The Dis­tri­b­u­tional Impacts of Early Em­ploy­ment Losses from COVID-19

COVID-19 sub­stan­tially decreased em­ploy­ment, but the effects vary among de­mo­graphic and so­cioe­co­nomic groups. We document the em­ploy­ment losses in April 2020 across various groups using the U.S. Current Pop­u­la­tion Survey. The un­em­ploy­ment rate un­der­states em­ploy­ment losses. We focus on the per­cent­age of the civilian pop­u­la­tion that is employed and at work. Young persons ex­pe­ri­enced the largest em­ploy­ment losses. In­di­vid­u­als with less education and lower family income ex­pe­ri­enced much larger em­ploy­ment losses than their more educated and higher income coun­ter­parts. Hispanics and blacks were more adversely affected than whites.

13266

Designing Reopening Strate­gies in the Aftermath of COVID-19 Lockdowns: Some Prin­ci­ples with an Ap­pli­ca­tion to Denmark

Gov­ern­ments across the globe have responded to the threat of the Covid-19 virus by imposing sub­stan­tial lockdown measures largely guided by epi­demi­o­log­i­cal concerns. These lockdowns come at sig­nif­i­cant economic costs with increased risk of e.g. mass un­em­ploy­ment. Recently, debates have emerged on how to design reopening strate­gies that achieve the largest possible economic gains while con­strain­ing the spread of the virus. The present paper iden­ti­fies five central chal­lenges econ­o­mists face in de­lin­eat­ing the trade-off between con­tain­ing the virus from spreading and the economic con­se­quences and costs of lockdown measures. While the principle of tradeoffs is at the core of economics, the road to actually op­er­a­tional­iz­ing this per­spec­tive on Covid-19-related lockdown measures is still unpaved. We present several workarounds to the iden­ti­fied chal­lenges based on a recently prepared economic expert as­sess­ment com­mis­sioned by the Danish gov­ern­ment. A reduced form indicator for virus spread pressure is developed and mapped against economic in­di­ca­tors. The resulting tool captures the trade-off between health and economic concerns and can guide the design of reopening strate­gies.

158

BackgroundData for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk.MethodsWe did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509.FindingsAmong 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors.InterpretationIn the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed.

10.1016/S2468-2667(20)30164-X

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

What the he’ll is going on in the Stock Market. GDP dropped by 32.9%(a disastrous number)and over the last 3 trading days the NASDAQ is up over 300 Points! Never mind the Pandemic and Rampant Unemployment.

Trust in the Time of Corona

The global spread of COVID-19 is one of the largest threats to people and gov­ern­ments since the Second World War. The on-going pandemic and its coun­ter­mea­sures have led to varying physical, psy­cho­log­i­cal, and emotional ex­pe­ri­ences, shaping not just public health and the economy but also societies. We focus on one pillar of society—trust—and explore how trust cor­re­lates with the in­di­vid­ual ex­pe­ri­ences of the pandemic. The analysis is based on a new global survey—‘Life with Corona’—and uses simple cor­re­la­tional sta­tis­tics. We show that those who have had contact with sick people and those that are un­em­ployed exhibit lower trust in people, in­sti­tu­tions, and in general. By contrast, no such dif­fer­ences exist for those who have per­son­ally ex­pe­ri­enced symptoms of the disease. These as­so­ci­a­tions vary across contexts and are not driven by concerns about personal health or the health of loved ones, but rather by increased levels of worry and stress. Our findings suggest that the effects of the pandemic go well beyond immediate health concerns, leading to important normative changes that are likely to shape how societies will emerge from the pandemic.

13386

If Sick-​Leave Becomes More Costly, Will I Go Back to Work? Could It Be Too Soon?

If Sick-​Leave Becomes More Costly, Will I Go Back to Work? Could It Be Too Soon?

If Sick-​Leave Becomes More Costly, Will I Go Back to Work? Could It Be Too Soon?

We in­ves­ti­gate the impact on work absence of a massive reduction in paid sick leave benefits. We exploit a policy change that only affected public sector workers in Spain and compare changes in the number and length of spells they take relative to un­af­fected private sector workers. Our results highlight a large drop in frequency mostly offset by increases in average duration. Overall, the policy did reduce number of days lost to sick leave. For some, however, return to work may have been premature as we document huge increases in both the pro­por­tion of relapses and working accidents rates.

