Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD

Introduction

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively.

Methods

Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021.

Results

Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period.

Summary

This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.

The stock market and NO2 emissions effects of COVID‐19 around the world

In this paper, we study the impact of the coronavirus disease 2019 pandemic in estimated panel vector autoregression models for 92 countries. The large cross‐section of countries allows us to shed light on the heterogeneity of the responses of stock markets and nitrogen dioxide emissions as high‐frequency measures of economic activity. We quantify the effect of the number of infections and four dimensions of policy measures: (1) containment and closure, (2) movement restrictions, (3) economic support, and (4) adjustments of health systems. Our main findings show that a surprise increase in the number of infections triggers a drop in our two measures of economic activity. Propping up economic support measures, in contrast, raises stock returns and emissions and, thus, contributes to the economic recovery. We also document vast differences in the responses across subsets of countries and between the first and the second wave of infections.

Associations between COVID-19 Pandemic, Lockdown Measures and Human Mobility: Longitudinal Evidence from 86 Countries

Recognizing an urgent need to understand the dynamics of the pandemic’s severity, this longitudinal study is conducted to explore the evolution of complex relationships between the COVID-19 pandemic, lockdown measures, and social distancing patterns in a diverse set of 86 countries. Collecting data from multiple sources, a structural equation modeling (SEM) technique is applied to understand the interdependencies between independent variables, mediators, and dependent variables. Results show that lockdown and confinement measures are very effective to reduce human mobility at retail and recreation facilities, transit stations, and workplaces and encourage people to stay home and thereby control COVID-19 transmission at critical times. The study also found that national contexts rooted in socioeconomic and institutional factors influence social distancing patterns and severity of the pandemic, particularly with regard to the vulnerability of people, treatment costs, level of globalization, employment distribution, and degree of independence in society. Additionally, this study portrayed a mutual relationship between the COVID-19 pandemic and human mobility. A higher number of COVID-19 confirmed cases and deaths reduces human mobility and the countries with reduced personal mobility have experienced a deepening of the severity of the pandemic. However, the effect of mobility on pandemic severity is stronger than the effect of pandemic situations on mobility. Overall, the study displays considerable temporal changes in the relationships between independent variables, mediators, and dependent variables considering pandemic situations and lockdown regimes, which provides a critical knowledge base for future handling of pandemics. It has also accommodated some policy guidelines for the authority to control the transmission of COVID-19.

The Impacts of COVID-19 on Distance Education with the Application of Traditional and Digital Appliances: Evidence from 60 Developing Countries

Educational disruptions from the COVID-19 pandemic during school closures have become a remarkable social issue, particularly among the developing countries. Ample literature has verified the adverse effects of the long-lasing epidemic on school education. However, rare studies seek to understand the association between the severity of COVID-19 and distance learning, an alternative education pattern, and foster policy designs to promote educational transition, particularly targeting the post-crisis phase of the COVID-19. By combining four data surveys, this article empirically examines the impacts of COVID-19 on children's distance education with the application of various appliances across 60 developing countries. The results suggest that, after controlling socio-economic, geographic, and demographic variables, a higher level of mortality rate of COVID-19 contributes to more households participating in distance education. In particular, this positive term is larger for distance education by using TVs and radios compared with the usage of digital appliances. To explore the potential channel of the above linkage, this article argues that the positive association between mortality rate and the use of traditional appliances is weakened through higher levels of stringency in lockdown measures. Timely policies are, therefore, recommended to guide towards distance learning with economic and technological supports to guarantee a wave of inclusive educational recovery in the ongoing post-COVID-19 era.

The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis

Background

The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood.

Objective

We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets.

Methods

We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a “no-lockdown” and a “lockdown” stage. COVID-19–related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices.

Results

We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage.

Conclusions

The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions.

