Changes in Satisfaction with Meaningful Activities and Onset of Depressive Symptoms among Community-Dwelling Japanese Older Adults: A Population-Based Study Before and During the COVID-19 Pandemic

ObjectivesThis study aimed to clarify the association between changes in satisfaction with meaningful activities and the occurrence of depressive symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic.DesignA population-based prospective cohort study (Tarumizu Study).Setting and ParticipantsA total of 231 community-dwelling older adults aged ≥65 years without depressive symptoms at baseline.MethodsThe participants completed baseline (June to December 2018, before the COVID-19 pandemic) and follow-up (September to December 2021, during the COVID-19 pandemic) assessments. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, and their satisfaction levels were evaluated. Satisfaction with the most meaningful activities was assessed as to whether it was maintained/improved or decreased at follow-up.ResultsIn the follow-up survey, 31 (14.3%) participants reported the occurrence of depressive symptoms. Compared with before the COVID-19 pandemic, the rates of meaningful activities during the COVID-19 pandemic decreased for interpersonal interaction and social life and increased for leisure, sports, self-care, and domestic life. Logistic regression analysis revealed that changes in satisfaction with meaningful activity were associated with the occurrence of depressive symptoms after adjusting for demographic variables, baseline GDS scores, cognitive and physical status, and instrumental activities of daily living (odds ratio, 2.78; 95% confidence interval, 1.17–6.59, P = .020).Conclusions and ImplicationsTo avoid decreasing satisfaction with meaningful activities, supporting older adults may be protective against the occurrence of depressive symptoms. Our findings highlight the need for health care professionals to not only encourage older adults to participate in activities for their mental health but also consider whether the activities are meaningful or satisfying for them.     

Adolescents' Perceived Socio-Emotional Impact of COVID-19 and Implications for Mental Health: Results From a U.S.-Based Mixed-Methods Study

PurposeCOVID-19 has disrupted many aspects of adolescents' lives, yet little data are available that document their subjective experiences of the pandemic. In a mixed-methods study of U.S. adolescents, we examined (1) adolescents' perceptions of how their social and emotional lives had changed during COVID-19; and (2) associations between these perceived changes and indices of their mental health, above and beyond their prepandemic mental health status.MethodsFour hundred seven U.S. adolescents (M_age = 15.24, standard deviation = 1.69; 50% female; 52%, 20% African American, 17% Hispanic/Latinx) completed surveys before (October 2019) and during (April 2020) the COVID-19 pandemic. They provided qualitative and quantitative responses on their experiences with COVID-19 and reports of their mental health.ResultsAdolescents perceived various changes in their relationships with family and friends (e.g., less perceived friend support) during COVID-19. They also perceived increases in negative affect and decreases in positive affect. These perceived social and emotional changes were associated with elevated depressive symptoms, anxiety symptoms, and loneliness in April 2020, controlling for mental health problems before the pandemic.ConclusionsOur findings sensitize clinicians and scholars to the vulnerabilities (changes in friendship dynamics), as well as resiliencies (supportive family contexts), presented to U.S. adolescents during the early months of COVID-19.     

Brief report: The impact of the COVID-19 pandemic on health behaviors in adolescents with Autism Spectrum Disorder

BackgroundThere is concern that the COVID-19 pandemic may negatively affect health behaviors in youth, especially youth diagnosed with Autism Spectrum Disorder (ASD).ObjectiveThe purpose of this paper was to examine changes in physical activity, screen-time, and sleep in adolescents with ASD due to the COVID-19 pandemic.MethodsNine adolescents with ASD completed surveys measuring physical activity, screen-time, and sleep duration prior to and during the pandemic.ResultsA significant decrease in days of physical activity (4.17 vs 2.27; p = 0.0006), and a significant increase in hours of both weekday (3.69 vs 6.25; p = 0.007) and weekend screen-time (5.94 vs. 7.39; p = 0.004) was observed during the pandemic. No changes regarding sleep duration was observed.ConclusionsAlthough preliminary, results suggest that physical activity and screen-time may be negatively affected by the COVID-19 outbreak in youth with ASD. The development of interventions to promote health behaviors in ASD populations during long periods of less-structured time (quarantine) should be considered.     