13379

Dynamics of Social Mobility during the COVID-19 Pandemic in Canada

As the number of cases increases globally, gov­ern­ments and au­thor­i­ties have continued to use mobility re­stric­tions that were, and still are, the only effective tool to control for the viral trans­mis­sion. Yet, the re­la­tion­ship between public orders and be­hav­ioral pa­ra­me­ters of social dis­tanc­ing observed in the community is a complex process and an important policy question. The evidence shows that adherence to public orders about the social dis­tanc­ing is not stable and fluc­tu­ates with degree of spatial dif­fer­ences in in­for­ma­tion and the level of risk aversion. This study aims to uncover the be­hav­ioural pa­ra­me­ters of change in mobility dynamics in major Canadian cities and questions the role of people’s beliefs about how con­ta­gious the disease is on the level of com­pli­ancy to public orders. Our findings reveal that the degree of social dis­tanc­ing under strict re­stric­tions is bound by choice, which is affected by the departure of people’s beliefs from the public order about how severe the effects of disease are. Un­der­stand­ing the dynamics of social dis­tanc­ing thus helps reduce the growth rate of the number of in­fec­tions, compared to that predicted by epi­demi­o­log­i­cal models.

13376

Partial Lockdown and the Spread of COVID-19: Lessons from the Italian Case

13375

This paper in­ves­ti­gates the effect of the lockdown on COVID-19 in­fec­tions. After the 22nd of March 2020, the Italian gov­ern­ment shut down many economic ac­tiv­i­ties to limit the contagion. Sectors deemed es­sen­tials for the economy were, however, allowed to remain active. We exploit the dis­tri­b­u­tion of the density of essential workers across provinces and rich ad­min­is­tra­tive data in a dif­fer­ence in dif­fer­ence framework. We find that a standard deviation increase in essential workers per square kilometre leads to an ad­di­tional daily reg­is­tered case per 100,000 in­hab­i­tants. This is a sizeable impact, and it rep­re­sents about 18% of the daily increase in COVID-19 cases after the 22nd of March. Back of envelope com­pu­ta­tions suggest that the about one third of the cases con­sid­ered could be at­trib­uted to the less stringent lockdown for essential sectors, with an ad­di­tional 107 million Euros in direct ex­pen­di­ture. Although this as­sess­ment should be taken with caution, this suggests that the less stringent lockdown came at moderate public health related economic costs. In addition, we find that these effects are het­ero­ge­neous across sectors, with services having a much larger impact than Man­u­fac­tur­ing, while there are only small dif­fer­ences across ge­o­graphic areas. These results are stable across a wide range of spec­i­fi­ca­tions and ro­bust­ness check.

13374

Using large, ge­o­graph­i­cally rep­re­sen­ta­tive surveys from the US and UK, we document variation in the per­cent­age of tasks workers can do from home. We highlight three di­men­sions of het­ero­gene­ity that have pre­vi­ously been neglected. First, the share of tasks that can be done from home varies con­sid­er­ably both across as well as within oc­cu­pa­tions and in­dus­tries. The dis­tri­b­u­tion of the share of tasks that can be done from home within oc­cu­pa­tions, in­dus­tries, and occupation-​industry pairs is sys­tem­atic and re­mark­ably con­sis­tent across countries and survey waves. Second, as the pandemic has pro­gressed, the share of workers who can do all tasks from home has increased most in those oc­cu­pa­tions in which the pre-​existing share was already high. Third, even within oc­cu­pa­tions and in­dus­tries, we find that women can do fewer tasks from home. Using machine-​learning methods, we extend our working-​from-home measure to all dis­ag­gre­gated occupation-​industry pairs. The measure we present in this paper is a critical input for models con­sid­er­ing the pos­si­bil­ity to work from home, including models used to assess the impact of the pandemic or design policies targeted at reopening the economy.

Work That Can Be Done from Home: Evidence on Variation within and across Oc­cu­pa­tions and In­dus­tries

10.31234/osf.io/hqcs6

We examined archival data from 98 countries (Study 1) and the 48 contiguous United States (Study 2) on country/state-level collectivism, COVID-19 case/death rates, relevant covariates (per-capita GDP, population density, spatial dependence), and in the U.S., percent of non-Whites. In Study 1, country-level collectivism negatively related to both cases (r = -.28) and deaths (r = -.40) in simple regressions; however, after controlling for covariates, the former became non-significant (rp = -.07), but the later remained significant (rp = -.20). In Study 2, state-level collectivism positively related to both cases (r = .56) and deaths (r = .41) in simple regressions, and these relationships persisted after controlling for all covariates except race, where a state’s non-White population dominated all other predictors of COVID-19 cases (rp = .35) and deaths (rp = .31). We discuss the strong link between race and collectivism in U.S. culture, and its implications for understanding COVID-19 responses.