Comparison of PM2.5 and CO2 Concentrations in Large Cities of China during the COVID-19 Lockdown

Estimating the impacts on PM_2.5 pollution and CO₂ emissions by human activities in different urban regions is important for developing efficient policies. In early 2020, China implemented a lockdown policy to contain the spread of COVID-19, resulting in a significant reduction of human activities. This event presents a convenient opportunity to study the impact of human activities in the transportation and industrial sectors on air pollution. Here, we investigate the variations in air quality attributed to the COVID-19 lockdown policy in the megacities of China by combining in-situ environmental and meteorological datasets, the Suomi-NPP/VIIRS and the CO₂ emissions from the Carbon Monitor project. Our study shows that PM_2.5 concentrations in the spring of 2020 decreased by 41.87% in the Yangtze River Delta (YRD) and 43.30% in the Pearl River Delta (PRD), respectively, owing to the significant shutdown of traffic and manufacturing industries. However, PM_2.5 concentrations in the Beijing-Tianjin-Hebei (BTH) region only decreased by 2.01% because the energy and steel industries were not fully paused. In addition, unfavorable weather conditions contributed to further increases in the PM_2.5 concentration. Furthermore, CO₂ concentrations were not significantly affected in China during the short-term emission reduction, despite a 19.52% reduction in CO₂ emissions compared to the same period in 2019. Our results suggest that concerted efforts from different emission sectors and effective long-term emission reduction strategies are necessary to control air pollution and CO₂ emissions.

Effects of Relaxed Lockdown on Pediatric ER Visits during SARS-CoV-2 Pandemic in Italy

Previously, we demonstrated an 81% reduction in pediatric Emergency Room (ER) visits in Italy during the strict lockdown due to the SARS-CoV-2 pandemic. Since May 2020, lockdown measures were relaxed until 6 November 2020, when a strict lockdown was patchily reintroduced. Our aim was to evaluate the impact of the relaxed lockdown on pediatric ER visits in Italy. We performed a retrospective multicenter study involving 14 Italian pediatric ERs. We compared total ER visits from 24 September 2020 to 6 November 2020 with those during the corresponding timeframe in 2019. We evaluated 17 ER specific diagnoses grouped in air communicable and non-air communicable diseases. We recognized four different triage categories: white, green, yellow and red. In 2020 total ER visits were reduced by 51% compared to 2019 (16,088 vs. 32,568, respectively). The decrease in air communicable diseases was significantly higher if compared to non-air communicable diseases (-64% vs. -42%, respectively). ER visits in each triage category decreased in 2020 compared to 2019, but in percentage, white and red codes remained stable, while yellow codes slightly increased and green codes slightly decreased. Our results suggest that preventive measures drastically reduced the circulation of air communicable diseases even during the reopening of social activities but to a lesser extent with regard to the strict lockdown period (March-May 2020).

PROXEMICS, COVID-19, AND THE ETHICS OF CARE IN SOUTH AFRICA

In South Africa, lockdown and its excesses have opened up questions on the limits of an ethics of care, whose ethics are privileged, how care is delivered, and what care means. We show how an ethics of proxemics and its operationalization as distance highlight everyday inequalities and limit the provision of care. Constraints on physical distancing in line with public health measures intended to limit the spread of the coronavirus echo the controls enforced under apartheid, showing how inequality is both embodied and legally entrenched.

Impact of the First Wave of the COVID-19 Pandemic on HIV/AIDS Programming in Kenya: Evidence from Kibera Informal Settlement and COVID-19 Hotspot Counties

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018–2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%–62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%–77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%–49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.

Lockdown Measures Which Reduced Greenhouse Gas Emissions With Little Negative Impact on Quality of Life

Lockdown measures in response to the new Covid-19 virus have caused the largest ever fall of annual greenhouse gas emissions. A key question that we attempt to answer in this study is which, if any, of these measures can be productively encouraged post-lockdown in efforts to sustain at least part of this reduction in emissions. Sweden is uniquely suited for our study because the voluntary nature of lockdown in Sweden allowed us to assess the level of compliance to recommendations and its effects on greenhouse gas emissions. First, we assessed the change of perceived quality of life (QOL) among 746 individuals from Stockholm region due to adhering to lockdown measures. Second, we calculated the associated change of annual per capita greenhouse emissions. We found that avoiding travel for work, avoiding purchasing, and avoiding restaurants had the least negative effect on QOL, and at the same time the largest positive effect on carbon dioxide equivalent (CO2e) emission reductions. We conclude that these are potential leverage points for stimulating behavioral change that has a positive climatic impact.

