The Pent-Up Demand for Breastfeeding Among US Women: Trends After COVID-19 Shelter-in-Place.

Objectives. To estimate changes in national breastfeeding trends immediately before and after COVID-19‒related workplace closures in early 2020. Methods. The implementation of shelter-in-place policies in early 2020, when 90% of people in the United States were urged to remain at home, represents a unique natural experiment to assess the pent-up demand for breastfeeding among US women that may be stymied by the lack of a national paid leave policy. We used the 2017-2020 Pregnancy Risk Assessment Monitoring System (n = 118 139) to estimate changes in breastfeeding practices for births occurring before and after shelter-in-place policies were implemented in the United States. We did this in the overall sample and by racial/ethnic and income subgroups. Results. There was no change in breastfeeding initiation and a 17.5% increase in breastfeeding duration after shelter-in-place, with lingering effects through late 2020. High-income and White women demonstrated the largest gains. Conclusions. The United States ranks worse than similar countries when it comes to breastfeeding initiation and duration. This study suggests that this is partly attributable to inadequate access to postpartum paid leave. This study also demonstrates inequities introduced by patterns of remote work during the pandemic. (Am J Public Health. 2023;113(8):870-873. https://doi.org/10.2105/AJPH.2023.307313).

Covid-19 shelter-in-place, modified reopening orders, and order compliance impact on adolescent alcohol use and drinking contexts in California: A longitudinal analysis.

INTRODUCTION: This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. MATERIALS AND METHODS: Differences-in-differences (DID) models and multi-level modeling analyses were conducted on longitudinal data collected as part of a larger study on alcohol use among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one's own home, another's home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. RESULTS: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR = 0.72, CI = 0.56-0.93, p < 0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking frequency and quantity as well as decreases in frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other's home and outdoors. CONCLUSIONS: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.

Association of Baseline Adherence to Antihypertensive Medications With Adherence After Shelter-in-Place Guidance for COVID-19 Among US Adults.

Importance: Adherence to selected antihypertensive medications (proportion of days covered [PDC]) declined after guidance to shelter in place for COVID-19. Objectives: To determine whether PDC for all antihypertensive medications collectively fell from the 6 months before sheltering guidance (September 15, 2019, to March 14, 2020 [baseline]) compared with the first (March 15 to June 14, 2020) and second (June 15 to September 14, 2020) 3 months of sheltering and to assess the usefulness of baseline PDC for identifying individuals at risk for declining PDC during sheltering. Design, Setting, and Participants: This retrospective cohort study included a random sample of US adults obtained from EagleForce Health, a division of EagleForce Associates Inc. Approximately one-half of the adults were aged 40 to 64 years and one-half were aged 65 to 90 years, with prescription drug coverage, hypertension, and at least 1 antihypertensive medication prescription filled at a retail pharmacy during baseline. Main Outcomes and Measures: Prescription claims were used to assess (1) PDC at baseline and changes in PDC during the first and second 3 months of sheltering and (2) the association of good (PDC ≥ 80), fair (PDC 50-79), and poor (PDC < 50) baseline adherence with adherence during sheltering. Results: A total of 27 318 adults met inclusion criteria (mean [SD] age, 65.0 [11.7] years; 50.7% women). Mean PDC declined from baseline (65.6 [95% CI, 65.2-65.9]) during the first (63.4 [95% CI, 63.0-63.8]) and second (58.9 [95% CI, 58.5-59.3]) 3 months after sheltering in all adults combined (P < .001 for both comparisons) and both age groups separately. Good, fair, and poor baseline adherence was observed in 40.0%, 27.8%, and 32.2% of adults, respectively. During the last 3 months of sheltering, PDC declined more from baseline in those with good compared with fair baseline adherence (-13.1 [95% CI, -13.6 to -12.6] vs -8.3 [95% CI, -13.6 to -12.6]; P < .001), whereas mean (SD) PDC increased in those with poor baseline adherence (mean PDC, 31.6 [95% CI, 31.3-31.9] vs 34.4 [95% CI, 33.8-35.0]; P < .001). However, poor adherence during sheltering occurred in 1034 adults (9.5%) with good baseline adherence, 2395 (31.6%) with fair baseline adherence, and 6409 (72.9%) with poor baseline adherence. Conclusions and Relevance: These findings suggest that individuals with poor baseline adherence are candidates for adherence-promoting interventions irrespective of sheltering guidance. Interventions to prevent poor adherence during sheltering may be more useful for individuals with fair vs good baseline adherence.

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco.

In this study, we consider the patient, provider, and public health repercussions of San Francisco's (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020-2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.

