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Arturo González was a thirty-eight-year-old man who presented to our hospital during the Delta variant surge with COVID-related pneumonia that badly damaged his lungs. He was cannulated for extracorporeal membrane oxygenation (ECMO) upon admission; he had been on ECMO for seventy days and was awake and alert when Ethics was consulted. Due to multiple marginalized identities—he was an undocumented immigrant, uninsured, and had limited social support—Arturo did not have access to a lung transplant and was dependent on ECMO for survival. In the face of mounting critical care resource scarcity, Arturo’s intensivists disagreed about whether to continue ECMO indefinitely or to explore discussions about withdrawing support. In this book chapter, we discuss our role as ethics consultants balancing the organizational duty to justly steward scarce resources with the professional duty to this vulnerable patient: setting treatment boundaries while collaborating with Arturo on a treatment plan within these boundaries. We also discuss our role in addressing the care team’s moral distress at the most haunting aspect of this case: that Arturo’s social position limited his access to a lifesaving transplant.
The COVID-19 pandemic disrupted daily social interactions, potentially affecting mental health. Understanding the risk of depressive and anxiety symptoms is essential for guiding mental health strategies during future crises.
Aims
To explore how social networks influenced mental health outcomes during the pandemic and how these relationships changed over time.
Method
Data from the Omtanke2020 study, a prospective cohort study of Swedish adults, were analysed using structural equation modelling (N = 10 918). Surveys at baseline and follow-up at 6 and 12 months assessed social networks, including structural components (e.g. relationship status, frequency of social contact) and perceived components (e.g. emotional support from family, feeling safe at home). Cross-lagged panel modelling was used to observe changes over time in the associations between social network indicators and depressive and anxiety symptoms.
Results
Stronger perceived social support – specifically closeness to family, perceived warmth or love from others and increased societal cohesion – were negatively correlated with depressive and anxiety symptoms across all time points (β coefficients = −0.14 to −0.23, all P < 0.001). Social network variables consistently predicted mental health outcomes, with effect sizes remaining relatively stable over time (β coefficient = −0.17 at baseline, β coefficient = −0.21 at 1-year follow-up).
Conclusions
This study highlights the protective role of the social network – namely perceived social support – in combatting depressive and anxiety symptoms during the COVID-19 pandemic. Interventions that strengthen close interpersonal ties and community cohesion may help mitigate mental health impacts during future public health crises.
This paper studies the impact of the COVID-19 epidemic on economic and health outcomes in China from January 20 to September 28, 2020. We first document China’s containment policies and present empirical evidence on the role of the online economy. We then use a SIR-macro model to study the macroeconomic and health outcomes of the epidemic. The model can generate infection and death dynamics broadly consistent with the data and the U-shaped recovery of the Chinese economy at the weekly frequency. The analysis reveals that, in addition to the containment policies, the development of the online economy (both online consumption and remote work) plays a critical role in fighting an epidemic.
To compare and analyze COVID-19 control outcomes, including case severity, vaccination, and excess mortality, across 6 nations (USA, UK, China, Russia, Japan, and South Africa) from January 2020 to December 2022.
Methods
This study utilized data from the “Our World in Data” dataset to characterize the epidemiological features of COVID-19 across 6 countries. Generalized linear models (GLMs) were employed to examine the associations between Stringency Index (SI), vaccination coverage, and epidemiological outcomes.
Results
The USA had the highest median cases per million and the UK the highest deaths per million, while China reported the lowest for both. Hospitalization and ICU rates were highest in the UK and the USA, respectively, and lowest in Japan. Vaccination coverage was highest in China and lowest in South Africa. Excess mortality was highest in Russia and lowest in Japan. Generalized linear models indicated a negative association between the SI and cases in China (β = −40, P = 0.015), which became stronger after adjusting for vaccination (β = −311, P < 0.001), but positive associations were observed in the USA, UK, and South Africa. SI was negatively associated with excess mortality in most countries.
Conclusions
Effective pandemic control is highly context-dependent. The relationships among vaccination, variant prevalence, and health care burden were complex, shaped by implementation context, public compliance, and health care capacity.