A Phylodynamic Workflow to Rapidly Gain Insights into the Dispersal History and Dynamics of SARS-CoV-2 Lineages

Since the start of the COVID-19 pandemic, an unprecedented number of genomic sequences of SARS-CoV-2 have been generated and shared with the scientific community. The unparalleled volume of available genetic data presents a unique opportunity to gain real-time insights into the virus transmission during the pandemic, but also a daunting computational hurdle if analyzed with gold-standard phylogeographic approaches. To tackle this practical limitation, we here describe and apply a rapid analytical pipeline to analyze the spatiotemporal dispersal history and dynamics of SARS-CoV-2 lineages. As a proof of concept, we focus on the Belgian epidemic, which has had one of the highest spatial densities of available SARS-CoV-2 genomes. Our pipeline has the potential to be quickly applied to other countries or regions, with key benefits in complementing epidemiological analyses in assessing the impact of intervention measures or their progressive easement.

Impacts of introducing and lifting nonpharmaceutical interventions on COVID-19 daily growth rate and compliance in the United States

We evaluate the impacts of implementing and lifting nonpharmaceutical interventions (NPIs) in US counties on the daily growth rate of COVID-19 cases and compliance, measured through the percentage of devices staying home, and evaluate whether introducing and lifting NPIs protecting selective populations is an effective strategy. We use difference-in-differences methods, leveraging on daily county-level data and exploit the staggered introduction and lifting of policies across counties over time. We also assess heterogenous impacts due to counties' population characteristics, namely ethnicity and household income. Results show that introducing NPIs led to a reduction in cases through the percentage of devices staying home. When counties lifted NPIs, they benefited from reduced mobility outside of the home during the lockdown, but only for a short period. In the long term, counties experienced diminished health and mobility gains accrued from previously implemented policies. Notably, we find heterogenous impacts due to population characteristics implying that measures can mitigate the disproportionate burden of COVID-19 on marginalized populations and find that selectively targeting populations may not be effective.

Changes in Food Consumption During the COVID-19 Pandemic: Analysis of Consumer Survey Data From the First Lockdown Period in Denmark, Germany, and Slovenia

This paper focuses on changes in food consumption that occurred during the COVID-19 pandemic. Its objective is to map changes at individual consumer level and identify the influence of different factors related to the COVID-19 pandemic on changes in individual food consumption. We conducted a cross-sectional online survey among 2,680 residents of Denmark (DK), Germany (DE), and Slovenia (SI) using quota sampling for gender, age and regional distribution. Data on consumption frequencies before and during the pandemic were collected with a food frequency questionnaire in the spring of 2020 (during the first lockdown period) for important types of fresh food and non-perishable food. Our results showed that, depending on the type of food, 15–42% of study participants changed their consumption frequency during the pandemic, compared to before. In all the study countries, the food categories with the highest rates of change were frozen food, canned food, and cake and biscuits; among the food categories with lower rates of change were bread, alcoholic drinks, and dairy products. People across all three countries shopped less frequently during lockdown and there was an overall reduction in the consumption of fresh foods, but an increase in the consumption of food with a longer shelf life in Denmark and Germany. Interestingly though, we observed diverging trends in all food categories analyzed, with some people decreasing and others increasing their consumption frequencies, demonstrating that the pandemic had different impacts on people's lifestyles and food consumption patterns. Using the method of multinomial regression analysis, we identified factors significantly (p < 0.01, p < 0.05, p < 0.1) related to increases and decrease in individuals' consumption frequencies in different food categories. The factors include restrictions put in place in response to the pandemic (i.e., closure of physical workplaces, canteens, cafés and restaurants, schools, and childcare institutions), changes in households' grocery shopping frequency, individuals' perceived risk of COVID-19, income losses due to the pandemic, and socio-demographic factors. Interesting differences between the countries were detected, allowing insights into the different food cultures. Conclusions include implications for policy-makers and actors in the food supply chain on the issues of healthy diets, food system resilience, and behavior change.