Social Connectedness, Physical Distancing, and Anxiety in Complying with Shelter-In-Place Orders and Advisories during the Once-In-A-Century COVID-19 Pandemic in the US: A Study of Social Media and Internet Users.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was first identified in Wuhan, China, in December 2019. As of 20 October 2020, the virus had infected 8,202,552 people, with 220,061 deaths in US, and in countries around the world, over 38 million people have become infected and over one million have died. The virus usually spreads via respiratory droplets from an infected person. At the time of compiling this paper, while countries around the world are still striving to find a "pharmaceutical intervention (PI)", including treatments and vaccines, they are left with only "non-pharmaceutical interventions (NPIs)", such as physical distancing, wearing masks, and maintaining personal hygiene. In the US, all 50 states, the District of Columbia, and five US territories issued mandatory stay-at-home orders between March 1 and 31 May 2020 to lower the risk of virus transmission. This study empirically examined how social connectedness and anxiety interact with shelter-in-place compliance and advisories during the pandemic. The study collected information from 494 adults using an online survey during April and July 2020.

US shelter in place policies and child abuse Google search volume during the COVID-19 pandemic.

The COVID-19 pandemic has led to unemployment, school closures, movement restrictions, and social isolation, all of which are child abuse risk factors. Our objective was to estimate the effect of COVID-19 shelter in place (SIP) policies on child abuse as captured by Google searches. We applied a differences-in-differences design to estimate the effect of SIP on child abuse search volume. We linked state-level SIP policies to outcome data from the Google Health Trends Application Programming Interface. The outcome was searches for child abuse-related phrases as a scaled proportion of total searches for each state-week between December 31, 2017 and June 14, 2020. Between 914 and 1512 phrases were included for each abuse subdomain (physical, sexual, and emotional). Eight states and DC were excluded because of suppressed outcome data. Of the remaining states, 38 introduced a SIP policy between March 19, 2020 and April 7, 2020 and 4 states did not. The introduction of SIP generally led to no change, except for a slight reduction in child abuse search volume in weeks 8-10 post-SIP introduction, net of changes experienced by states that did not introduce SIP at the same time. We did not find strong evidence for an effect of SIP on child abuse searches. However, an increase in total search volume during the pandemic that may be differential between states with and without SIP policies could have biased these findings. Future work should examine the effect of SIP at the individual and population level using other data sources.

Association of Shelter-in-Place Hotels With Health Services Use Among People Experiencing Homelessness During the COVID-19 Pandemic.

Importance: Some jurisdictions used hotels to provide emergency noncongregate shelter and support services to reduce the risk of COVID-19 infection among people experiencing homelessness (PEH). A subset of these shelter-in-place (SIP) hotel guests were high users of acute health services, and the association of hotel placement with their service use remains unknown. Objective: To evaluate the association of SIP hotel placements with health services use among a subset of PEH with prior high acute health service use. Design, Setting, and Participants: This study used a matched retrospective cohort design comparing health services use between PEH with prior high service use who did and did not receive a SIP hotel placement, from April 2020 to April 2021. The setting was 25 SIP hotels in San Francisco, California, with a daily capacity of 2500 people. Participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. Data analysis for this study was performed from February 2021 to May 2022. Exposures: SIP hotel placement with on-site supportive services. Main Outcomes and Measures: The primary outcomes were ED visits, hospitalizations and bed days, psychiatric emergency visits, psychiatric hospitalizations, outpatient mental health and substance use visits, and outpatient medical visits. Results: Of 2524 SIP guests with a minimum of 90-day stays, 343 (13.6%) met criteria for high service use. Of 686 participants with high service use (343 SIP group; 343 control), the median (IQR) age was 54 (43-61) years, 485 (70.7%) were male, 283 (41.3%) were Black, and 337 (49.1%) were homeless for more than 10 years. The mean number of ED visits decreased significantly in the high-user SIP group (1.84 visits [95% CI, 1.52-2.17 visits] in the 90 days before SIP placement to 0.82 visits [95% CI, 0.66-0.99 visits] in the 90 days after SIP placement) compared with high-user controls (decrease from 1.33 visits [95% CI, 1.39-1.58 visits] to 1.00 visits [95% CI, 0.80-1.20 visits]) (incidence rate ratio [IRR], 0.60; 95% CI, 0.47-0.75; P < .001). The mean number of hospitalizations decreased significantly from 0.41 (95% CI, 0.30-0.51) to 0.14 (95% CI, 0.09-0.19) for SIP guests vs 0.27 (95% CI, 0.19-0.34) to 0.22 (95% CI, 0.15-0.29) for controls (IRR, 0.41; 95% CI, 0.27-063; P < .001). Inpatient hospital days decreased significantly from a mean of 4.00 (95% CI, 2.44-5.56) to 0.81 (95% CI, 0.40-1.23) for SIP guests vs 2.27 (95% CI, 1.27-3.27) to 1.85 (95% CI, 1.06-2.65) for controls (IRR, 0.25; 95% CI, 0.12-0.54; P < .001), as did psychiatric emergency visits, from a mean of 0.03 (95% CI, 0.01-0.05) to 0.01 (95% CI, 0.00-0.01) visits for SIP guests vs no change in the control group (IRR, 0.25; 95% CI, 0.11-0.51; P < .001). Conclusions and Relevance: These findings suggest that in a population of PEH with high use of acute health services, SIP hotel placement was associated with significantly reduced acute care use compared with high users without a placement.

