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This case study presents a scenario where a small community hospital faces a surge of patients during the early stages of the SARS-COVID pandemic. The hospital, located near a cruise ship port, has limited resources, including a 10-bed emergency department (ED) and a two-bed ICU. Several patients from a cruise ship, who are all part of the same family, present with worsening respiratory symptoms, including cough, fever, and shortness of breath. As more patients arrive, the ED staff must manage the influx while facing limited ventilators and critical care equipment. The scenario challenges participants to perform emergency triage, prioritize treatment for respiratory distress, manage limited resources, and follow pandemic protocols to prevent the spread of infection. Through these events, healthcare providers must transition from conventional operations to crisis standards of care while managing an overwhelmed system, making difficult decisions regarding resource allocation and patient survival.
Negative out-group attitudes are often attributed to perceptions of competition or threat. We propose an alternative source: culture, conceptualized as cultural scripts—interconnected networks of meanings that link particular group identities to negatively connoted phenomena. Evidence comes from three studies on the reactivation of the cultural script of traditional antisemitism in Germany. We begin our analysis by isolating the cultural script through automated analysis of a corpus of antisemitic texts. Next, using survey data collected during the COVID-19 pandemic (n = 17,800), we document an increase in antisemitism among Christian believers. This, we argue, is due to the pandemic activating the cultural script of traditional antisemitism, which links Judaism with the spread of disease. By means of an additional survey (n = 2,000) and a concept association task, we demonstrate the presence of the cultural script in the minds of Christian believers. Two priming experiments explore how elements of the script can be triggered. Our work demonstrates the deep cultural roots of negative out-group attitudes and suggests a novel set of methods for studying them.
While previous chapters have focused on the deaths of Christians under roughly ordinary circumstances, this chapter turns to deaths precipitated by pandemics and natural disaster. The necrosima accordingly features a number of poems that address instances of mass death due to pandemic and pestilence. In both form and context of preservation, these hymns were manifestly part of their communities’ ritual repertoire. At the same time, however, they witness to periods in which ordinary ritual pathways had broken down. In the midst of sickness and bereavement, the hymns suggest, churches stood empty, clergy mourned the loss of their brothers, even burials had ceased in light of death’s relentless onslaught. This chapter examines the madrāshê in question as spaces for reconfiguring communities’ ritual practices. The necrosima’s pandemic hymns and other, roughly contemporaneous liturgical sources thus point to communities’ embrace of lament, petition, and penance as models for engaging the divine.
Post-COVID condition (PCC) describes new or worsening symptoms that develop after initial SARS-CoV-2 infection and are persistent for months without alternative explanations. Common PCC symptoms include post-exertional malaise, fatigue, breathlessness, cough, dizziness, “brain fog,” and gastrointestinal symptoms, and they may occur in upwards of 10% of patients infected with SARS-CoV-2. The physical, cognitive, and mental health sequalae seen in post-intensive care syndrome (PICS) are also common in PCC, particularly in COVID-19 patients that have survived critical illness. The pathophysiology of PCC remains poorly understood. Patients’ symptoms should be managed aggressively; management has significant overlap with the treatment approach to PICS patients. Dedicated PCC clinics or combined PICS/PCC clinics should include specific expertise in the diagnosis and management of symptoms relating to COVID-19, including fatigue, dyspnea, exertional intolerance, GI discomfort, psychological sequelae, and cognitive dysfunction, and actively collaborate with an interdisciplinary team of clinicians and staff with PCC expertise.
In March 2020, nine EU heads of state co-signed a letter demanding a coordinated response to the pandemic and the adoption of common debt. Recent literature has shown the relevance of the European Council in the response to the pandemic, as well as the rising importance of interstate coalitions in EU policymaking. Yet, empirical understanding of these coalitions is limited, and the literature largely assumes their constitution along ‘structuralist’ logics (e.g., ‘debtors’ vs. ‘creditors’). The emergence of a ‘solidarity coalition’ proposing the ‘coronabond’ is puzzling for its contrast with the euro crisis. The aim of this paper is to explain how these countries coalesced and to understand how that relates and informs a shift in the imperatives of ‘responsible government’ in the EU. Tracing the negotiation of the letter, through interviews and discourse analysis, the paper makes a critical contribution to our understanding of the evolution in EU economic governance.
The introduction and use of digital contact tracing apps as part of pandemic management have notably raised many legal and ethical challenges, ranging from determinations of public interest in using gathered data to privacy protections for app users and broader considerations of national socio-economic priorities. As the use of these digital contact tracing apps is supported by laws, legal preparedness is essential in determining appropriate legal authority that considers necessary trade-offs such as temporary privacy infringements, proportional data gathering and collective public health benefits. This paper examines the extent of legal preparedness in addressing competing interests between public health and individuals in the use of digital contact tracing apps. It does so through two main lenses: (1) an analysis of Singapore’s legal framework pertaining to data protection, privacy and contact tracing apps and (2) an analysis of the domestic social and political influences that explain why Singapore’s approach to digital contact tracing was viable, and assess its potential or limits for broader applicability.
