Management of the health workforce in facing COVID-19: disinformation and absences in Brazil's Public Policies.

The objective of this research was to analyse federal government interventions in crisis management and the consequences for health professionals. This is a documentary-type qualitative research. Brazilian Federal regulations referring to work and health education produced during the pandemic emergency of COVID-19, published from January 28 to June 2, 2020, were identified. Of the total of 845 documents, 62 were selected in accordance with the inclusion criteria and were then submitted to Thematic Content Analysis. The results and discussions were grouped into four categories:workforce management, workforce protection, workforce training and academic-workforce relationship. Absence of a federal coordinating actions and policies for desinformation were identified. This lacking mechanisms for coordination contributed decisively to the tragic epidemiological situation still underway, especially in terms of the exposure of health workers to the risk of contamination, revealed in the extremely high rates of professionals infected or killed by COVID-19 in Brazil and the failure to control the pandemic in the population.

Trade-off Between Quarantine Length and Compliance to Optimize COVID-19 Control.

BACKGROUND: Guidance on COVID-19 quarantine duration is often based on the maximum observed incubation periods assuming perfect compliance. However, the impact of longer quarantines may be subject to diminishing returns; the largest benefits of quarantine occur over the first few days. Additionally, the financial and psychological burdens of quarantine may motivate increases in noncompliance behavior. METHODS: We use a deterministic transmission model to identify the optimal length of quarantine to minimize transmission. We modeled the relation between noncompliance behavior and disease risk using a time-varying function of leaving quarantine based on studies from the literature. RESULTS: The first few days in quarantine were more crucial to control the spread of COVID-19; even when compliance is high, a 10-day quarantine was as effective in lowering transmission as a 14-day quarantine; under certain noncompliance scenarios a 5-day quarantine may become nearly protective as 14-day quarantine. CONCLUSION: Data to characterize compliance dynamics will help select optimal quarantine strategies that balance the trade-offs between social forces governing behavior and transmission dynamics.

Government actions for COVID-19 control and prevention in prisons: a scoping review. / Ações governamentais para controle e prevenção da COVID-19 em prisões: uma revisão de escopo.

This is a scoping review of the literature on actions taken by countries during 2020 regarding the care for people living in the prison environment during the COVID-19 pandemic. We selected 54 publications for data mining and found data from 45 countries, which were organized into categories. Most of the literature addressed strategies adopted by countries with advanced economies. All of them mentioned some strategies to reduce viral transmission - the major ones were restricted/suspended family visits and desincarceration - and interventions to improve infrastructures in prisons, the provision of a telephone or other devices for calls or video calls being the most mentioned. Policies to mitigate the effects of the epidemic and interventions were found in publications referencing 33 countries, with the main focus on keeping family contact and reviewing the public safety policy. Concerning governance policies, measures from 11 countries were reported, and the most cited was national authority reinforcement. This study highlights the need for research on the success of each strategy and the differences among those countries.

Trata-se de uma revisão de escopo da literatura sobre as ações adotadas pelos países, durante o ano de 2020, para o cuidado das pessoas que vivenciam o ambiente prisional durante a pandemia de COVID-19. Selecionamos 54 publicações para extração de dados, encontrando dados de 45 países, que foram organizados em categorias. A maior parte das publicações abordava as estratégias adotadas pelos países de economia avançada. Todas as publicações citavam alguma estratégia destinada a reduzir a transmissão viral - as principais foram a restrição/suspensão da visitação de familiares e o desencarceramento - e intervenções relativas à melhoria da infraestrutura nas prisões, sendo mais citada a disponibilização de telefone e/ou outro dispositivo para chamadas ou videochamadas. As políticas destinadas à mitigação das consequências da epidemia e das intervenções foram encontradas em publicações referentes a 33 países, sendo mais abordada a manutenção do contato familiar e a revisão da política de segurança pública. Em relação às políticas de governança, foram relatadas ações de 11 países, sendo a mais citada o fortalecimento da autoridade nacional. Este estudo aponta para a necessidade de pesquisas a respeito do sucesso de cada estratégia e das diferenças entre os países.

People with Disabilities and COVID-19 in the state of Espírito Santo, Brazil: between invisibility and lack of Public Policies. / Pessoas com Deficiência e COVID-19 no estado do Espírito Santo, Brasil: entre a invisibilidade e a falta de Políticas Públicas.