Changes in life experiences of adults with intellectual disabilities in the COVID-19 pandemics in South Korea

BackgroundThe COVID-19 pandemic has had a significant impact on adults with intellectual disabilities who are dependent on community services.ObjectiveThis study explored the experiences of adults with intellectual disabilities from their perspective during the COVID-19 pandemic in South Korea, where most community-based services were suspended.MethodsWe conducted in-depth interviews with 15 adults with intellectual disabilities who lost access to services during COVID-19 pandemic. Inductive thematic analysis was conducted.ResultsFive overarching themes emerged: changes in (a) daily life, (b) health behaviors, (c) family relationships, (d) social relationships, and (e) social participation. Most participants experienced the loss of daily routines and healthy behaviors, family conflicts, and social isolation, but they also developed new ways of adapting and finding a new normal.ConclusionsThe findings offer valuable evidence of ways to develop and stabilize community-based services during a pandemic, with insights into the experiences of people with intellectual disabilities.     

Depressive Symptoms Among Older Adults Pre– and Post–COVID-19 Pandemic

ObjectivesIt is a concern that public health measures to prevent older people contracting COVID-19 could lead to a rise in mental health problems such as depression.The aim of this study therefore is to examine trends of depressive symptoms before and during the COVID-19 pandemic in a large cohort of older people.DesignObservational study with 6-year follow-up.Setting & ParticipantsMore than 3000 community-dwelling adults aged ≥60 years participating in The Irish Longitudinal Study on Ageing (TILDA).MethodsMixed effects multilevel models were used to describe trends in depressive symptoms across 3 waves of TILDA: wave 4 (2016), wave 5 (2018), and a final wave conducted July-November 2020. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D), with a score ≥9 indicating clinically significant symptoms.ResultsThe prevalence of clinically significant depressive symptoms at waves 4 and 5 was 7.2% [95% confidence interval (CI) 6.5, 7.9] and 7.2% (95% CI 6.5, 8.0), respectively. This more than doubled to 19.8% (95% CI 18.5, 21.2) during the COVID-19 pandemic. There was no change in CES-D scores between waves 4 and 5 (β = 0.09, 95% CI –0.04, 0.23), but a large increase in symptoms was observed during the pandemic (β = 2.20, 95% CI 2.07, 2.33). Age ≥70 years was independently associated with depressive symptoms (β = 0.45, 95% CI 0.18, 0.72) during the pandemic but not from wave 4 to 5 (β = 0.09, 95% CI –0.18, 0.36). Living with others was associated with a lower burden of symptoms during the pandemic (β = −0.40, 95% CI –0.71, −0.09) but not between waves 4 and 5 (β = −0.40, 95% CI –0.71, −0.09).Conclusions and ImplicationsThis study demonstrates significant increases in the burden of depressive symptoms among older people during the COVID-19 pandemic, particularly those aged ≥70 years and/or living alone. Even a small increase in the incidence of late life depression can have major implications for health care systems and societies in general. Improving access to age-attuned mental health care should therefore be a priority.     

Adolescent Independent Eating Occasions,Dietary Intake,and Parenting Practices During the COVID-19 Pandemic: A Qualitative Study of Parents and Adolescents From Households With Low Income