Impact on neurosurgical management in a Level 1 trauma center post COVID-19 shelter-in-place restrictions.

The stringent restrictions from shelter-in-place (SIP) policies placed on hospital operations during the COVID-19 pandemic led to a sharp decrease in planned surgical procedures. This study quantifies the surgical rebound experienced across a neurosurgical service post SIP restrictions in order to guide future hospital programs with resource management. We conducted a retrospective review of all neurosurgical procedures at a public Level 1 trauma center between February 15th to August 30th for the years spanning 2018-2020. We categorized patient procedures into four comparative one-month periods: pre-SIP; SIP; post-SIP; and late recovery. Patient procedures were designated as either cranial; spinal; and other; as well as Elective or Add-on (Urgent/Emergent). Categorical variables were analyzed using χ2 tests and Fisher's exact tests. A total of 347 cases were reviewed across the four comparative periods and three years studied; with 174 and 152 spinal and cranial procedures; respectively. There was a proportional increase; relative to historical controls; in total spinal procedures (p-value < 0.001) and elective spinal procedures (p-value < 0.001) in the 2020 SIP to Post-SIP. The doubling of elective spinal cases in the Post-SIP period returned to historical baseline levels in three months after SIP restrictions were lifted. Total cranial procedures were proportionally increased during the SIP period relative to historical controls (p-value = 0.005). We provide a census on the post-pandemic neurosurgical operative demands at a major public Level 1 trauma hospital, which can potentially be applied for resource allocations in other disaster scenarios.

Phylogenomics of Severe Acute Respiratory Syndrome Coronavirus 2 in Emergency Shelters for People Experiencing Homelessness.

BACKGROUND: Residents and staff of emergency shelters for people experiencing homelessness (PEH) are at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The importance of shelter-related transmission of SARS-CoV-2 in this population remains unclear. It is also unknown whether there is significant spread of shelter-related viruses into surrounding communities. METHODS: We analyzed genome sequence data for 28 SARS-CoV-2-positive specimens collected from 8 shelters in King County, Washington between March and October, 2020. RESULTS: We identified at least 12 separate SARS-CoV-2 introduction events into these 8 shelters and estimated that 57% (16 of 28) of the examined cases of SARS-CoV-2 infection were the result of intrashelter transmission. However, we identified just a few SARS-CoV-2 specimens from Washington that were possible descendants of shelter viruses. CONCLUSIONS: Our data suggest that SARS-CoV-2 spread in shelters is common, but we did not observe evidence of widespread transmission of shelter-related viruses into the general population.

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study.

BACKGROUND: Opioid-related harms, including fatal and non-fatal overdoses, rose dramatically during the COVID-19 pandemic and presented unique challenges during outbreaks in congregate settings such as shelters. People who are deprived of permanent housing have a high prevalence of substance use and substance use disorders, and need nimble, rapid, and portable harm reduction interventions to address the harms of criminalized substance use in an evidence-based manner. CASE STUDY: In February 2021, a COVID-19 outbreak was declared at an emergency men's shelter in Hamilton, Ontario, Canada. Building on pre-existing relationships, community and hospital-based addictions medicine providers and a local harm reduction group collaborated to establish a shelter-based opioid agonist treatment and safer supply program, and a volunteer run safer drug use space that also distributed harm reduction supplies. In the 4 weeks preceding the program, the rate of non-fatal overdoses was 0.93 per 100 nights of shelter bed occupancy. During the 26 days of program operation, there were no overdoses in the safer use space and the rate of non-fatal overdoses in the shelter was 0.17 per 100 nights of shelter bed occupancy. The odds ratio of non-fatal overdose pre-intervention to during intervention was 5.5 (95% CI 1.63-18.55, p = 0.0059). We were not able to evaluate the impact of providing harm reduction supplies and did not evaluate the impact of the program on facilitating adherence to public health isolation and quarantine orders. The program ended as the outbreak waned, as per the direction from the shelter operator. CONCLUSIONS: There was a significant reduction in the non-fatal overdose rate after the safer drug use and safer supply harm reduction program was introduced. Pre-existing relationships between shelter providers, harm reduction groups, and healthcare providers were critical to implementing the program. This is a promising approach to reducing harms from the criminalization of substance use in congregate settings, particularly in populations with a higher prevalence of substance use and substance use disorders.

Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study.

BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

Routing algorithms as tools for integrating social distancing with emergency evacuation.

One of the lessons from the COVID-19 pandemic is the importance of social distancing, even in challenging circumstances such as pre-hurricane evacuation. To explore the implications of integrating social distancing with evacuation operations, we describe this evacuation process as a Capacitated Vehicle Routing Problem (CVRP) and solve it using a DNN (Deep Neural Network)-based solution (Deep Reinforcement Learning) and a non-DNN solution (Sweep Algorithm). A central question is whether Deep Reinforcement Learning provides sufficient extra routing efficiency to accommodate increased social distancing in a time-constrained evacuation operation. We found that, in comparison to the Sweep Algorithm, Deep Reinforcement Learning can provide decision-makers with more efficient routing. However, the evacuation time saved by Deep Reinforcement Learning does not come close to compensating for the extra time required for social distancing, and its advantage disappears as the emergency vehicle capacity approaches the number of people per household.

Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Disproportionately Affects the Latinx Population During Shelter-in-Place in San Francisco.

BACKGROUND: There is an urgent need to understand the dynamics and risk factors driving ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during shelter-in-place mandates. METHODS: We offered SARS-CoV-2 reverse-transcription polymerase chain reaction (PCR) and antibody (Abbott ARCHITECT IgG) testing, regardless of symptoms, to all residents (aged ≥4 years) and workers in a San Francisco census tract (population: 5174) at outdoor, community-mobilized events over 4 days. We estimated SARS-CoV-2 point prevalence (PCR positive) and cumulative incidence (antibody or PCR positive) in the census tract and evaluated risk factors for recent (PCR positive/antibody negative) vs prior infection (antibody positive/PCR negative). SARS-CoV-2 genome recovery and phylogenetics were used to measure viral strain diversity, establish viral lineages present, and estimate number of introductions. RESULTS: We tested 3953 persons (40% Latinx; 41% White; 9% Asian/Pacific Islander; and 2% Black). Overall, 2.1% (83/3871) tested PCR positive: 95% were Latinx and 52% were asymptomatic when tested; 1.7% of census tract residents and 6.0% of workers (non-census tract residents) were PCR positive. Among 2598 tract residents, estimated point prevalence of PCR positives was 2.3% (95% confidence interval [CI], 1.2%-3.8%): 3.9% (95% CI, 2.0%-6.4%) among Latinx persons vs 0.2% (95% CI, .0-.4%) among non-Latinx persons. Estimated cumulative incidence among residents was 6.1% (95% CI, 4.0%-8.6%). Prior infections were 67% Latinx, 16% White, and 17% other ethnicities. Among recent infections, 96% were Latinx. Risk factors for recent infection were Latinx ethnicity, inability to shelter in place and maintain income, frontline service work, unemployment, and household income <$50 000/year. Five SARS-CoV-2 phylogenetic lineages were detected. CONCLUSIONS: SARS-CoV-2 infections from diverse lineages continued circulating among low-income, Latinx persons unable to work from home and maintain income during San Francisco's shelter-in-place ordinance.

Shelter-in-place orders, loneliness, and collaborative behavior.

The outbreak of COVID-19 resulted in numerous jurisdictions instituting "shelter-in-place'' orders (SPOs). While designed to restrict or impede normal levels of social proximity, SPOs altered the way or degree to which workers interact with each other and have likely imposed a toll on employee well-being. The authors exploit the temporal and geographic variation in U.S. SPOs to investigate their effect on loneliness among online workers. Variation in loneliness is then linked to worker behavior in a simple two-person, collaborative task (a framed stag hunt). The analysis reveals a strong positive relationship between SPOs and loneliness on average, peaking during the wave associated with the most prolonged duration of isolation. SPOs disproportionately impacted workers in occupations not substantially involving teamwork or collaboration. As reported loneliness increases, the probability of an individual collaborating in a simple interactive workplace scenario decreases significantly. In the final survey wave, SPOs are scarcer, loneliness subsides, and cooperative behavior increases dramatically.

Love in the time of COVID-19: A brief report on relationship and individual functioning among committed couples in the United States while under shelter-in-place orders.

