The Trump Administration and the COVID-19 crisis: Exploring the warning-response problems and missed opportunities of a public health emergency

The Association of County-Level Presidential Election Outcome and COVID-19 Mortality in Colorado, 2020-2022

CONTEXT

The Coronavirus disease 2019 (COVID-19) pandemic occurred during a time of political tension in the United States. County-level political environment may have been influential in COVID-19 outcomes.

OBJECTIVE

This study examined the association between county-level political environment and age-adjusted COVID-19 mortality rates from 2020 to 2022.

DESIGN SETTING

Political environment was measured by the 2020 Presidential election results and compared with age-adjusted COVID-19 mortality rates by county in Colorado.

MAIN OUTCOME MEASURES

Rate ratios (RR) and 95% confidence intervals (CI) were estimated using negative binomial regression incorporating a population offset term. Models adjusted for populational differences using the demographics percentile from Colorado's EnviroScreen Environmental Justice Tool.

RESULTS

Age-adjusted county mortality rates ranged from 14.3 to 446.8.0 per 100 000. 2021 COVID-19 mortality rates were nearly twice as high in counties voting for Donald Trump compared to those voting for Joseph Biden (adjusted RR = 1.98, 95% CI: 1.59, 2.47). Results for 2020 and 2022 mortality models were also in the positive direction, though the confidence intervals crossed null values.

CONCLUSION

These results build on a growing body of evidence that political environment may have been influential for COVID-19 mortality, helping to understand the drivers of health outcomes. Implications for the public health system as we shift into the endemic period of COVID-19 include motivation for collaborative work to restore and rebuild trust among and between stakeholders and the community, as well as increase health education given its' influence on both individual and community behaviors.

Pandemic Times and Health Care Exclusion: Attitudes toward Health Care Exclusion of Undocumented Immigrants

CONTEXT

Most of the 11 million undocumented immigrants living in the United States are excluded from government health care programs. Yet, health care inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government health care programs.

METHODS

The project's first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government health care programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape health care deservingness attitudes.

FINDINGS

The results show that respondents view undocumented immigrants as less deserving of health care than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants among both Republicans and Democrats.

CONCLUSIONS

The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

Depolarized by the Media? The Role of Heterogeneous and Homogeneous Traditional and Digital Media Diets in Issue Polarization Around COVID-19 in the United States

Research suggests that a heterogeneous media diet can foster more objective information evaluations, reducing issue polarization as a result. These findings beg the question: Can increased news heterogeneity reduce issue polarization around COVID-19? Using data from a cross-sectional survey in the United States (N = 1,262), this study found that - in line with theoretical expectations - at high levels of homogeneity of traditional and digital news consumption, the difference in support for COVID-19 prevention between Biden and Trump supporters was significantly large. Conversely, this attitude gap narrowed at high news heterogeneity levels. Our results continue to advance research on the role of homogeneous and heterogeneous media diets and biased cognitive processing in issue polarization, a crucial endeavor as polarization poses a challenge to effective public health policy implementation and pandemic management. At the outset, the implications of our findings for pandemic communication (and health communication more generally) are discussed.

Engaging communities in therapeutics clinical research during pandemics: Experiences and lessons from the ACTIV COVID-19 therapeutics research initiative

This manuscript addresses a critical topic: navigating complexities of conducting clinical trials during a pandemic. Central to this discussion is engaging communities to ensure diverse participation. The manuscript elucidates deliberate strategies employed to recruit minority communities with poor social drivers of health for participation in COVID-19 trials. The paper adopts a descriptive approach, eschewing analysis of data-driven efficacy of these efforts, and instead provides a comprehensive account of strategies utilized. The Accelerate COVID-19 Treatment Interventions and Vaccines (ACTIV) public-private partnership launched early in the COVID-19 pandemic to develop clinical trials to advance SARS-CoV-2 treatments. In this paper, ACTIV investigators share challenges in conducting research during an evolving pandemic and approaches selected to engage communities when traditional strategies were infeasible. Lessons from this experience include importance of community representatives' involvement early in study design and implementation and integration of well-developed public outreach and communication strategies with trial launch. Centralization and coordination of outreach will allow for efficient use of resources and the sharing of best practices. Insights gleaned from the ACTIV program, as outlined in this paper, shed light on effective strategies for involving communities in treatment trials amidst rapidly evolving public health emergencies. This underscores critical importance of community engagement initiatives well in advance of the pandemic.