What is the association between partisanship, individual views and behaviours towards the pandemic? This research note explores this question empirically using two datasets collected before and during the Covid‐19 pandemic: a daily survey covering nearly 100,000 individuals and county level mobility matched to UK 2019 general election results. At the individual level, our findings show that partisanship is strongly correlated with differences in both views and behaviours. Conservative voters were less likely to perceive Covid‐19 as dangerous and less likely to stay home during the national lockdown. At the county level, the effect of the national lockdown on mobility was negative and statistically significant only in less Conservative counties. Thus, partisanship is associated with different individual views and behaviours towards the pandemic even when there is broad consensus among the main political parties and the government about the nature of a public health problem and the appropriate policy response.
As countries around the world went into lockdown, we turned to 32 leading scholars working on different aspects of democracy and asked them what they think about how the COVID-19 pandemic has impacted democracy. In this article, we synthesize the reflections of these scholars and present five key insights about the prospects and challenges of enacting democracy both during and after the pandemic: (1) COVID-19 has had corrosive effects on already endangered democratic institutions, (2) COVID-19 has revealed alternative possibilities for democratic politics in the state of emergency, (3) COVID-19 has amplified the inequalities and injustices within democracies, (4) COVID-19 has demonstrated the need for institutional infrastructure for prolonged solidarity, and (5) COVID-19 has highlighted the predominance of the nation-state and its limitations. Collectively, these insights open up important normative and practical questions about what democracy should look like in the face of an emergency and what we might expect it to achieve under such circumstances.
That the present moment ties multiple crises together—not least because each is a future of pasts that wound(ed) through each other—must be factored into our intercessions and visions. If every crisis is also a call to order, then what order, old or new, does the pandemic call us to? Its literality provokes us to keep both the pan and the demos in sight, just as they are being extinguished through borders, disease, poverty, insecurity, hatred, and disposability in the global postcolony. We are asked to remember that capital and colony are inseparable, that the nation-state is too suspicious a source of comfort, that the eroding claims of citizenship across the postcolonial and post-democratic fascist failed states are instructive and prophetic, and that the assumptions of place and movement in our frames of the democratic political need revisiting.
This article provides a new perspective on EU exit as an exemplary form of disruptive dissensus or extreme Euroscepticism by examining how it is shaped by people’s attitudes towards the Union’s actions during the COVID-19 pandemic. We test how the dissatisfaction about how the EU handled the pandemic limited the trust in how it would manage it in the future, and influences a preference to exit the EU. We use a multi-level statistical model which combines individual-level data from a Eurobarometer survey and country-level characteristics from all 27 EU member states. The results indicate that disruptive dissensus is linked to both the retrospective and prospective attitudes towards the EU policy initiatives, even when controlling for the severity of the pandemic as well as the populists in government at the country level. We also find that the link between specific and diffuse support at the EU level holds during crises.
That effective leadership is crucial during global emergencies is uncontested. However what that leadership looks like, and how it plays out in different contexts is less straightforward. In representative democracy, diversity is considered to be a key element for true representation of the society. In addition, previous research has unequivocally demonstrated the positive impacts of gender equality in leadership. The COVID-19 pandemic has laid bare some of the real world implications of gender inequalities in the leadership context. In this article, we examine the differential impacts of COVID-19 on women, and reflect on potential pathways for women's active participation.
The COVID-19 pandemic has had devastating effects across the world, yet different countries have had varying degrees of success in their attempts to manage it. One of the reasons behind the different outcomes observed so far lies in the strengths and weaknesses of different governance arrangements leveraged to tackle the crisis. In this article we examine what we can learn about the operational capacity of different democracies through their early responses to the crisis. We provide a framework of four positive qualities of multilevel governance that might lead to greater chances of positive practical outcomes and present an illustrative case study of the experiences of Switzerland and the United Kingdom (UK). We conclude with some areas for further research and investigation.
The response to the COVID-19 pandemic has revealed how public health decisions in mass liberal democracies always reflect a political trade-off between protecting privileged groups and leaving more marginalized groups precariously exposed. Examining the “political epidemiology” of COVID-19, I focus on the ways that the lives and well-being of children are sacrificed to secure adult interests. I argue that in our efforts to protect older adults we have endangered children and abandoned the future of today's youth. This, I conclude, is indicative of a liberal preoccupation with adults and adult forms of agency, a defect that can only be adequately challenged by working toward more robust forms of democratic inclusion that include children and youth.