Culture, COVID-19, and Collectivism: A Paradox of American Exceptionalism?

10.31234/osf.io/7um3x

Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about the psychological and spiritual well-being of patients with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to address these patients' needs adequately, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness and shared decision making with patients’ families.

Biopsychosocial and Spiritual Implications of Patients with COVID-19 Dying in Isolation

10.3386/w27295

The Federal Reserve has reacted swiftly to the COVID-19 pandemic. It has resuscitated many of its programs from the last crisis by lending to the financial sector, which we refer to as “Wall Street QE.” The Fed is now proposing to also lend directly to, and purchase debt directly from, non-financial firms, which we label “Main Street QE.” Our paper develops a new framework to compare and contrast these different policies. In a situation in which financial intermediary balance sheets are impaired, such as the Great Recession, Main Street and Wall Street QE are perfect substitutes and both stimulate aggregate demand. In contrast, for situations like the one we are now facing due to COVID-19, where the production sector is facing significant cash flow shortages, Wall Street QE becomes almost completely ineffective, whereas Main Street QE can be highly stimulative.

Wall Street vs. Main Street QE

Issue/problemPoor health behaviours are at the centre of most non-communicable chronic diseases and account for a significant amount of morbidity and mortality. Healthcare professionals, and especially physicians, are in a unique position to be able to positively influence their patients and aid them in changing poor health behaviours. However, most physicians report having low confidence or a lack of skills to effectively achieve this.Description of the problemThe main approach that physicians take to influence their patients’ poor health behaviours is to provide them with advice and evidence about the impact of the poor health behaviours. This strategy has been shown to have limited impact on changing patient behaviour. As such, there is a need to develop effective interventions that target changing physician health behaviour counselling behaviours, effectively, a behaviour change intervention for physicians so that they are better at helping patients change their behaviour.ResultsUsing a structured stakeholder-oriented approach (the ORBIT model for developing behavioural interventions) we have systematically developed a robust behaviour change-based continuing medical education curriculum (leveraging motivational communication), and online assessment tool to improve physician competency. These were developed by a pan-Canadian team with notable international input through the IBTN.LessonsThe use of a structured stakeholder-driven process, we have developed an intervention which seems to have greater relevancy to the target audience, lead to greater engagement, and a higher probability of implementation than a researcher led approach. Whilst the studies are still ongoing, it is anticipated that this intervention will be able to dramatically improve the health of individuals through effective health behaviour change interventions by healthcare professionals.

10.1093/eurpub/ckz185.812

Applying behavioural science to improve physicians’ ability to help people improve their own health behaviours

Physician payment models are perceived to be an important strategy for improving health, access, quality, and the value of health care. Evidence is predominantly from primary care, and little is known regarding whether specialists respond similarly.We conducted a systematic review to synthesize evidence on the impact of specialist physician payment models across the domains of health care quality; clinical outcomes; utilization, access, and costs; and patient and physician satisfaction. We searched Medline, Embase, and six other databases from their inception through October 2018. Eligible articles addressed specialist physicians, payment models, outcomes of interest, and used an experimental or quasi-experimental design.Of 11,648 studies reviewed for eligibility, 11 articles reporting on seven payment reforms were included. Fee-for-service (FFS) was associated with increased desired utilization and fewer adverse outcomes (in the case of hemodialysis patients) and better access to care (in the case of emergency department services). Replacing FFS with capitation and salary models led to fewer elective surgical procedures (cataracts and tubal ligations) and, with an episode-based model, appeared to increase the use of less costly resources. Four of the seven reforms met their goals but many had unintended consequences.Payment model appears to affect utilization of specialty care, although the association with other outcomes is unclear due to mixed results or lack of evidence. Studies of salary and salary-based reforms point to specialists responding to some incentives differently than theory would predict. Additional research is warranted to improve the evidence driving specialist payment policy.