This study aimed to evaluate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and inactivated virus vaccination on intracytoplasmic sperm injection (ICSI) outcomes in infertile couples. A retrospective case–control study was conducted at the Royan Institute from August 2020 to March 2022. The study included 90 couples in the COVID-19 infection phase and 31 in the vaccination phase. A total of 30 infected but unvaccinated couples were compared to a control group of 60 couples with no COVID-19 infection or vaccination history. Additionally, 31 couples underwent treatment before and after receiving the Sinopharm inactivated vaccine. Key variables analysed included sperm parameters (concentration, motility, progressive motility and morphology), ovarian parameters (antral follicle count, oocyte retrieval), embryological outcomes and pregnancy outcomes. SARS-CoV-2 infection significantly reduced sperm motility (P = 0.02) and progressive motility (P = 0.01) compared to controls. Sperm concentration and morphology showed non-significant declines. Post-vaccination analysis revealed similar but statistically insignificant changes in sperm parameters. Ovarian stimulation parameters and embryological outcomes remained unaffected by both infection and vaccination. Although biochemical, clinical pregnancy and live birth rates were lower among the infected group, these differences did not reach statistical significance (p = 0.16, 0.08 and 0.09). SARS-CoV-2 infection has been associated with impaired sperm progressive motility, which may negatively influence ICSI outcomes. In contrast, vaccination with an inactivated virus does not appear to impact fertility outcomes. These findings provide crucial guidance for physicians and infertile couples managing treatments during and after the pandemic, suggesting the need for extended recovery periods before ART procedures following COVID-19 infection.
Although extensive research has been conducted on the impact of the COVID-19 pandemic on global mental health, a systematic synthesis of the cross-time dynamics of suicidal ideation (SI) remains lacking. This study aims to systematically synthesise the global aggregated prevalence of SI before and after the pandemic, investigate the potential association between pandemic exposure and the SI risk through meta-regression analysis of longitudinal studies, and explore key moderating factors.
Methods
A systematic search was conducted in Web of Science, PubMed, PsycINFO and ProQuest databases up to August 2025. Observational studies were included if they employed cross-sectional or longitudinal designs and reported the prevalence of SI before and after the pandemic across global regions.
Results
The analysis included 354 cross-sectional studies (N = 8,247,875) and 27 longitudinal studies. In cross-sectional studies, the pooled prevalence of SI was 13.20% [95% CI 12.06%–14.42%]. Pre-pandemic prevalence was 12.52% [95% CI 8.46%–18.14%], and post-pandemic prevalence was 13.24% [95% CI 12.07%–14.50%], with no significant difference. Meta-regression analysis identified three moderators. Specifically, larger sample sizes (n) were associated with lower prevalence (β = −0.232, P < 0.0001); higher study quality predicted lower prevalence (β = −0.278, P < 0.001); and studies on adults reported significantly lower prevalence than adolescents (β = −0.366, P < 0.05). Conversely, time progression during the pandemic, development level, geographical area, gender and measurement method did not show significant independent effects. Interaction analyses also found no significant moderating effect of economic development level or geographical area on the temporal trend of SI prevalence. Longitudinal analysis found no significant increase in prevalence from the pre-pandemic to the post-pandemic period (P = 0.101). However, a small but significant increase occurred between early and late stages within the pandemic (β = 0.265, P = 0.021). Subgroup analyses showed no significant moderation of these temporal changes.
Conclusions
The COVID-19 pandemic’s impact on SI was dynamic. While no significant prevalence change was found between pre- and post-pandemic periods, a significant increase occurred as the crisis progressed. This deteriorating trend was more pronounced in adolescents, identifying them as a key vulnerable group. Methodologically, findings were moderated by the measurement instrument, study quality and sample size, with evidence suggesting potential small-study effects. These findings underscore the need for robust mental health surveillance and targeted interventions for at-risk populations during prolonged public health crises.
The protocol was registered on PROSPERO (CRD42024603151).
Chapter 5 explores xiangchou as a materially and culturally embedded concept in the 2010s, which represented an ‘era of crises’ in China. The chapter frames crises as both the acute global COVID-19 pandemic, as well as through longer-term and more embedded ‘crises,’ categorized broadly as: the ’big city disease’, the existential crisis of meaninglessness, and the three-rural issue. Discursive analysis of various government text illustrates how different state organs can invoke the language of xiangchou to describe both a symptom of such crises as well as a response and potential remedy to these crises. Various case studies also demonstrate how feelings of homesickness and the inevitable separations from those ‘left behind’ can compel various forms of ‘rural return,’ but to varying effects and opportunities.