Psychological distress in the Greek general population during the first COVID-19 lockdown

BACKGROUND

SARS-CoV-2 has rapidly spread worldwide, threatening public health and financial and social life.

AIMS

The current study's aim was to determine the prevalence of psychological distress and post-traumatic stress symptoms in the Greek population during the first COVID-19 lockdown, and to detect potential correlates.

METHOD

An anonymous online survey was conducted between 10 April and 4 May 2020, to collect information regarding people's psychological functioning and COVID-19-related perceptions.

RESULTS

A total of 1443 individuals completed the survey; 293 (20%) reported clinically significant anxiety symptoms, 188 (12.9%) reported clinically significant depressive symptoms and 506 (36.4%) suffered from definite post-traumatic stress disorder. Anxiety symptoms were independently associated with female gender (β = 1.281, 95% CI 0.808-1.755, P < 0.001), educational level (β = -1.570, 95% CI -2.546 to -0.595, P = 0.002), perceived severity (β = -1.745, 95% CI -3.146 to -0.344, P = 0.015) and COVID-19-related worry (β = 7.633, 95% CI 6.206-9.060, P < 0.001). Depressive symptoms were strongly correlated with educational level (β = -1.298, 95% CI -2.220 to -0.377, P = 0.006), perceived severity (β = -1.331, 95% CI -2.579 to -0.082, P = 0.037) and COVID-19-related worry (β = 4.102, 95% CI 2.769-5.436, P < 0.001). Finally, post-traumatic stress symptoms were linked to female gender (β = 6.451, 95% CI 4.602-8.299, P < 0.001), educational level (β = -5.737, 95% CI -9.479 to -1.996, P = 0.003), psychiatric history (β = -4.028, 95% CI -6.274 to -1.782, P < 0.001) and COVID-19-related worry (β = 23.865, 95% CI 18.201-29.530, P < 0.001).

CONCLUSIONS

A significant percentage of the population reported clinically important anxiety, depressive and post-traumatic stress symptoms. Women, less-educated individuals and people with a psychiatric history appeared more vulnerable to the pandemic's psychological impact.

The Differential Impact of Lockdown Measures Upon Migrant and Female Psychiatric Patients - A Cross-Sectional Survey in a Psychiatric Hospital in Berlin, Germany

The COVID-19 pandemic could have major effects on already vulnerable individuals with psychiatric disorders. It is important to assess how different patient groups respond to stress related to the pandemic, and what additional factors influence it, including family-related stress, migration background, and sex. We conducted a survey in a sample of 294 psychiatric patients in a large outpatient clinic in Berlin, measuring level of distress in relation to COVID-19 lockdown as well as family-related distress. We also measured potential influencing factors such as media consumption and medical support. In the migration background group, we found that women had more lockdown related psychological distress than men. This was not apparent in those patients with a German background. We found that females were more strongly affected by family-related distress, particularly those with a migration background. People with PTSD were most strongly affected by family-related distress, whereas people with psychotic disorders and addiction reported the least distress. There were no effects of media consumption. There were no differences in ability to abide by the lockdown related restrictions across diagnoses. Our results support earlier findings on differential vulnerability of diagnostic groups to these stressors. Thus, clinicians can optimize treatment by taking family-related stressors into account particularly for females and people with a migrant background.