10.1016/j.healthpol.2020.02.007

Impact of payment model on the behaviour of specialist physicians: A systematic review

Handwashing is widely accepted as being key to the prevention of hospital-acquired infection but the frequency of handwashing by healthcare workers has been found to be low. A systematic critical literature review was conducted to establish the effectiveness of interventions aimed at increasing compliance with handwashing in healthcare workers.The results showed that one-off educational interventions have a very short-term influence on handwashing behaviour. Use of strategically placed reminders, or asking patients to remind staff of the need to conduct handwashing can have a modest but more sustained effect. Feedback of performance can increase levels of handwashing but if feedback is not repeated regularly, then this effect is not maintained over long periods. Automated sinks increase the quality of handwashing but healthcare workers can be discouraged from using these because of the additional time involved. Provision of moisturized soaps appears to make little difference to handwashing behaviour but providing 'dry' hand rubs near patient beds may lead to a minimal increase in the frequency with which staff decontaminate their hands. Multifaceted approaches which combine education with written material, reminders and continued feedback of performance can have an important effect on handwashing compliance and rates of hospital-acquired infection.

10.1053/jhin.2000.0882

The effectiveness of interventions aimed at increasing handwashing in healthcare workers - a systematic review

The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).

Increasing Handwashing Compliance With More Accessible Sinks

Objective:To determine the motivating and behavioral factors responsible for improving compliance with hand washing among physicians.Design:Five unobtrusive, observational studies recording hand washing after direct patient contact, with study results reported to physicians.Setting:A 450-bed hospital in a health maintenance organization with an 18-bed medical-surgical intensive care unit (ICU) and a 12-bed cardiac care unit.Methods:An infectious disease physician met individually with participants to report study results and obtain a commitment to hand washing guidelines. Follow-up interviews were conducted to evaluate behavioral factors and educational programs. Hand washing study results were presented to all staff physicians by live and videotaped inservice presentations and electronic mail (e-mail) newsletters. The importance of influencing factors and the educational effectiveness of the hand washing program were evaluated.Results:Five observational hand washing studies were conducted in the ICU between April 1999 and September 2000. Rates of physician compliance with hand washing were 19%, 85%, 76%, 74%, and 68%, respectively. There were 71 initial encounters and 55 follow-up interviews with the same physicians. Physician interviews revealed that 73% remembered the initial encounter, 70% remembered the hand washing inservice presentations, and 18% remembered the e-mail newsletters. Personal commitment and meeting with an infectious disease physician had the most influence on hand washing behavior. Direct inservice presentations (either live or videotaped) had more influence than did e-mail information. Rates of ventilator-associated pneumonia did not significantly change before and during the study periods. A decrease in the rate of central-line–related bloodstream infections from 3.2 to 1.4 per 1,000 central-line days was found, but could not be solely attributed to improved physician compliance with hand washing.Conclusions:Physician compliance with hand washing can improve. Personal encounters, direct meetings with an infectious disease physician, and videotaped presentations had the greatest impact on physician compliance with hand washing at our medical center, compared with newsletters sent via e-mail. Local data on compliance with hand washing and physician involvement are factors to be considered for physician hand washing compliance programs in other medical centers.

Hand Washing and Physicians: How to Get Them Together

10.1371/journal.pcbi.1008035

The modeling of the spreading of communicable diseases has experienced significant advances in the last two decades or so. This has been possible due to the proliferation of data and the development of new methods to gather, mine and analyze it. A key role has also been played by the latest advances in new disciplines like network science. Nonetheless, current models still lack a faithful representation of all possible heterogeneities and features that can be extracted from data. Here, we bridge a current gap in the mathematical modeling of infectious diseases and develop a framework that allows to account simultaneously for both the connectivity of individuals and the age-structure of the population. We compare different scenarios, namely, i) the homogeneous mixing setting, ii) one in which only the social mixing is taken into account, iii) a setting that considers the connectivity of individuals alone, and finally, iv) a multilayer representation in which both the social mixing and the number of contacts are included in the model. We analytically show that the thresholds obtained for these four scenarios are different. In addition, we conduct extensive numerical simulations and conclude that heterogeneities in the contact network are important for a proper determination of the epidemic threshold, whereas the age-structure plays a bigger role beyond the onset of the outbreak. Altogether, when it comes to evaluate interventions such as vaccination, both sources of individual heterogeneity are important and should be concurrently considered. Our results also provide an indication of the errors incurred in situations in which one cannot access all needed information in terms of connectivity and age of the population.