ObjectiveExamine how experiencing the coronavirus disease 2019 (COVID-19) pandemic influenced adolescent independent eating occasions (iEOs) and iEO-related parenting practices from the perspective of parents and adolescentsMethodsCross-sectional remote interviews were conducted for this basic qualitative research study. Participants were a purposive sample of multiracial/ethnic adolescents aged 11–14 years and their parents from households with low income (n = 12 dyads) representing 9 US states. The main outcome measures were iEOs and iEO-related parenting practices. Data were analyzed using directed content analysis.ResultsAbout half of the parents indicated that their adolescents had more iEOs during the COVID-19 pandemic and that there were changes in the types of foods consumed during iEOs. In contrast, most adolescents indicated their iEOs had not changed remarkably in frequency or foods consumed since the onset of the pandemic. Most parents reported no change in how they taught their adolescents about healthy food, the rules for foods/beverages permitted during iEOs, or how they monitored what their adolescents ate during iEOs; adolescent reports were in general agreement. Most parents indicated that family members were home together more often during the pandemic, which increased cooking frequency.Conclusions and ImplicationsThe effect of the COVID-19 pandemic on adolescents’ iEOs varied, and the parenting practices used to influence iEOs remained stable during the pandemic. Families experienced having more time together and cooking at home more often.     

Disaster Management and School Nutrition: A Qualitative Study of Emergency Feeding During the COVID-19 Pandemic

BackgroundSchool nutrition programs mitigate child food insecurity across the United States. With the onset of the coronavirus disease 2019 (COVID-19) pandemic, kindergarten through grade 12 physical school campuses closed, which led to those programs transitioning to emergency feeding. The Sendai Framework for Disaster Risk Reduction has 4 action priorities that guided the assessment of school nutrition employees’ emergency response during the COVID-19 pandemic.ObjectiveOur aim was to explore the experience of school nutrition employees as they provided emergency feeding services during the COVID-19 pandemic and evaluate their actions based on the Sendai Framework for Disaster Risk Reduction .DesignA qualitative study with semi-structured interviews (n = 34) was conducted via videoconferencing software. A purposive sample of school nutrition employees across all 7 US Department of Agriculture regions who were involved in the COVID-19 emergency feeding response participated during April and May 2020.Participants/settingSchool nutrition employees were selected randomly for participation from those indicating willingness to be interviewed during their participation in a related survey. Recruitment continued until all 7 US Department of Agriculture regions were represented. Participants held various roles, ranging from state agency leaders to front-line supervisors, although most were district-level directors or assistant directors.AnalysisData were analyzed using a phenomenological qualitative analytic approach.ResultsFour themes emerged. First, participants described the progression of the initial shock associated with the pandemic and service disruption, the flexibility they practiced, and the development of new routines. Second, keeping people (children, coworkers, and the community) safe was highlighted. The next theme captured participants’ feeling that they came “out of the shadows” as communities and stakeholders recognized their important contribution to children’s food security. Finally, they shared insight on communication and accountability during the emergency feeding response.ConclusionsThese programs demonstrated flexibility, resilience, and commitment to children during this crisis. As the pandemic continues and future disasters are considered, school nutrition programs and leaders can use the Sendai Framework for Disaster Risk Reduction’s “build back better” concept to refine disaster preparedness plans and advocate for changes that will continue to combat child food insecurity in the United States.     

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic.MethodsA sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income).ResultsAbout 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18–29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 (‘very worried’ AOR = 8.00, p < 0.001).ConclusionPandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.     

Impact of the COVID-19 pandemic on daily life,mood, and behavior of adults with Down syndrome

BackgroundThe Down syndrome population has been disproportionately affected by Coronavirus 2019 (COVID-19) in terms of experiencing severe illness and death. Societal efforts to curb the spread of COVID-19 may also have taken a heavy toll on the daily lives of individuals with Down syndrome.Objective/hypothesisThe goal of the study was to understand how the COVID-19 pandemic has altered daily life (including residence, employment, and participation in adult disability day programs) and influenced the mood and behavior of adults with Down syndrome.MethodsBetween September 2020 and February 2021, caregivers of 171 adults with Down syndrome (aged 22–66 years) located across the United States and in the United Kingdom enrolled in the Alzheimer's Biomarker Research Consortium on Down Syndrome (ABC-DS) completed a survey.ResultsThe residence of 17% of individuals was altered, and 89% of those who had been employed stopped working during the pandemic. One-third (33%) of individuals were reported to be more irritable or easily angered, 52% were reported to be more anxious, and 41% were reported to be more sad/depressed/unhappy relative to prepandemic. The majority of changes in mood and behavior were of modest severity.ConclusionsThe COVID-19 pandemic has had widespread effects on the daily life and mood and behavior of adults with Down syndrome. In the short term, caregivers and providers should be prepared to help adults with Down syndrome with changes in daily routines, residence, employment, or adult disability day programs as society shifts away from COVID-19 safety protocols.     