The COVID-19 pandemic raises questions about the future of democracy and civil society. Some recent predictions seem to use the suffering to score points in ongoing political arguments. As a better example of how to describe the future during a crisis, I cite the prophetic voice of Martin Luther King, Jr. King does not merely predict: he calls for action, joins the action, and makes himself responsible for its success or failure. With these cautions about prediction in mind, I venture two that may guide immediate responses. First, communities may erect or strengthen unjustifiable barriers to outsiders, because boundaries enhance collective action. Second, although the pandemic may not directly change civic behavior, an economic recession will bankrupt some organizations through which people engage.
In this paper, we leverage newly available rich administrative data to study the heterogeneous evolution of fertility and newborn health during the pandemic. We focus on Tuscany, a representative region of Italy, which was one of the first countries to experience the severe impact of the COVID-19 outbreak in early 2020. Our findings indicate a decline in the number of births relative to the pre-pandemic trend in late 2020 and early 2021, roughly nine to twelve months after the pandemic onset. However, starting in March 2021, birth numbers consistently exceeded the pre-pandemic trend, resulting in a cumulative “baby bump” compared to the counterfactual scenario. This aggregate increase conceals significant heterogeneity across sociodemographic groups, with positive deviations entirely driven by native, educated, and employed parents. During the same period, newborn health indicators showed no signs of deterioration and, if anything, slightly improved.
People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.
Aims
To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.
Method
This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive–behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.
Results
Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8–30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.
Conclusions
For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.
This chapter examines the likelihood of voluntary compliance in public health contexts, with emphasis on lessons learned during COVID-19 regarding trust in mask wearing, social distancing, and vaccine uptake.
The COVID-19 pandemic exacerbated psychological distress, but limited information is available on the shifts in mental health symptoms and their associated factors across different stages. This study was conducted to more reliably estimate shifts in mental health impacts and to identify factors associated with symptoms at different pandemic stages.
Methods
We performed a national repeated cross-sectional study at stable (2021), recurrence (2022), and end-of-emergency (2023) stages based on representative general national population with extensive geographic coverage. Anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia symptoms were evaluated by GAD-7, PHQ-9, IES-R and ISI scales, respectively, and their associated factors were identified via multivariable linear regression.
Results
Generally, 42,000 individuals were recruited, and 36,218, 36,097 and 36,306 eligible participants were included at each stage. The prevalence of anxiety, depression and insomnia symptoms increased from 13.7–16.4% at stable to 17.3–22.2% at recurrence and decreased to 14.5–18.6% at end of emergency, while PTSD symptom continuously increased from 5.1% to 7.6% and 9.2%, respectively (all significant, P < 0.001). Common factors associated with mental health symptoms across all stages included centralized quarantine, frontline work and residence in initially widely infected areas. Centralized quarantine was linked to anxiety, depression, PTSD and insomnia during the stable, recurrence and end-of-emergency stages. Frontline workers exhibited higher risks of anxiety, depression and insomnia throughout these stages. Individuals in initially widely infected areas were more likely to experience depression and PTSD, particularly during the stable and recurrence stages. Stage-specific risk factors were also identified. Lack of outdoor activity was associated with anxiety, depression and insomnia during the stable and recurrence stages. Residents in high-risk areas during the recurrence stage correlated with increased anxiety and insomnia. Suspected infection was tied to anxiety and insomnia in the recurrence and end-of-emergency stages, while the death of family or friends was linked to PTSD during recurrence and to depression, PTSD and insomnia at the end-of-emergency stage.
Conclusions
Mental health symptoms increased when pandemic recurred, and could remain after end-of-emergency, requiring prolonged interventions. Several key factors associated with mental symptoms and their variations were identified at different pandemic stages, suggesting different at-risk populations.
Acute poisoning is a major cause of pediatric emergency department (PED) visits, with the COVID-19 pandemic potentially altering exposure risks and care-seeking behaviors. This study compares pediatric poisoning characteristics before and during the pandemic.
Methods
A retrospective analysis was conducted at the Gazi University PED between January 2018 and June 2022. Patients aged 1 month-18 years diagnosed with poisoning were identified via ICD codes grouped into before pandemic and during pandemic cases. A systematic random sampling yielded 178 BP (before the pandemic) and 94 DP (during the pandemic) cases with complete data. Demographic and clinical properties of cases were analyzed.
Results
The mean age was significantly higher during the pandemic (BP:7.63±0.49; DP:9.27±0.69). A higher prevalence of chronic diseases was noted in DP cases (BP:0.29±0.049; DP:0.57±0.100). Hotline consultations were higher in DP period (54.5% vs.72.5%) while hospitalization rates were lower (55% vs. 35.2%). While suicide attempts were significantly higher in women compared to men before the pandemic, this difference disappeared during the pandemic period (BP:8.6% of males vs. 37.2% of females; DP: 25% of males vs. 39% of females).
Conclusion
The COVID-19 pandemic significantly impacted pediatric poisoning profiles, underscoring the need for targeted prevention strategies and adaptive emergency protocols.