Sanctions have overall made a negative impact on the health outcomes of the North Korean people. The reasons are multifactorial. Sanctions are complex and have created massive administrative barriers and logistical challenges for the organizations that wish to take the time and effort to navigate them to provide humanitarian aid. Banks are hesitant to partner with those who work in the DPRK to avoid any possible risk that they could unknowingly be evading sanctions. For a similar reason, international funding for health in the DPRK has plummeted. The Covid-19 pandemic and associated DPRK-imposed border shutdown has exacerbated the precarious health status of the North Korean people. A reform of the sanctions regime is needed to ensure necessary humanitarian aid reaches the most vulnerable.
The COVID-19 pandemic sent shockwaves throughout the world. Even though the Czech Republic has less stable state structures and a less consolidated party system than its West European counterparts, during the first wave, the country actually performed better than most West European countries in terms of infection rates, death rates, and economic growth. During the second wave, however, the country’s position radically dropped. Despite its increasing health problems, its social policies still performed rather well and managed to keep unemployment at comparatively low levels. How can we explain these differences between erratic performance on the health side and comparatively solid performance on the social policy side? Our study explains why traditional social policies basically remained path dependent, while epidemiological policies dealing directly with fighting the spread of COVID-19 did not. Our explanation combines sociological and rational choice institutionalism and links them with the concepts of repeated games and bounded rationality.
Many, if not most, phenomena faced by political elites are characterized by uncertainty. This characterization also holds for the concept uncertainty itself, with conceptualizations and operationalizations differing both across and within bodies of scholarship. The conceptual vagueness poses a challenge to the accumulation of knowledge. To address this challenge, we integrate and expand existing work and develop an uncertainty grid to map phenomena (e.g., Covid-19; digitalization) or aspects thereof (e.g., vaccines; generative Artificial Intelligence [AI]). The uncertainty grid includes both the nature of a phenomenon’s uncertainty (epistemic and/or aleatory) and its level and enables labeling phenomena as certain, resolvably uncertain, or radically uncertain. We demonstrate the utility of the uncertainty grid by mapping the development of uncertainty during the Covid-19 pandemic onto it. Moreover, we discuss how researchers can use the grid to develop testable hypotheses regarding political elites’ behavior in response to uncertain phenomena.
This study aimed to assess the prevalence of post-COVID syndrome (PCS) and identify associated risk factors among healthcare workers (HCWs) in a large tertiary care hospital, with the objective of highlighting the importance of preparedness for similar post-viral syndromes in future pandemics.
Background:
Post-COVID syndrome, a form of post-viral syndrome, encompasses a range of long-term symptoms affecting multiple organ systems, which can persist after the recovery from COVID-19.
Methods:
A cross-sectional study was conducted using an online self-administered survey among HCWs who tested positive for COVID-19 at a large tertiary medical centre in Beirut.
Findings:
Among the 134 participants who had experienced COVID-19, nearly half (47.7%) reported symptoms consistent with PCS. Fatigue, shortness of breath, poor memory, and poor concentration were the most frequently reported symptoms, lasting for over three months post-COVID-19 infection in the majority of patients. Direct care of COVID-19 patients and higher severity of acute COVID-19 infection were significantly associated with an increased likelihood of developing PCS. Further research to enhance understanding and management of post-viral syndromes is needed. Additionally, proactive strategies should be implemented to mitigate associated risks in healthcare settings, emphasizing the importance of preparedness for future pandemics.
We study how COVID-19 affected the ownership co-location network of French multinationals over 2012–2022. Using INSEE’s LiFi, we build annual country-industry co-location networks and assess robustness via topology (density, centralization, assortativity, and clustering) and edge survival (Weighted Jaccard). We then test for post-shock shifts in the determinants of dyadic co-location with multiple regression quadratic assignment procedure. Three results emerge. First, the network’s core is robust: topology shows no discontinuity and centrality persists. Second, adaptation is continuous at the margin: around one-third of edges rewire, concentrated in the periphery while core ties endure. Third, after 2020 the determinants of tie weights change, with a reduced role for gravity-like factors and greater cross-sector rebalancing. Thus the system is structurally robust with active peripheral adjustment. Rather than strict resilience in the sense of a return to the pre-COVID configuration, we observe durable strategic reweighting.