This article aims to analyze the profile of people with disabilities among the cases notified by the COVID-19 panel of Espírito Santo and the possible associations with the positive result of the COVID-19 test. Descriptive cross-sectional study among people with disabilities with positive and negative tests for the diagnosis of COVID-19. Associations of epidemiological and clinical variables were performed using the chi-square test and logistic regression models to estimate the odds ratio. Lethality rate of COVID-19 was 4.9% (175 cases) in the group of people with disabilities, and 3% (3,016) in the group without disabilities. People with disabilities, male (OR=1.34; 95%CI 1.22-1.47), race/black color (OR=1.55; 95%CI 1.09-2.20), and those who were hospitalized (OR=2.27; 95%CI 1.71-3.02) were associated with positive tests for COVID-19. The pandemic emphasizes the need to create specific legal care mechanisms and targeted public policies for this population.

O objetivo deste artigo é analisar o perfil das pessoas com deficiência dentre os casos notificados pelo painel COVID-19 do Espírito Santo e possíveis associações com o resultado positivo do teste COVID-19. Estudo Transversal descritivo entre as pessoas com deficiência com testes positivos e negativos para o diagnóstico de COVID-19. Foram realizadas associações das variáveis epidemiológicas e clínicas, utilizando o teste qui-quadrado e modelos de regressão logística para se estimar o odds ratio. A letalidade por COVID-19 foi de 4,9% (175 casos) no grupo das pessoas com deficiência, e 3% (3.016) no grupo sem deficiência. Pessoas com deficiência do sexo masculino (OR=1,34; IC95% 1,22-1,47), raça/cor preta (OR=1,55; IC95% 1,09-2,20), e as que ficaram internadas (OR=2,27; IC95% 1,71-3,02) apresentaram associação com testes positivos para COVID-19. A pandemia enfatiza a necessidade de criar mecanismos legais de cuidados específicos e políticas públicas focalizadas para essa população.

Interview with Sonia Guajajara: the Indigenous movement in the face of the COVID-19 pandemic. / Entrevista com Sonia Guajajara: o movimento indígena frente à pandemia da COVID-19.

In this interview, Sonia Guajajara, the executive coordinator of the Brazil's Indigenous Peoples Articulation (APIB), addresses the analyzis and strategies developed by the Indigenous movement to face the COVID-19 pandemic. Among other topics, she highlights some of the movement's strategies concerning communication, surveillance, and the monitoring of COVID-19, as well as its actions to support Indigenous territories, the initiatives carried out in the Legislative and Judiciary realms, the movement's international incidence, and its articulation with academia. Sonia shows the important role played by the Indigenous movement to control the health emergency and to defend the rights of the Indigenous peoples, in the framework of intense conflicts with the federal government and setbacks in public policies.

Nesta entrevista, Sonia Guajajara, coordenadora executiva da Articulação dos Povos Indígenas do Brasil (APIB), aborda as análises e estratégias desenvolvidas pelo movimento indígena para o enfrentamento da pandemia da COVID-19. Entre os pontos destacados, estão as estratégias de comunicação, vigilância e monitoramento da COVID-19, o apoio aos territórios indígenas, as iniciativas no Legislativo e no Judiciário, a incidência internacional e a articulação com a academia. Torna-se evidente o importante protagonismo do movimento indígena nas ações de contenção da emergência sanitária e na defesa dos direitos dos povos indígenas, em uma conjuntura de embate com o governo federal e de retrocessos nas políticas públicas.

A shared agenda for gender and COVID-19 research: priorities based on broadening engagement in science.

While the acute and collective crisis from the pandemic is over, an estimated 2.5 million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings. The collaborative research agenda-setting exercise engaged over 900 participants primarily from low/middle-income countries in varied activities. The top 21 research questions included the importance of the needs of pregnant and lactating women and information systems that enable sex-disaggregated analysis. Gender and intersectional aspects to improving vaccine uptake, access to health services, measures against gender-based violence and integrating gender in health systems were also prioritised. These priorities are shaped by more inclusive ways of working, which are critical for global health as it faces further uncertainties in the aftermath of COVID-19. It remains imperative to address the basics in gender and health (sex-disaggregated data and sex-specific needs) and also advance transformational goals to advance gender justice across health and social policies, including those related to global research.

Characteristics associated with buying alcohol to-go and for delivery during the first year of the COVID-19 pandemic among a national sample of US adults.