Assessing the association between area deprivation index on COVID-19 prevalence: a contrast between rural and urban U.S. jurisdictions

BackgroundThe COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S.ObjectivesTo understand the spread and impact of COVID-19 across the U.S., county level data for confirmed cases of COVID-19 were examined by Area Deprivation Index (ADI) and Metropolitan vs. Nonmetropolitan designations from the National Center for Health Statistics (NCHS). These designations were the basis for making comparisons between Urban and Rural jurisdictions.MethodKendall''s Tau-B was used to compare effect sizes between jurisdictions on select ADI composites and well researched social determinants of health (SDH). Spearman coefficients and stratified Poisson modeling was used to explore the association between ADI and COVID-19 prevalence in the context of county designation.ResultsResults show that the relationship between area deprivation and COVID-19 prevalence was positive and higher for rural counties, when compared to urban ones. Family income, property value and educational attainment were among the ADI component measures most correlated with prevalence, but this too differed between county type.ConclusionsThough most Americans live in Metropolitan Areas, rural communities were found to be associated with a stronger relationship between deprivation and COVID-19 prevalence. Models predicting COVID-19 prevalence by ADI and county type reinforced this observation and may inform health policy decisions.     

Lack of association between vaccination rates and excess mortality in Cyprus during the COVID-19 pandemic

BackgroundIt has been claimed that COVID-19 vaccination is associated with excess mortality during the COVID-19 pandemic, a claim that contributes to vaccine hesitancy. We examined whether all-cause mortality has actually increased in Cyprus during the first two pandemic years, and whether any increases are associated with vaccination rates.MethodsWe calculated weekly excess mortality for Cyprus between January 2020 and June 2022, overall and by age group, using both a Distributed Lag Nonlinear Model (DLNM) adjusted for mean daily temperature, and the EuroMOMO algorithm. Excess deaths were regressed on the weekly number of confirmed COVID-19 deaths and on weekly first-dose vaccinations, also using a DLNM to explore the lag-response dimension.Results552 excess deaths were observed in Cyprus during the study period (95% CI: 508–597) as opposed to 1306 confirmed COVID-19 deaths. No association between excess deaths and vaccination rates was found overall and for any age group except 18–49 years, among whom 1.09 excess deaths (95% CI: 0.27–1.91) per 10,000 vaccinations were estimated during the first 8 weeks post-vaccination. However, detailed cause-of-death examination identified just two such deaths potentially linked to vaccination, therefore this association is spurious and attributable to random error.ConclusionsExcess mortality was moderately increased in Cyprus during the COVID-19 pandemic, primarily as a result of laboratory-confirmed COVID-19 deaths. No relationship was found between vaccination rates and all-cause mortality, demonstrating the excellent safety profile of COVID-19 vaccines.     

Brief Cost Analysis of Surgical Personal Protective Equipment During the COVID-19 Pandemic

ObjectivesThis study aimed to compare the costs incurred and saved from universal use of N95 respirators with surgical masks for operating room providers in the United States during the COVID-19 pandemic.MethodsWe built a decision analytic model to compare direct medical costs of healthcare workers (HCWs) infected with COVID-19 during operating room procedures from expected transmission when using an N95 respirator relative to a surgical mask. We also examined quarantine costs.ResultsResults varied depending upon prevalence and false-negative rates of tests, but if N95 respirators reduce transmission by 2.8%, prevalence is at 1%, and testing yields 20% false negatives, providers should be willing to pay an additional $0.64 per HCW for the additional protection. Under this scenario, approximately 11 COVID-19 cases would be averted among HCWs per day.ConclusionsPotential savings depend on disease prevalence, rate of asymptomatic patients with COVID-19, accuracy of testing, the marginal cost of respirators, and the quarantine period. We provide a range of calculations to show under which conditions N95 respirators are cost saving.     