A crisis of confidence? Intervening in vaccine hesitancy in North Dakota

In November 2020, North Dakota reported a higher number of cases and deaths per capita from COVID-19 than any other state in the United States. Several months later, it reported one of the country's highest rates of vaccine hesitancy, leading to the development and implementation of the state-funded and physician-led "Vaccine Champion" ("VaxChamp") program. Glossing the primary problem as one of "provider confidence," the VaxChamp program emphasized a standardized, scalable intervention that targeted healthcare providers directly, and patients only indirectly. Although the program hit its quantitative benchmarks, a qualitative inquiry into the program's history and context reveals multiple crises of confidence, many beyond the bioscientific domain of the program's focus. Drawing from work in medical and linguistic anthropology, we describe and analyze the "multiple levers of vaccine confidence" at play in the intervention and its surrounding context, as well as how these crises of confidence emerged.

Why do democracies respond differently to COVID-19? A comparison of the United States and South Korea

Background

COVID-19 has posed severe challenges to crisis management in democracies. Different democracies respond to the crisis differently. This article proposes an analytical framework to explain why democracies respond differently to the public health crisis and how different contextual factors affect crisis response in democracies.

Methods

By comparing COVID-19 responses in the US and South Korea, this article conducts a comparative case study with a most similar system design. The two countries have been selected as cases because they are both developed democracies with a robust healthcare system. However, different contextual factors in the two countries have created different crisis responses by shaping different crisis leadership and political and social solidarity. This study collected data from different sources, including government documents, official websites, leaders' speeches, research reports, academic articles and news media. We tried to enhance the reliability of the data by comparing different data sources.

Results

We found that individual, institutional and cultural dimensions of contextual factors can influence different crisis responses of democratic countries by shaping crisis leadership and political and social solidarity. On the individual and institutional dimensions, leadership style and governance structure shape crisis leadership (sense making, decision making and coordinating, and meaning making), which in turn influences crisis management. On the cultural dimension, political and social solidarity measured by political polarization and social cooperation are shaped by cultural and social norms.

Conclusion

Our findings indicate that democracies require strong crisis leadership and a high degree of political and social solidarity to tackle public health crises. A centralized and coordinated system, as well as a political elite leadership style shaped by rich crisis response experience, expertise and high sensitivity to crises are conducive to crisis management. Fostering a cultural and social norm that facilitates state-society collaboration can promote crisis management. These findings provide valuable insights for decision-makers to effectively respond to future pandemics.

Association Between Partisan Affiliation of State Governments and State Mortality Rates Before and During the COVID-19 Pandemic

Policy Points The increasing political polarization of states reached new heights during the COVID-19 pandemic, when response plans differed sharply across party lines. This study found that states with Republican governors and larger Republican majorities in legislatures experienced higher death rates during the COVID-19 pandemic-and in preceding years-but these associations often lost statistical significance after adjusting for the average income and health status of state populations and for the policy orientations of the states. Future research may help clarify whether the higher death rates in these states result from policy choices or have other explanations, such as the tendency of voters with lower incomes or poorer health to elect Republican candidates.

CONTEXT

Increasing polarization of states reached a high point during the COVID-19 pandemic, when the party affiliation of elected officials often predicted their policy response. The health consequences of these divisions are unclear. Prior studies compared mortality rates based on presidential voting patterns, but few considered the partisan orientation of state officials. This study examined whether the partisan orientation of governors or legislatures was associated with mortality outcomes during the COVID-19 pandemic.

METHODS

Data on deaths and the partisan orientation of governors and legislators were obtained from the Centers for Disease Control and Prevention and the National Conference of State Legislatures, respectively. Linear regression was used to measure the association between Republican representation (percentage of seats held) in legislatures and (1) age-adjusted, all-cause mortality rates (AAMRs) in 2015-2021 and (2) excess death rates during three phases of the COVID-19 pandemic, controlling for median household income, the prevalence of four risk factors (obesity, chronic obstructive pulmonary disease, heart attack, stroke), and state policy orientation. Associations between excess death rates and the governor's party were also examined.

FINDINGS

States with Republican governors or greater Republican representation in legislatures experienced higher AAMRs during 2015-2021, lower excess death rates during Phase 1 of the COVID-19 pandemic (weeks ending March 28, 2020, through June 13, 2020), and higher excess death rates in Phases 2 and 3 (weeks ending June 20, 2020, through April 30, 2022; p < 0.05). Most associations lost statistical significance after adjustment for control variables.