SARS-CoV-2 Pandemic Impact on Pediatric Emergency Rooms: A Multicenter Study

From 9 March to 3 May 2020, lockdown was declared in Italy due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Our aim was to evaluate how the SARS-CoV-2 pandemic and related preventive strategies affected pediatric emergency rooms (ERs) during this period. We performed a retrospective cohort multicenter study, comparing the lockdown period to the corresponding period in 2019. We examined 15 Italian pediatric ERs in terms of visit rates, specific diagnoses (grouped as air communicable diseases and non-air communicable diseases), and triage categories. During the lockdown period, ER admissions decreased by 81% compared to 2019 (52,364 vs. 10,112). All ER specific diagnoses decreased in 2020 and this reduction was significantly higher for air communicable diseases (25,462 vs. 2934, p < 0.001). Considering the triage category, red codes remained similar (1% vs. 1%), yellow codes increased (11.2% vs. 22.3%), and green codes decreased (80.3% vs. 69.5%). We can speculate that social distancing and simple hygiene measures drastically reduced the spread of air communicable diseases. The increase in yellow codes may have been related to a delay in primary care and, consequently, in ER admissions.

Are Lockdown Measures Effective Against COVID-19?

As the Coronavirus Disease 2019 (COVID-19) pandemic progresses, countries around the world are increasingly implementing a range of responses that are intended to help prevent the transmission of this disease. In the absence of a COVID-19 vaccine, we assess the potential role of containment measures to suppress the virus transmission, thereby slowing down the growth rate of cases and rapidly reducing case incidence. The aim of this study is to show that country lockdown has a critical and significant impact on the pandemic. This is explored using real time incidence data in Lebanon. We analyze COVID-19 cases in Lebanon before and after lockdown measures have been implemented. The findings show that the nationwide lockdown was effective in reducing cases and has been successful in, so far, containing the virus. This study could be an evidence-based call to continue with the lockdown measures, based on real time incidence data. Further research is encouraged.

Novel Criteria for When and How to Exit a COVID-19 Pandemic Lockdown

In the first month of 2020, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus spreading quickly via human-to-human transmission, caused the coronavirus disease 2019 (COVID-19) pandemic. Italy installed a successful nationwide lockdown to mitigate the exponential increase of case numbers, as the basic reproduction number R0 reached 1 within 4 weeks. But is R0 really the relevant criterion as to whether or not community spreading is under control? In most parts of the world, testing largely focused on symptomatic cases, and we thus hypothesized that the true number of infected cases and relative testing capacity are better determinants to guide lockdown exit strategies. We employed the SEIR model to estimate the numbers of undocumented cases. As expected, the estimated numbers of all cases largely exceeded the reported ones in all Italian regions. Next, we used the numbers of reported and estimated cases per million of population and compared it with the respective numbers of tests. In Lombardy, as the most affected region, testing capacity per reported new case seemed between two and eight most of the time, but testing capacity per estimated new cases never reached four up to April 30. In contrast, Veneto's testing capacity per reported and estimated new cases were much less discrepant and were between four and 16 most of the time. As per April 30 also Marche, Lazio and other Italian regions arrived close to 16 ratio of test capacity per new estimated infection. Thus, the criterion to exit a lockdown should be decided at the level of the regions, based on the local testing capacity that should reach 16 times the estimated true number of newly infected cases as predicted.

Is Lockdown Bad for Social Anxiety in COVID-19 Regions?: A National Study in The SOR Perspective

Lockdown measures have been widely used to control and prevent virus transmission in pandemic regions. However, the psychological effects of lockdown measures have been neglected, and the related theoretical research lags behind the practice. The present study aimed to better understand the mechanism of social anxiety in pandemic regions where the lockdown measures were imposed, based on the conceptual framework of the Stimulus-Organism-Response (SOR). For that, this research investigated how lockdown measures and psychological distance influenced social anxiety in the pandemic region. The Chinese national data was analyzed for the outcome. The results showed that (1) psychological distance mediated the relationship between pandemic COVID-19 severity and social anxiety, (2) lockdown measures buffered the detrimental effect of the COVID-19 pandemic severity on social anxiety, (3) lockdown measures moderated the mediation effect of psychological distancing on social anxiety caused by the COVID-19 pandemic. In conclusion, under the SOR framework, the lockdown measures had a buffer effect on social anxiety in pandemic regions, with the mediating role of psychological distancing.