public transport use frequency decreased from an average of 6.14 to 3.96 trips per week during the COVID-19 pandemic (before the rollout of vaccination programme). We also found residential density (p < 0.05) and the number of bus stop was negatively associated with the decline in their active travel (p < 0.01), while a higher destination mix was associated with more significant decrease in active travel (p < 0.01). A higher availability of recreational facilities in neighbourhoods was associated with a greater decrease in public transport use (p < 0.05). In addition, those who were older or having depressive symptoms, which are considered a vulnerable group, were negatively associated with decrease in their mobility (p < 0.001). CONCLUSIONS: Maintaining mobility and social interactions are crucial for older adults' health during the COVID-19 pandemic. This study found that individual and environmental factors differentially affected older adults' active travel and public transport use during the pandemic. Our findings contribute to understanding the COVID-19 impact on daily mobility in older adults and support more effective active travel promotion policies in the post-pandemic future.

Factors associated with meeting physical activity guidelines during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic impacted individual physical activity levels. Less is known regarding how factors such as sociodemographic and built environment were associated with physical activity engagement during the pandemic. Understanding these factors is critical to informing future infectious disease mitigation policies that promote, rather than hinder physical activity. The purpose of this study was to assess predictors of physical activity levels during the beginning of the pandemic (April-June 2020), including Stay-at-Home length and orders, neighborhood safety, and sociodemographic characteristics. METHODS: Data included 517 participants who responded to an anonymous online survey. Physical activity was assessed with a modified Godin Leisure-time exercise questionnaire. We used logistic regression models to estimate unadjusted and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) for the associations between independent variables (e.g., demographic variables, neighborhood safety, COVID Stay-at-Home order and length of time) and physical activity levels that did not meet (i.e., < 600 metabolic equivalents of task [MET]-minutes/week) or met guidelines (i.e., ≥ 600 MET-minutes/week). We used R-Studio open-source edition to clean and code data and SAS V9.4 for analyses. RESULTS: Most participants were 18-45 years old (58%), female (79%), Hispanic (58%), and college/post-graduates (76%). Most (70%) reported meeting physical activity guidelines. In multivariate-adjusted analyses stratified by income, in the highest income bracket (≥ $70,000) pet ownership was associated with higher odds of meeting physical activity guidelines (aOR = 2.37, 95% CI: 1.23, 4.55), but this association did not persist for other income groups. We also found lower  perceived neighborhood safety was associated with significantly lower odds of meeting physical activity guidelines (aOR = 0.15, 95% CI:0.04-0.61), but only among individuals in the lowest income bracket (< $40,000). Within this lowest income bracket, we also found that a lower level of education was associated with reduced odds of meeting physical activity guidelines. DISCUSSION: We found that perceived neighborhood safety, education and pet ownership were associated with meeting physical activity guidelines during the early months of the COVID-19 pandemic, but associations differed by income. These findings can inform targeted approaches to promoting physical activity during subsequent waves of COVID-19 or future pandemics.

Experiencing Public Spaces in Southern Chile: Analysing the Effects of the Built Environment on Walking Perceptions.

In Latin American cities, the built environment is facing crucial challenges in the 21st century, not only in terms of the redesign of the physical environment, but also how to remodel public spaces as healthier places for walking and social interaction. The objective of this article is to evaluate the effects of the built environment on walking perceptions in a central neighbourhood in the intermediate city of Valdivia, Chile. The methodology integrates quantitative and qualitative methods to explore which elements of the physical built environment ease and hinder walkability. Depthmap software and Simpson's Diversity Index are used to evaluate connectivity and diversity of land uses at street level. Additionally, the People Following method and 26 walking interviews are conducted using the Natural Go-Along technique to analyse pedestrians' perceptions about their mobility environment. The results show that the factors that promote walkability mainly include streets with high connectivity values, wide pavements, diversity of greening, and facade characteristics of buildings with architectural heritage causing tranquillity, longing, and happiness. On the contrary, factors that inhibit walkability are related to poor-quality and narrow sidewalks, cars parked on sidewalks, dirty streets, and motorized traffic and vehicular noise causing negative emotions in walking perceptions such as tiredness, anger, disgust, discomfort, and insecurity, with negative effects on the well-being of residents that vary according to age and gender. Finally, recommendations are oriented to improve public spaces in central areas in southern Chile, to address moving towards more liveable and inclusive environments and support well-being through urban design in these types of context.

The impact of built environment on mental health: A COVID-19 lockdown perspective.