INTRODUCTION: This study: (i) determined the population coverage of alcohol delivery and to-go/carryout policies (i.e., policies permitting bars/restaurants to sell individual drinks for off-site consumption) in 2019 and 2020; and (ii) identified characteristics associated with alcohol delivery and to-go purchases. METHODS: Data are from the National Alcohol Survey and Alcohol Policy Information System (n = 1677 adults, 52.1% female). Population coverage models summed state populations across state-level bar/restaurant delivery and to-go/carryout policies by beverage. Regression outcomes were past-year alcohol delivery and to-go purchases. Independent variables included demographics, excessive drinking, COVID-19 impacts and state COVID-19 bar/restaurant alcohol laws. Chi-squared tests and logistic regression models tested associations between delivery/to-go purchases and independent variables. RESULTS: Overall, 7.5% of adults had alcohol delivered and 14.5% bought alcohol to-go. From December 2019 to December 2020, the number of people living in states allowing beer/wine/spirits delivery (284%) and to-go sales (627%) rose steeply. People who were Black (vs. White; adjusted odds ratio [aOR] 2.92, p < 0.001), excessive drinkers (vs. non-excessive drinkers; aOR 2.06, p < 0.001) or lived in states allowing beer/wine/spirits to-go sales (aOR 2.20, p = 0.01) had higher odds of buying alcohol to-go. Conversely, older people had lower odds of buying alcohol to-go (aOR 0.97, p < 0.001). People with some college or more (vs. high school degree or less, aOR 2.21, p < 0.001) and a higher economic burden (vs. fewer COVID-19 impacts, aOR 2.32, p = 0.05) had higher odds of alcohol delivery. DISCUSSION AND CONCLUSIONS: A select sub-population defined by socioeconomic status, race, excessive drinking and state policies bought alcohol for delivery or to-go in the Unites States.

Futureproofing Social Support Policies for Population Health.

Policy Points In America, wages appear to be growing relative to purchasing power over time. However, while the ability to purchase consumer goods has indeed improved, the cost of basic survival needs such as health care and education has increased faster than wages have grown. America's weakening social policy landscape has led to a massive socioeconomic rupture in which the middle class is disappearing, such that most Americans now cannot afford basic survival needs, such as education and health insurance. Social policies strive to rebalance societal resources from socioeconomically advantaged groups to those in need. Education and health insurance benefits have been experimentally proven to also improve health and longevity. The biological pathways through which they work are also understood.

COVID-19 Disruptions of Food Systems and Nutrition Services in Ethiopia: Evidence of the Impacts and Policy Responses.

Background: Since its first case of COVID-19 on March 13, 2020, Ethiopia has exerted efforts to curb the spread of SARS-CoV-2 (COVID-19) without imposing a nationwide lockdown. Globally, COVID-19 related disruptions and mitigation measures have impacted livelihoods and food systems, nutrition, as well as access and use of health services. Objective: To develop a comprehensive understanding of the impacts of the COVID-19 pandemic on food systems, health services, and maternal and child nutrition and to synthesize lessons from policy responses to the COVID-19 pandemic in Ethiopia. Methods: We conducted a review of literature and 8 key informant interviews across government agencies, donors, and non-governmental organizations (NGOs), to map the impacts of the COVID-19 pandemic on the food and health systems in Ethiopia. We summarized policy responses and identified recommendations for future actions related to the COVID-19 pandemic and other future emergencies. Results: The impacts of the COVID-19 pandemic were felt across the food system and include limited agriculture inputs due to travel restrictions and closed borders restricting trade, reduced in-person support by agriculture extension workers, income losses, increases in food prices, and the reduction in food security and dietary diversity. Maternal and child health services were disrupted due to fear of contacting COVID-19, diversion of resources, and lack of personal protective equipment. Disruptions eased over time due to the expansion of social protection through the Productive Safety Net Program, and the increased outreach and home service provision by the health extension workers. Conclusion: Ethiopia experienced disruptions to food systems and maternal and child nutrition services due to the COVID-19 pandemic. However, by expanding existing social protection programs and public health infrastructure and leveraging partnerships with non-state actors, the extent of the impact of the pandemic was largely minimized. Nevertheless, vulnerabilities and gaps remain and there is a need for a long-term strategy that considers the potential for future pandemics and other shocks.

Judicial Power and Influence on Population Health.