Indicators of poor mental health and stressors during the COVID-19 pandemic,by disability status: A cross-sectional analysis

BackgroundEvidence from previous public health emergencies indicates that adults with disabilities have higher risk for morbidity (physical and mental) and mortality than adults without disabilities.ObjectiveTo provide estimates of mental health indicators and stressors for US adults by disability status during April and May 2020, shortly following the emergence of the COVID-19 pandemic.MethodsWe analyzed data from Porter Novelli View 360 opt-in Internet panel survey conducted during the weeks of April 20th and May 18th^, 2020 among 1004 English-speaking adults aged ≥18 years without and with disabilities (serious difficulty with hearing, vision, cognition, or mobility; any difficulty with self-care or independent living). Weighted logistic regression was used to test for significant differences between calculated prevalence estimates at the P ≤ .05 level.ResultsOne in four adults reported any disability. Adults with any disability were significantly more likely than adults without disability to report current depressive symptoms, frequent mental distress, suicidal ideation, and COVID-19-related initiated or increased substance use (all p values < .0001). Adults with disabilities also reported significantly higher levels of stressors, such as access to health care services (p < .0001), difficulty caring for their own (or another’s) chronic condition (p < .0001), emotional or physical abuse from others (p < .001), and not having enough food (p < .01).ConclusionsThe disproportionately high levels of poor mental health indicators among adults with disabilities as compared to those without highlight the importance of delivering timely mental health screening and treatment/intervention during and after the COVID-19 pandemic to persons with disabilities.     

COVID-19 Quarantine-Related Mental Health Symptoms and their Correlates among Mothers: A Cross Sectional Study

Background

One of the strictest quarantines worldwide to limit the spread of coronavirus was enforced in Jordan during the COVID-19 pandemic.

Objectives

This study investigated reported mental health and changes in lifestyle practices among Jordanian mothers during COVID-19 quarantine. The specific objectives included studying the level of depression, anxiety, and stress symptoms and their potential statistical associations with demographic and lifestyle variables. Furthermore, the study aimed to investigate differences in mental health between different demographic and socio-economic groups and to examine the major lifestyle changes that occurred on mothers during the quarantine.

Methods

An online survey was developed and administered to 2103 mothers. Participants were asked to complete a sociodemographic data form, Depression, Anxiety, and Stress Scale (DASS-21), and a lifestyle section comparing the life of mothers before and during the quarantine. Reported scores of depression, anxiety, and stress were calculated and compared across different levels of demographics including income, education level, employment status, and city of residence.

Results

This study found that mothers with lower income, lower education, not employed, or living in cities outside the capital of Jordan reported having more depression, anxiety, and stress symptoms (p < .005). Changes in their lifestyle practices included weight gain, increased time allocated for teaching children at home, increased familial violence at home, and increased time allocated for caring for their family members (average increase of 5 hours daily).

Conclusions for Practice

The unprecedented times of quarantine have put mothers in unprecedented reported mental health problems. Providing psychological support to this group might be a priority.

     

Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing

BackgroundOnline media play an important role in public health emergencies and serve as essential communication platforms. Infoveillance of online media during the COVID-19 pandemic is an important step toward gaining a better understanding of crisis communication.ObjectiveThe goal of this study was to perform a longitudinal analysis of the COVID-19–related content on online media based on natural language processing.MethodsWe collected a data set of news articles published by Croatian online media during the first 13 months of the pandemic. First, we tested the correlations between the number of articles and the number of new daily COVID-19 cases. Second, we analyzed the content by extracting the most frequent terms and applied the Jaccard similarity coefficient. Third, we compared the occurrence of the pandemic-related terms during the two waves of the pandemic. Finally, we applied named entity recognition to extract the most frequent entities and tracked the dynamics of changes during the observation period.ResultsThe results showed no significant correlation between the number of articles and the number of new daily COVID-19 cases. Furthermore, there were high overlaps in the terminology used in all articles published during the pandemic with a slight shift in the pandemic-related terms between the first and the second waves. Finally, the findings indicate that the most influential entities have lower overlaps for the identified people and higher overlaps for locations and institutions.ConclusionsOur study shows that online media have a prompt response to the pandemic with a large number of COVID-19–related articles. There was a high overlap in the frequently used terms across the first 13 months, which may indicate the narrow focus of reporting in certain periods. However, the pandemic-related terminology is well-covered.     

Spatio-Temporal Clustering of Adolescent Bereavement in the United States During the Extended Response to COVID-19: A Follow-Up Study

PurposeThis follow-up study investigated the spatio-temporal clustering of adolescent bereavement during the extended response to COVID-19 from October 2020–January 2022 in the continental United States.MethodsDeidentified and anonymized bereavement data from Crisis Text Line (CTL), a text-based crisis intervention service, and SaTScan cluster analysis were used to identify space-time clustering of bereavement among adolescents, aged 24 years and less, during the COVID-19 pandemic.ResultsClustering of bereavement conversations occurred during waves of high COVID-19 case and death counts, with the highest risk occurring in the Southeastern United States during the fall of 2020 (relative risk: 5.86, confidence interval: 3.48–8.24). Of the CTL texters who shared their demographic information, Indigenous American, Black, male, and female adolescents were more likely to seek help for bereavement when compared to the other CTL users.DiscussionFindings show an increased need for bereavement counseling resources during periods of high COVID-19 cases and deaths.     

Parents Who First Allowed Adolescents to Drink Alcohol in a Family Context During Spring 2020 COVID-19 Emergency Shutdowns

PurposeCOVID-19 stay-at-home orders during Spring 2020 dramatically changed daily life and created significant challenges for families. We document levels and predictors of U.S. parents who newly allowed adolescents to drink alcohol at home during the shutdown.MethodsParticipants in an ongoing longitudinal study were two adolescent siblings (N = 911, M = 14.43, SD = 1.54 years) and one parent (N = 456; 85% mothers) who provided self-report data before the pandemic (T1) and during the shutdown.ResultsNo parents permitted adolescent drinking with family at T1; nearly one in six allowed it during the shutdown. In full models, adolescents who previously drank (without permission) and had light or heavy drinking parents were more likely to be newly permitted to drink.ConclusionsParents’ alcohol permissibility within family contexts changed during the pandemic and was shaped by both parent and adolescent drinking. Well-child visits should continue adolescent alcohol screening and parent support during and after the pandemic.     

The Interplay Between Policy and COVID-19 Outbreaks in South Asia: Longitudinal Trend Analysis of Surveillance Data

BackgroundCOVID-19 transmission rates in South Asia initially were under control when governments implemented health policies aimed at controlling the pandemic such as quarantines, travel bans, and border, business, and school closures. Governments have since relaxed public health restrictions, which resulted in significant outbreaks, shifting the global epicenter of COVID-19 to India. Ongoing systematic public health surveillance of the COVID-19 pandemic is needed to inform disease prevention policy to re-establish control over the pandemic within South Asia.ObjectiveThis study aimed to inform public health leaders about the state of the COVID-19 pandemic, how South Asia displays differences within and among countries and other global regions, and where immediate action is needed to control the outbreaks.MethodsWe extracted COVID-19 data spanning 62 days from public health registries and calculated traditional and enhanced surveillance metrics. We use an empirical difference equation to measure the daily number of cases in South Asia as a function of the prior number of cases, the level of testing, and weekly shifts in variables with a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R.ResultsTraditional surveillance metrics indicate that South Asian countries have an alarming outbreak, with India leading the region with 310,310 new daily cases in accordance with the 7-day moving average. Enhanced surveillance indicates that while Pakistan and Bangladesh still have a high daily number of new COVID-19 cases (n=4819 and n=3878, respectively), their speed of new infections declined from April 12-25, 2021, from 2.28 to 2.18 and 3.15 to 2.35 daily new infections per 100,000 population, respectively, which suggests that their outbreaks are decreasing and that these countries are headed in the right direction. In contrast, India’s speed of new infections per 100,000 population increased by 52% during the same period from 14.79 to 22.49 new cases per day per 100,000 population, which constitutes an increased outbreak.ConclusionsRelaxation of public health restrictions and the spread of novel variants fueled the second wave of the COVID-19 pandemic in South Asia. Public health surveillance indicates that shifts in policy and the spread of new variants correlate with a drastic expansion in the pandemic, requiring immediate action to mitigate the spread of COVID-19. Surveillance is needed to inform leaders whether policies help control the pandemic.     

