Local COVID-19 Epicenter in Detroit Metropolitan Area Causing Profound and Pervasive Reorganization of Clinical, Educational, Research, and Financial Programs of a Large Academic Gastroenterology Division with a GI Fellowship and Primary Medical School Affiliation.

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

Imbalance and breakout in the post-epidemic era: Research into the spatial patterns of freight demand network in six provinces of central China.

This study aims to explore the freight demand network spatial patterns in six provinces of central China from the perspective of the spread of the epidemic and the freight imbalance and breakout. To achieve this purpose, the big data of "cart search" demand information provided by small and medium freight enterprises on the freight information platform are analyzed. 343,690 pieces of freight demand big data on the freight information platform and Python, ArcGIS, UCINET, and Gephi software are used. The results show that: (1) The choke-point of unbalanced freight demand network is Wuhan, and the secondary choke-points are Hefei and Zhengzhou. (2) In southern China, a chain reaction circle of freight imbalance is formed with Wuhan, Hefei, and Nanchang as the centers. In northern China, a chain reaction circle of freight imbalance is formed with Zhengzhou and Taiyuan as the centers. (3) The freight demand of the six provinces in central China exhibits typical characteristics of long tail distribution with large span and unbalanced distribution. (4) The import and export of freight in different cities vary greatly, and the distribution is unbalanced. This study indicates the imbalance difference, chain reaction, keys and hidden troubles posed by the freight demand network. From the perspectives of freight transfer breakout, freight balance breakout, freight strength breakout, and breakout of freight periphery cities, we propose solutions to breakouts in the freight market in six provinces of central China in the post-epidemic era.

The short-term impacts of coronavirus quarantine in São Paulo: The health-economy trade-offs.

We analyze the trade-offs between health and the economy during the period of social distancing in São Paulo, the state hardest hit by the COVID-19 pandemic in Brazil. We use longitudinal data with municipal-level information and check the robustness of our estimates to several sources of bias, including spatial dependence, reverse causality, and time-variant omitted variables. We use exogenous climate shocks as instruments for social distancing since people are more likely to stay home in wetter and colder periods. Our findings suggest that the health benefits of social distancing differ by levels of municipal development and may have vanished if the COVID-19 spread was not controlled in neighboring municipalities. In turn, we did not find evidence that municipalities with tougher social distancing performed worse economically. Our results also highlight that estimates that do not account for endogeneity may largely underestimate the benefits of social distancing on reducing the spread of COVID-19.

Tourism and Livable Towns Beyond the Coronavirus Disease 2019: A Case Study for Chongqing, China.

Based on the data of 812 small towns in Chongqing, China, this paper attempts to conduct an empirical analysis on whether tourist towns with excellent natural environment, policy advantage, and market preference are more ecologically livable than ordinary small towns. It is found that as a whole, tourist towns are indeed more ecologically livable than ordinary small towns. Also, from the perspective of grading, both the national and provincial tourist towns have the advantage of ecological livability, but the advantage of national ones is more prominent. Furthermore, the ecological livability of tourist towns is affected by location advantage and policy inclination. The implications of the results are discussed following the outcomes of the coronavirus disease 2019 outbreak. The suggestions beyond the coronavirus disease 2019 are also provided.