CONCLUSIONS

Mortality was higher in states with Republican governors and greater Republican legislative representation before and during much of the pandemic. Observed associations could be explained by the adverse effects of policy choices, reverse causality (e.g., popularity of Republican candidates in states with lower socioeconomic and health status), or unmeasured factors that predominate in states with Republican leaders.

A Comparison of the 1918 and 2019 Pandemics in the United States

ABSTRACT

There are eerie similarities between the 1918 Spanish influenza and 2019 COVID-19 pandemics that are somewhat surprising and disheartening, given that the time interval between the 2 pandemics is more than 100 years. This article covers the national response, etiology and pathophysiology, disease course and treatments, nursing shortages, healthcare responses, sequelae following infections, and economic and social impacts of both pandemics. Understanding the development and course of both pandemics will inform clinical nurse specialists about the changes that need to be made to be better prepared to recognize the changes that need to be made to prepare for the next pandemic.

Administrative characteristics and timing of governments' crisis responses: A global study of early reactions to COVID-19

In a crisis, fast reaction is key. But what can public administration tell us about this? This study develops a theoretical framework explaining how administrative characteristics, including fragmentation, capacities, legacies and learning, affect governments' response timing. The COVID-19 pandemic is exploited as a unique empirical setting to test this framework and its scope conditions. Region fixed-effects models and survival analysis of partly hand collected data for more than 150 national governments confirm some limited predictive power of administrative structures and traditions: Especially in developing countries, governments with a separate ministry of health adopted binding containment measures faster. Countries with hierarchical administrative traditions, for example, socialist, adopted some interventions like school closures faster than more liberal traditions, for example, Anglo-American. These characteristics increase threat perception and availability of a response, respectively. Results also suggest that intracrisis and intercrisis learning supply governments with response options. The study advances comparative public administration and crisis research.

African Americans and the COVID-19 pandemic: A qualitative inquiry of preparedness, challenges, and strategies on how we can move forward

RATIONALE

The COVID-19 pandemic has disproportionately impacted Black Americans. Inequities in systems and social determinants of health along with racial health disparities impact degree of pandemic preparedness.

OBJECTIVE

In early pandemic stages, we aimed to explore: 1) state of pandemic preparedness; 2) effects of socio-ecological factors on preparedness; and 3) multi-level strategies to increase preparedness among uniquely, vulnerable Black American subgroups.

METHODS

We conducted 62 in-depth interviews with Black American community members representing parents, individuals with underlying medical conditions, essential workers, and young adults. Based on the McLeroy's Model Ecological for Health Promotion, an inductive-deductive content analysis approach was used to analyze the interview data around the factors influencing preparedness on individual, interpersonal processes and primary groups, community/institutional, and public policy.

RESULTS

Majority (56.5%) of the participants stated they were somewhat or very prepared. We identified four themes: 1) Lived Experiences during the COVID-19 Pandemic; 2) Challenges experienced during the COVID-19 Pandemic; 3) I would do this differently they say; 4) Changes Needed to Survive the Pandemic relate to Public Policy, Community/institutional factors, and Interpersonal processes and primary group(s). All participants described their adjustments to live in the new norm. Participants identified perceived challenges and solutions on multi-levels, driven by subgroup.

CONCLUSIONS

Pandemic response plans should use targeted strategies across multi-levels to enhance the preparedness of Black Americans, especially those in vulnerable groups. This could reduce the disproportionate COVID-19 disease burden exhibited by Black Americans and better prepare for future pandemics.

What matters the most in curbing early COVID-19 mortality? A cross-country necessary condition analysis

COVID-19 represents a turbulent problem: a volatile, uncertain, complex, and ambiguous crisis, in which bounded-rational policymakers may not be able to do everything right, but must do critical things right in order to reduce the death toll. This study conceptualizes these critical things as necessary conditions (NCs) that must be absent to prevent high early mortality from occurring. We articulate a policy-institution-demography framework that includes seven factors as NC candidates for high early COVID-19 mortality. Using necessary condition analysis (NCA), this study pinpoints high levels of a delayed first response, political decentralization, elderly populations, and urbanization as four NCs that have inflicted high early COVID-19 mortality across 110 countries. The results highlight the critical role of agility as a key dimension of robust governance solutions-a swift early public-health response as a malleable policy action-in curbing early COVID-19 deaths, particularly for politically decentralized and highly urbanized countries with aging populations.