A Qualitative Exploration of Predominantly White Non-Hispanic Tennessee WIC Participants’ Food Retail and WIC Clinic Experiences During COVID-19

BackgroundThe novel coronavirus disease 2019 (COVID-19) has widened many existing nutrition disparities. In response, federal nutrition assistance programs have introduced flexibility waivers in programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), to rapidly respond to support the nutritional health status of income-eligible participants during COVID-19. Waivers were approved that permitted flexibilities in the WIC food package, WIC vendor guidelines, and WIC clinic experience. The impact of these waivers on WIC participants’ retail and clinic experiences remains unknown.ObjectivesOur aims were to understand the experiences of WIC participants in food retail settings and with WIC clinics during the COVID-19 pandemic and to explore WIC participants’ perceptions of the impact of COVID-19 on their family’s overall health, well-being, and daily lives.DesignWe conducted semi-structured phone interviews between April 30 and May 7, 2020.Participants/settingParticipants were 24 adults in WIC-enrolled families residing in Tennessee.AnalysisUsing grounded theory as the analytical framework, 2 coders completed an iterative, data-driven analytic process within NVivo, version 12. Hierarchical maps, coding matrices, and concept maps were used to aid direct content analysis for theme detection.ResultsFive primary themes emerged, including shopping barriers (existing compounded with new), coping strategies, impact on mental and emotional health, social comparison, and unintended consequences of COVID-19 on WIC families.ConclusionsCOVID-19 created additional barriers to food security among WIC families and negatively affected their health and well-being. To meet the needs of this vulnerable population during and beyond the pandemic, the carryover of WIC flexibilities (ie, physical presence and food package substitution waivers) after COVID-19 may improve the ease of overall program participation.     

Tracking Self-reported Symptoms and Medical Conditions on Social Media During the COVID-19 Pandemic: Infodemiological Study

BackgroundHarnessing health-related data posted on social media in real time can offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time.ObjectiveThis study aimed to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the COVID-19 pandemic, to determine how discussion of these symptoms and medical conditions changed over time, and to identify correlations between frequency of the top 5 commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new deaths, new active cases, and new recovered cases) in the United States.MethodsWe used natural language processing (NLP) algorithms to identify symptom- and medical condition–related topics being discussed on social media between June 14 and December 13, 2020. The sample posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of posts. We also assessed the frequency of health-related discussions on social media over time during the study period, and used Pearson correlation coefficients to identify statistically significant correlations between the frequency of the 5 most commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics.ResultsWithin a total of 9,807,813 posts (nearly 70% were sourced from the United States), we identified a discussion of 120 symptom-related topics and 1542 medical condition–related topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts in the frequency of anxiety, generalized pain, and weight loss were significant but negatively correlated with daily new COVID-19 cases in the United States (r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue positively and significantly correlated with daily changes in both new deaths and new active cases in the United States (r ranged=0.39-0.48; P<.05).ConclusionsCOVID-19 and symptoms of anxiety were the 2 most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population’s mental health status and enhance public health surveillance for infectious disease.