Data-driven contact structures: From homogeneous mixing to multilayer networks

There is currently a tsunami of misinformation out there about how Sweden handled the coronavirus pandemic. Sweden did not opt to use a brief hard lockdown like many other countries, but instead put into place a robust set of long-term restrictions that combined both legal bans and voluntary guidelines. This was because leaving a hard lockdown would probably cause a major increase in number of cases as societies opened up again.

Sweden Did Not Take Herd Immunity Approach Against Coronavirus Pandemic

The U.S. economy suffered its sharpest downturn since at least the 1940s in the second quarter, highlighting how the pandemic has ravaged businesses across the country and left millions of Americans out of work.Gross domestic product shrank 9.5% in the second quarter from the first, a drop that equals an annualized pace of 32.9%, the Commerce Department’s initial estimate showed on Thursday. That’s the steepest annualized decline in quarterly records dating back to 1947 and compares with analyst estimates for a 34.5% contraction. Personal spending, which makes up about two-thirds of GDP, slumped an annualized 34.6%, also the most on record.

U.S. Economy Shrinks at Record 32.9% Pace in Second Quarter

10.31234/osf.io/rnw9q

Up until 2019, `psychological reform' mostly meant methodological and statistical reform of empirical research practices in psychology. Since then, however, we have seen a surge of proposals for theoretical reform. While those calling for theoretical reform may agree on many things, they also do not form a monolith. One aim of the present commentary is to highlight some of this diversity by commenting on Fried's target article in this broader context.

Theory development requires an epistemological sea change

10.1038/d41586-020-02231-6

The US government needs to strengthen the agency charged with preventing the spread of disease — not undermine it.

The Trump administration must stop sidelining the CDC

JASP 0.11 has been released and is now available on our download page. This version adds the Machine Learning module with 13 brand new analyses that can be used for supervised and unsupervised learning. With supervised learning, the goal is to predict a target variable by learning from existing labeled data. The goal of unsupervised learning, on the other hand, is to look for underlying patterns/structures in unlabeled data. For supervised learning, the Machine Learning module differentiates between regression and classification purposes. A supervised learning problem tries to find the underlying relationship between a target variable and possibly many predictor variables. When the target is continuous (e.g., housing prices) we use a regression method to model this relation, and when the target is nominal (e.g., “deceased” or “survived”) we use a classification method. The Machine Learning module contains the following four analyses for regression:Boosting RegressionK-Nearest Neighbors RegressionRandom Forest Regression 

Introducing JASP 0.11: The Machine Learning Module

A quick visual aid of major studies & levels of evidence against #hydroxychloroquine for the use in COVID-19 patients. No robust studies have found any type of benefit for HCQ.

2007.15034

Containment measures implemented by some countries to suppress the spread of COVID-19 have resulted in a slowdown of the epidemic characterized by time series of daily infections plateauing over extended periods of time. We prove that such a dynamical pattern is compatible with critical Susceptible-Infected-Removed (SIR) dynamics. In traditional analyses of the critical SIR model, the critical dynamical regime is started from a single infected node. The application of containment measures to an ongoing epidemic, however, has the effect to make the system enter in its critical regime with a number of infected individuals potentially large. We describe how such non-trivial starting conditions affect the critical behavior of the SIR model. We perform a theoretical and large-scale numerical investigation of the model. We show that the expected outbreak size is an increasing function of the initial number of infected individuals, while the expected duration of the outbreak is a non-monotonic function of the initial number of infected individuals. Also, we precisely characterize the magnitude of the fluctuations associated with the size and duration of the outbreak in critical SIR dynamics with non-trivial initial conditions. Far from heard immunity, fluctuations are much larger than average values, thus indicating that predictions of plateauing time series may be particularly challenging.

Epidemic plateau in critical SIR dynamics with non-trivial initial conditions

What’s the Covid State of Play? Join Dr. Margaret Bourdeaux and Professor Jonathan Zittrain, co-chairs of the Berkman Klein Center’s Digital Pandemic Response Working Group, as they try to untangle the challenges in the fight against COVID-19 in a chat with former NSC pandemic policy staffer Beth Cameron and Chief of Strategy and Policy for Partners in Health's MA COVID-19 Response KJ Seung.

Covid State of Play: Jonathan Zittrain & Margaret Bourdeaux with Beth Cameron & KJ Seung

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NESCAC Fall Plans Map