Tackling mental health has become a priority for governments around the world because it influences not only individuals but also the whole society. As people spend a majority of their time (i.e., around 90%) in buildings, it is pivotal to understand the relationship between built environment and mental health, particularly during COVID-19 when people have experienced recurrent local and national lockdowns. Despite the demonstration by previous research that the design of the built environment can affect mental health, it is not clear if the same influence pattern remains when a 'black swan' event (e.g., COVID-19) occurs. To this end, we performed logistic regression and hierarchical regression analyses to examine the relationship between built environment and mental health utilising a data sample from the United Kingdom (UK) residents during the COVID-19 lockdown while considering their social demographics. Our results show that compared with depression and anxiety, people were more likely to feel stressed during the lockdown period. Furthermore, general house type, home workspace, and neighbourhood environment and amenity were identified to have significantly contributed to their mental health status. With the ensuing implications, this study represents one of the first to inform policymakers and built environment design professionals of how built environment should be designed to accommodate features that could mitigate mental health problems in any future crisis. As such, it contributes to the body of knowledge of built environment planning by considering mental health during the COVID-19 lockdown.

Effects of the built environment and human factors on the spread of COVID-19: A systematic literature review.

Soon after its emergence, COVID-19 became a global problem. While different types of vaccines and treatments are now available, still non-pharmacological policies play a critical role in managing the pandemic. The literature is enriched enough to provide comprehensive, practical, and scientific insights to better deal with the pandemic. This research aims to find out how the built environment and human factors have affected the transmission of COVID-19 on different scales, including country, state, county, city, and urban district. This is done through a systematic literature review of papers indexed on the Web of Science and Scopus. Initially, these databases returned 4264 papers, and after different stages of screening, we found 166 relevant papers and reviewed them. The empirical papers that had at least one case study and analyzed the effects of at least one built environment factor on the spread of COVID-19 were selected. Results showed that the driving forces can be divided into seven main categories: density, land use, transportation and mobility, housing conditions, demographic factors, socio-economic factors, and health-related factors. We found that among other things, overcrowding, public transport use, proximity to public spaces, the share of health and services workers, levels of poverty, and the share of minorities and vulnerable populations are major predictors of the spread of the pandemic. As the most studied factor, density was associated with mixed results on different scales, but about 58 % of the papers reported that it is linked with a higher number of cases. This study provides insights for policymakers and academics to better understand the dynamic roles of the non-pharmacological driving forces of COVID-19 at different levels.

Excess Mortality during the COVID-19 Pandemic in Cities of Chile: Magnitude, Inequalities, and Urban Determinants.

We estimated excess mortality in Chilean cities during the COVID-19 pandemic and its association with city-level factors. We used mortality, and social and built environment data from the SALURBAL study for 21 Chilean cities, composed of 81 municipalities or "comunas", grouped in 4 macroregions. We estimated excess mortality by comparing deaths from January 2020 up to June 2021 vs 2016-2019, using a generalized additive model. We estimated a total of 21,699 (95%CI 21,693 to 21,704) excess deaths across the 21 cities. Overall relative excess mortality was highest in the Metropolitan (Santiago) and the North regions (28.9% and 22.2%, respectively), followed by the South and Center regions (17.6% and 14.1%). At the city-level, the highest relative excess mortality was found in the Northern cities of Calama and Iquique (around 40%). Cities with higher residential overcrowding had higher excess mortality. In Santiago, capital of Chile, municipalities with higher educational attainment had lower relative excess mortality. These results provide insight into the heterogeneous impact of COVID-19 in Chile, which has served as a magnifier of preexisting urban health inequalities, exhibiting different impacts between and within cities. Delving into these findings could help prioritize strategies addressed to prevent deaths in more vulnerable communities.

Nursing Home Adoption of CDC and ASHRAE COVID-19 Built Environment Recommendations: A Characterization Study of Colorado Nursing Home Facilities.

BACKGROUND: During the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) and ASHRAE provided infection control recommendations for the built environments and ventilation systems of nursing homes (NHs). The level of adoption of the suggested strategies is unknown, as little information has been obtained from NHs identifying the strategies that were implemented. OBJECTIVE: The primary goal of our study was to characterize the built environments of Colorado NHs during the COVID-19 pandemic to assess the level of adoption of CDC and ASHRAE recommendations. Our secondary goal was to identify opportunities and barriers that NHs face as they work to create health-protective built environments in the future. METHOD: We used the Nursing Home Built Environment survey to obtain data related to three main categories of CDC and ASHRAE recommendation for Colorado NHs: Resident Isolation, Improved Indoor Air Quality, and Staff Separation/Support. RESULTS: Key findings included: (1) On average, NHs had 34% of their beds located in single-occupancy rooms; (2) seven (9%) NHs had designated COVID-positive "neighborhoods"; (3) 14 (20%) NHs had common area ventilation systems that were utilizing filters with a minimum efficiency reporting value 13 rating, or higher. CONCLUSION: Most Colorado NHs did not fully implement the COVID-19 built environment strategies recommended by CDC and ASHRAE. While there are barriers to the adoption of many of the strategies, there are also opportunities for immediate improvements that can support the health of vulnerable NH populations as we continue to see high rates of aerosolized infectious disease spread in NH facilities.