The COVID-19 pandemic profoundly disrupted societies worldwide, creating not only a global health emergency but also a severe test of governance. Governments were required to mobilise resources with unprecedented urgency, under conditions of uncertainty and limited oversight. In this setting, politicians and bureaucrats exercised unusually broad discretion over resource allocation. We argue that these conditions created opportunities for corruption – what we term crisis-induced corruption – the misuse of public resources that emerges in crisis contexts where urgent spending collides with fragile oversight. Drawing on Afrobarometer Round 9 surveys from 39 African countries, we examine how perception of crisis-induced corruption (COVID-19 corruption) shaped citizens’ evaluations of government mismanagement and whether these effects varied with institutional quality (control of corruption). Results from multilevel models show that citizens who perceive higher levels of COVID-19 corruption are more likely to judge their governments as mismanaging the pandemic. However, contrary to expectations, we do not find evidence that stronger corruption control buffers governments from these negative perceptions. Instead, in countries with higher corruption control, corruption perceptions are linked to a sharper increase in perceived government mismanagement of the pandemic. Robustness checks – including disaggregating government mismanagement into pandemic management and relief distribution, and employing alternative outcomes such as trust in vaccine safety and satisfaction with relief provision – confirm the stability of these results. The findings highlight not only the damaging impact of corruption during global emergencies but also the critical importance of effective crisis management for sustaining public trust.
Stress is a response to external environmental conditions that encourages individuals to pursue changes in their lives. We examine the relationship between stress and federal and provincial political leaders’ approval ratings. We theorize that, as a strategy to cope with the pandemic stresses outside of their direct control, individuals will redirect their frustrations toward incumbents. We hypothesize that greater experiences with stress will negatively correlate with the approval of political incumbents even among members of incumbents’ political in-group. We analyze data from the COVID-19 Monitor survey, a multi-wave, cross-sectional survey of over 56,000 Canadians. On three out of four measures, we find that stress negatively impacted incumbent approval, and that these negative impacts occur among the incumbent’s supporters and non-supporters. On the fourth measure, we find the effect of stress on approval is moderated, positive or negative, by whether regional leaders took action to limit the spread of coronavirus disease 2019.
The COVID-19 pandemic offers unique insight into how regimes govern in 'hard times.' In Southeast Asia, public health and economic strain revealed the scope for adaptation in the face of crisis, against the pull of path-dependent habits and patterns. Recent experience of SARS and other outbreaks, as well as wider political and economic contexts, shaped readiness and responses. Especially important were legacies of the developmental-state model. Even largely absent a prior welfarist turn, core developmentalist attributes helped foster citizen buy-in and compliance: how efficiently and well states could coordinate provision of necessary infrastructure, spur biomedical innovation, marshal resources, tamp down political pressure, and constrain rent-seeking, all while maintaining popular trust. Also salient to pandemic governance were the actual distribution of authority, beyond what institutional structures imply, and the extent to which state–society relations, including habits of coercion or rent-seeking, encourage more or less programmatic or confidence-building frames and approaches.
Respiratory infections trigger asthma exacerbations. Despite being less severely affected by COVID-19 than adults, the subsequent lockdowns had a great impact on children. Previous studies showed a decrease in asthma exacerbations during the COVID-19 lockdowns, but findings from secondary care settings are scarce. We aimed to elucidate the trends in frequency and characteristics of asthma exacerbations in children presenting on an emergency department (ED) of a secondary care setting before, during, and after the COVID-19 pandemic. A retrospective analysis was conducted using data from ED visits between January 2018 and November 2022 for asthma exacerbations in children. The incidence of ED visits, hospital admissions, paediatric intensive care unit (PICU) admissions, administered medication, and demographic information were compared. A total of 1121 exacerbations were reported in 670 children, of whom 476 (42%) were admitted to hospital and 44 (3.9%) required PICU admission. We observed a decrease in ED visits for asthma exacerbations during the pandemic but an increased risk in hospital admissions and PICU transfers for exacerbations. This suggests a more severe course of exacerbations. Barriers to health care and lower viral exposure may contribute to this.
