COVID-19 and CKD: Employment, Food Security and Healthcare in El Salvador.

Background: In Central America, the COVID-19 pandemic coexists with a devastating epidemic of chronic kidney disease of unknown origin. The consequences of these overlapping health crises remain largely unknown. Methods: We assessed vulnerability to and impact of the first wave of COVID-19 on participants in a cohort study of chronic kidney disease (CKD) in El Salvador (n = 229). Participants were contacted by phone during August and September 2020. We queried changes to employment, healthcare access, household income and food security due to the pandemic (from March 2020 until the time of the interview) and COVID-19-associated symptoms during that time. Findings: We reached 94% of the cohort (n = 215). Nearly 40% of participants reported an unexpected change in employment or work activities and 8.8% reported new unemployment due to the pandemic. Participants with CKD (n = 27) had higher odds of reporting new income insecurity, food insecurity, and reductions in medical care access due to the pandemic. COVID-19-associated symptoms (an approximation of disease) were reported in 7.0% (n = 15). Participants with CKD were more likely to report COVID-19-associated symptoms compared to those without CKD, although these differences were not statistically significant. Conclusions: Overall, participants with CKD suffered greater economic consequences as a result of the pandemic and may have experienced higher incidence of COVID-19 disease, although laboratory diagnostics would be required to draw this conclusion. Longitudinal analyses are required to comprehensively evaluate the implications of the pandemic for individuals with CKD in Central America.

Characterizing the Environmental Health Literacy and Sensemaking of Indoor Air Quality of Research Participants.

This study is based on in-depth semi-structured interviews with the participants of an indoor air quality monitoring study. The purpose of the interviews was to capture participants' perceptions of indoor air quality and engage them in a discussion of those factors that influenced their behavior. Interview study participants (n = 20) noted the importance of family health concerns and their own sensory awareness of possible contaminants. They discussed their level of personal control over their home environment as well as their access to needed resources. This study is based on grounded theory and applies interpretivist epistemological methods. Study findings offer insights into how people perceive their home environment and what influences their decision making and action. Analyses indicate that perceived agency, risk perception, access to resources, and information all influenced participants' sense of ability to take action as well as their interest in taking action. These insights serve to challenge some of the current work in environmental health literacy which tends to focus on and measure an individual's knowledge or skills. Our analysis suggests that consideration be given to a number of factors that include perceived agency, access to resources, and the quality of information provided.

Descriptive characterization of sound levels in an environmental justice city before and during a global pandemic.

Many environmental justice communities face elevated exposures to multiple stressors, given biases in urban and environmental policy and planning. This paper aims to evaluate sound level exposure in a densely populated environmental justice city in close proximity to major roadways, a nearby airport and high levels of industrial activity. In this study we collected various sound level metrics to evaluate the loudness and frequency composition of the acoustical environment in Chelsea, Massachusetts, USA. A total of 29 week-long sites were collected from October 2019 to June 2020, a time period that also included the influence of the COVID-19 pandemic, which drastically altered activity patterns and corresponding sound level exposures. We found that Chelsea is exposed to high levels of sound, both day and night (65 dB (A), and 80 dB and 90 dB for low frequency, and infrasound sound levels). A spectral analysis shows that 63 Hz was the dominant frequency. Distance to major roads and flight activity (both arrivals and departures) were most strongly correlated with all metrics, most notably with metrics describing contributing from lower frequencies. Overall, we found similar patterns during the COVID-19 pandemic but at levels up to 10 dB lower. Our results demonstrate the importance of noise exposure assessments in environmental justice communities and the importance of using additional metrics to describe communities inundated with significant air, road, and industrial sound levels. It also provides a snapshot of how much quieter communities can be with careful and intentional urban and environmental policy and planning.