Policy Points Since its founding, the Supreme Court has played a major role in defining the parameters of governments' public health powers and the scope of individual health-related rights. Although conservative courts have been less favorable to public health objectives, federal courts have, for the most part, advanced public health interests through consensus and adherence to the rule of law. In establishing the current six-three conservative supermajority, the Trump administration and the Senate shifted the Supreme Court dramatically. A majority of Justices, led by Chief Justice Roberts, did shift the Court in a decidedly conservative direction. It did so incrementally, guided by the Chief's intuition that the Institution itself should be preserved, mindful of maintaining public trust and appearing outside the political fray. That has all changed because Roberts' voice no longer holds sway. Five members of the Court have displayed a willingness to overturn even long-held precedent and dismantle public health policy in favor of the Justices' core ideological tenants-notably the extensive reach of the First and Second Amendments and a parsimonious view of executive and administrative action. Public health is vulnerable to judicial rulings in this new conservative era. This includes classic public health powers in infectious disease control as well as reproductive rights; lesbian, gay, bisexual, trans, queer or questioning, and others (LGBTQ+) rights; firearm safety; immigration; and climate change. Congress has the power to curb the most extreme actions of the Court while still adhering to the vital ideal of a nonpolitical branch. That does not require Congress itself to overreach (such as by "packing" the Supreme Court, as Franklin Delaeno Roosevelt once proposed). Congress could, however, 1) disempower lower federal judges from issuing injunctions that apply nationwide, 2) limit the Supreme Court's so-called shadow docket, 3) alter the way that presidents appoint federal judges, and 4) set reasonable term limits for federal judges and Supreme Court Justices.

The impact of state paid sick leave policies on weekday workplace mobility during the COVID-19 pandemic.

OBJECTIVES: This study aimed to evaluate whether the Families First Coronavirus Response Act (FFCRA) modified the association between pre-existing state paid sick leave (PSL) and weekday workplace mobility between February 15 and July 7, 2020. STUDY DESIGN: This was a longitudinal, observational study. METHODS: The 50 US states and Washington, D.C., were divided into exposure groups based on the presence or absence of pre-existing state PSL policies. Derived from Google COVID-19 Community Mobility Reports, the outcome was measured as the daily percent change in weekday workplace mobility. Mixed-effects, interrupted time series regression was performed to evaluate weekday workplace mobility after the implementation of the FFCRA on April 1, 2020. RESULTS: States with pre-existing PSL policies exhibited a greater drop in mobility following the passage of the FFCRA (ß = -8.86, 95% confidence interval: -11.6, -6.10, P < 001). This remained significant after adjusting for state-level health, economic, and sociodemographic indicators (ß = -3.13, 95% confidence interval: -5.92, -0.34; P = .039). CONCLUSIONS: Pre-existing PSL policies were associated with a significant decline in weekday workplace mobility after the FFCRA, which may have influenced local health outcomes. The presence of pre-existing state policies may differentially influence the impact of federal legislation enacted during emergencies.

Assessing the accuracy of California county level COVID-19 hospitalization forecasts to inform public policy decision making.

BACKGROUND: The COVID-19 pandemic has highlighted the role of infectious disease forecasting in informing public policy. However, significant barriers remain for effectively linking infectious disease forecasts to public health decision making, including a lack of model validation. Forecasting model performance and accuracy should be evaluated retrospectively to understand under which conditions models were reliable and could be improved in the future. METHODS: Using archived forecasts from the California Department of Public Health's California COVID Assessment Tool ( https://calcat.covid19.ca.gov/cacovidmodels/ ), we compared how well different forecasting models predicted COVID-19 hospitalization census across California counties and regions during periods of Alpha, Delta, and Omicron variant predominance. RESULTS: Based on mean absolute error estimates, forecasting models had variable performance across counties and through time. When accounting for model availability across counties and dates, some individual models performed consistently better than the ensemble model, but model rankings still differed across counties. Local transmission trends, variant prevalence, and county population size were informative predictors for determining which model performed best for a given county based on a random forest classification analysis. Overall, the ensemble model performed worse in less populous counties, in part because of fewer model contributors in these locations. CONCLUSIONS: Ensemble model predictions could be improved by incorporating geographic heterogeneity in model coverage and performance. Consistency in model reporting and improved model validation can strengthen the role of infectious disease forecasting in real-time public health decision making.

Priming COVID-19's consequences can increase support for investments in public health.