The COVID-19 pandemic significantly impacted Saskatchewan, resulting in high per capita case counts and COVID-19-related deaths. While vaccination mandates have been a key strategy to control the pandemic, their impact in Saskatchewan remains poorly documented. This study assessed the effect of COVID-19 vaccine mandates on the incidence of COVID-19 cases and deaths in Saskatchewan during the first year following vaccine rollout.
Methods
A single-group interrupted time series analysis with multiple intervention points was conducted using aggregated daily COVID-19 incidence and mortality rates as outcome variables. The models accounted for confounding effects of daily total vaccine doses administered and public health countermeasures, including the stringency index and economic support index, from April 1, 2020 to January 20, 2022. Average daily COVID-19 incidence and mortality rates were estimated for the pre-vaccine rollout period (April 1 to December 14, 2020), and the post-rollout period (December 15, 2020 to January 20, 2022). In addition, nine supplementary initiatives were introduced during the implementation phase. All estimated effects reflected cumulative changes in trend relative to the pre-vaccination period.
Results
Cumulatively, COVID-19 incidence increased faster than the pre-vaccination trend, likely driven by successive variant surges from wild-type to Omicron, while COVID-19–related deaths remained stable across the same period. The implementation of vaccine rollout, prioritization of vaccines for high-risk populations, and proof-of-vaccination policy were effective in reducing daily COVID-19 incidence and deaths in Saskatchewan. Economic support and an increased number of daily vaccine doses administered were also associated with an improved provincial COVID-19 response. Conversely, surges in COVID-19 incidence and deaths occurred following the introduction of the centralized virtual booking system and booster doses. These surges may reflect accessibility challenges, increased testing, emergence of immune-escape variants, relaxation of public health measures before achieving herd immunity, and waning immunity over time.
Conclusions
Economic support, policy measures, and vaccination efforts played important roles in managing public health crises, hence the need for an integrated approach to managing public health crises. However, temporary surges following certain interventions underscore the need for accessible, adaptable strategies that account for variant emergence, immunity waning and public adherence.
The COVID-19 pandemic has changed the way people from all walks of life relate to one another. Soon after COVID-19 was first identified in Mainland China in 2019, the governments and civic societies in Taiwan and Hong Kong promptly responded to the crisis by employing strict border control, drawing on lessons learnt from the SARs pandemic in 2003. In the past two decades, the Chinese government has increased its influence in the Pacific region in different forms. This paper discusses how the response to the pandemic in Taiwan and Hong Kong was transforming and transformed by the politics of identity and citizenship against this background. We argue that the efforts of the Chinese Government to promote Chinese identity in those Sino-phone countries and the political movements building a distinctive national identity from China there is central to this transformation.
We aimed to investigate the effects of the COVID-19 pandemic on the education and professional development, working conditions, and wellbeing of early career psychiatrists (ECPs) in Europe, as well as their attitudes to telepsychiatry.
Methods
A questionnaire comprising 24 items was designed by the Early Career Psychiatrists Committee of the European Psychiatric Association. Data were collected online from June 2020 to September 2021. A series of multiple regression analyses were conducted to determine variables that could predict the dependent variables.
Results
Data were obtained from 517 early career psychiatrists from 39 different countries. Men were more confident than women in their knowledge of COVID-19 symptoms and management, including in managing patients with a comorbidity of COVID-19 and a mental disorder. Providing specific recommendations during the COVID-19 pandemic, access to additional educational activities for ECPs, following COVID-19-related recommendations and access to protective equipment were the significant predictors of a higher confidence in managing patients with comorbidity of COVID-19 and mental disorders. The obligation to change the place of work predicted a decreased satisfaction with telepsychiatry as well as a decreased willingness to use telepsychiatry after the COVID-19 pandemic, while a diagnosis of COVID-19, having recommendations for telepsychiatry and access to dedicated platform for telemedicine were predictors of an increased satisfaction with telepsychiatry.
Conclusions
The COVID-19 pandemic has affected ECPs in Europe to varying degrees. The results point to areas where decision-makers can improve the working conditions for ECPs.