The COVID-19 pandemic in the United States has changed many aspects of people's daily life, including increased time at home in response to shelter-in-place orders, heightened stress about health effects of COVID-19, and shifts in other domains of life (e.g., employment). These lifestyle changes are likely to impact the well-being of individuals and their romantic relationships. This investigation examined how COVID-19 influenced couple and individual well-being in real-time during the early phase of the pandemic. Data were collected in early May 2020 during shelter-in-place orders in the United States. Participants in committed relationships (n = 332) completed an online survey assessing their experiences currently and before the pandemic. Results suggested that while couple functioning overall maintained or even improved, individual well-being was more negatively impacted by the pandemic. Moreover, some groups who are at higher risk of a poor health outcome from COVID-19 or experience unique challenges as a result of COVID-19 reported worse outcomes (e.g., those whose employment changed) while others did not decline in their psychological and couple functioning (e.g., Black individuals and older individuals). These findings suggest that the pandemic has had varied impacts on couples and individuals, as well as across different virus-related risk factors. Further research is needed to understand the nuanced effects of this pandemic on couples and individuals across time.

La pandemia de la COVID-19 en los Estados Unidos ha cambiado muchos aspectos de la vida diaria de las personas, por ejemplo, el aumento del tiempo que pasan en sus hogares en respuesta a órdenes de confinamiento, un estrés más elevado por los efectos de la COVID-19 en la salud, y cambios en otros aspectos de la vida (p. ej.: en el empleo). Estos cambios en el estilo de vida probablemente repercutan en el bienestar de las personas y en sus relaciones amorosas. En esta investigación se analizó cómo la COVID-19 influyó en el bienestar de las parejas y de los individuos en tiempo real durante la primera fase de la pandemia. A principios de mayo de 2020 se recopilaron datos durante las órdenes de confinamiento en los Estados Unidos. Los participantes que estaban en relaciones de pareja estables (n=332) contestaron una encuesta en línea donde se evaluaron sus experiencias de ese momento y las anteriores a la pandemia. Los resultados indicaron que, si bien el funcionamiento de la pareja en general se mantuvo o incluso mejoró, la pandemia afectó más negativamente el bienestar individual. Además, algunos grupos que tienen mayor riesgo de resultados desfavorables en la salud como consecuencia de la COVID-19 o enfrentan dificultades singulares como resultado de la COVID-19 informaron peores resultados (p. ej.: aquellos cuyos empleos cambiaron), mientras que otros no tuvieron un empeoramiento de su funcionamiento psicológico y de pareja (p. ej.: las personas de color y las personas mayores). Estos resultados sugieren que la pandemia ha tenido efectos variados en las parejas y en los individuos, así como entre los diferentes factores de riesgo relacionados con el virus. Se necesitan más investigaciones para comprender los efectos sutiles de esta pandemia en las parejas y en los individuos con el transcurso del tiempo.

Tuberculosis-Associated Hospitalizations and Deaths after COVID-19 Shelter-In-Place, San Francisco, California, USA.

A mandated shelter-in-place and other restrictions associated with the coronavirus disease pandemic precipitated a decline in tuberculosis diagnoses in San Francisco, California, USA. Several months into the pandemic, severe illness resulting in hospitalization or death increased compared with prepandemic levels, warranting heightened vigilance for tuberculosis in at-risk populations.

Managing the unexpected: The role of homeless service providers during the 2017-2018 California wildfires.

People experiencing homelessness during the 2017-2018 California wildfires faced significant risks of disruption. Homeless service organizations (HSOs) are an essential safety net for this population. To learn about how HSOs performed during the wildfires, this study interviewed U.S. Department of Veterans Affairs (VA) staff overseeing HSOs providing transitional housing under the VA's Grant and Per Diem (GPD) program to Veterans experiencing homelessness. We employed a comparative case study approach exploring GPD organizations' disaster response actions, including evacuating Veterans from wildfire-affected areas or taking in disaster-displaced Veterans. This article presents three themes in the GPD organizations' disaster response: (1) Organizations benefitted from close collaboration and communication with the VA during the disaster, creating a safety net to ensure Veterans' well-being and enact rapid re-housing to prevent homelessness; (2) Organization staff performed heroically under stressful disaster conditions; and (3) Organizations benefitted from the written disaster plans that VA requires them to create, but were not as well-prepared for wildfires as they had been for earthquakes. As emergent threats such as the COVID-19 pandemic, wildfires, and a very active 2020 hurricane season amplify the importance of mitigating risks, comprehensive disaster planning is needed to ensure the safety and support of people experiencing homelessness.