Can messaging that emphasizes the costs of COVID-19 increase popular support for more proactive public health policies? People who experience disasters often become more supportive of policies to address their underlying causes, and the pandemic may have similar spillover effects for public opinion. To test this idea, the study implements a survey experiment in Italy, Germany, and the United States in which half of the respondents were randomly assigned to a prime about the impact of the pandemic prior to answering questions about their support for public health policies. The results show that respondents who received the prime became more favorable toward increased government spending on domestic and foreign public health programs alike. These treatment effects were consistent across countries, across two different surveys in the United States conducted at different points in time, and across partisan subgroups. However, the treatment did not consistently increase support for more active and intrusive government policies to address specific public health challenges like smoking or HIV/AIDS. The results suggest that public health advocates may benefit from messaging that connects COVID-19 to the need for public health funding beyond the context of the pandemic.

Use of a multi-method approach to rapidly assess the impact of public health policies at the state and local level: a case study of flavored e-cigarette policies.

BACKGROUND: E-cigarettes are the most-commonly used tobacco product by youth since 2014. To prevent youth access and use of e-cigarettes, many U.S. states and localities have enacted policies over a relatively short period of time. The adoption of these policies has necessitated timely data collection to evaluate impacts. METHODS: To assess the impact of flavored e-cigarette policies in select states and local jurisdictions across the United States, a multi-method, complementary approach was implemented from July 2019 to present, which includes analyses of cross-sectional online surveys of young people ages 13-24 years with retail sales data. RESULTS: From February 2020 through February 2023, cross-sectional surveys have been conducted in three cities, one county, and eight states where policy changes have been enacted or are likely to be enacted. Data collection occurred every six months to provide near real-time data and examine trends over time. Additionally, weekly retail sales data were aggregated to showcase monthly sales trends at the national level and for the selected states. DISCUSSION: This rapid and efficient method of coupling online survey data with retail sales data provides a timely and effective approach for monitoring a quickly changing tobacco product landscape, particularly for states and localities where rapidly-available data is often not available. This approach can also be used to monitor other health behaviors and relevant policy impacts.

Maintaining Adherence to COVID-19 Preventive Practices and Policies Pertaining to Masking and Distancing in the District of Columbia and Other US States: Systematic Observational Study.

BACKGROUND: Prior to the development of effective vaccines against SARS-CoV-2, masking and social distancing emerged as important strategies for infection control. Locations across the United States required or recommended face coverings where distancing was not possible, but it is unclear to what extent people complied with these policies. OBJECTIVE: This study provides descriptive information about adherence to public health policies pertaining to mask wearing and social distancing and examines differences in adherence to these policies among different population groups in the District of Columbia and 8 US states. METHODS: This study was part of a national systematic observational study using a validated research protocol for recording adherence to correct mask wearing and maintaining social distance (6 feet/1.83 meters) from other individuals. Data were collected from December 2020 to August 2021 by research team members who stationed themselves in outdoor areas with high pedestrian traffic, observed individuals crossing their paths, and collected data on whether individuals' masks were present (visible or not visible) or worn (correctly, incorrectly, not at all) and whether social distance was maintained if other individuals were present. Observational data were entered electronically into Google Forms and were exported in Excel format for analysis. All data analyses were conducted using SPSS. Information on local COVID-19 protection policies (eg, mask wearing requirements) was obtained by examining city and state health department websites for the locations where data were being collected. RESULTS: At the time these data were collected, most locations in our study required (5937/10,308, 57.6%) or recommended (4207/10,308, 40.8%) masking. Despite this, more than 30% of our sample were unmasked (2889/10136, 28.5%) or masked incorrectly (636/10136, 6.3%). Masking policy was significantly related to correct masking with locations that required or recommended masking (66% correct masking vs 28/164, 17.1% in locations that did not require masking, P<.001). Participants who maintained social distance from others were more likely to be correctly masked than those who were not (P<.001). Adherence to masking policy by location was significant (P<.001); however, this was driven by 100% compliance in Georgia, which did not require masks at any point during the data collection period. When the same analysis was conducted for compliance with mask requirements and recommendations, there was no significant difference by location. Overall adherence to masking policies was 66.9. CONCLUSIONS: Despite a clear relationship between mask policies and masking behavior, one-third of our sample was nonadherent to those policies, and approximately 23% of our sample did not have any mask, either on or visible. This may speak to the confusion surrounding "risk" and protective behaviors, as well as pandemic fatigue. These results underscore the importance of clear public health communication, particularly given variations in public health policies across states and localities.