Health and non-health benefits and equity impacts of individual-level economic relief programs during epidemics/pandemics in high income settings: a scoping review.

BACKGROUND: Economic relief programs are strategies designed to sustain societal welfare and population health during a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity. METHODS: We conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3, 2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and economic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in duplicates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach. RESULTS: We identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19 and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9) were most common. Individual-level economic relief programs were reported to have varying degrees of impact on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave programs had the highest number of studies reporting health-related outcomes and positively impacted public health measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services). Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food security, financial resilience, and job security. CONCLUSIONS: Our findings suggest that individual-level economic relief programs can have significant impacts on public health measures, population health outcomes and equity. As countries prepare for future pandemics, our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal when designing pandemic preparedness policies.

COVID-19 Federal Funding To Health Centers: Tracking Distribution, Locations, And Patient Characteristics.

In 2020 and 2021, health centers received federal funding to support their COVID-19 pandemic response, yet little is known about how the funds were distributed. This study identified ten sources of funding distributed to 1,352 centers, ranging from $19 to $1.22 billion per center. When we examined patient and organizational characteristics by quartiles of funding per patient, health centers in the highest-funded quartile (quartile 4) were more likely rural and in the South; employed lower percentages of physicians; and had the highest percentages of sicker, uninsured, and unhoused patients. Centers in the lowest-funded quartile (quartile 1) were more likely urban, employed lower percentages of nurse practitioners, and had the highest percentages of Medicaid enrollees. With the end of pandemic-related funding in 2023, combined with Medicaid unwinding concerns, targeted investment is needed to mitigate a financial cliff and help maintain health centers' capacity to provide high-quality services to those most in need.

Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru.

Peru has a fragmented health insurance system in which most insureds can only access the providers in their insurer's network. The two largest sub-systems covered about 53% and 30% of the population at the start of the pandemic; however, some individuals have dual insurance and can thereby access both sets of providers. We use data on 24.7 million individuals who belonged to one or both sub-systems to investigate the effect of dual insurance on COVID-19 mortality. We estimate recursive bivariate probit models using the difference in the distance to the nearest hospital in the two insurance sub-systems as Instrumental Variable. The effect of dual insurance was to reduce COVID-19 mortality risk by 0.23% compared with the sample mean risk of 0.54%. This implies that the 133,128 COVID-19 deaths in the sample would have been reduced by 56,418 (95%CI: 34,894, 78,069) if all individuals in the sample had dual insurance.

The financial burden of SARS-CoV-2 pregnancies in a tertiary exclusive COVID-19 maternity.

The COVID-19 pandemic had a major impact on health systems worldwide, and Romania was no exception. The impact on healthcare expenses for pregnant women was considerable, especially in COVID-19-only tertiary centers. This study aimed to analyze the impact of the COVID-19 pandemic on healthcare costs in a designated COVID-19 maternity ward. We conducted an observational study comparing pregnant women with SARS-CoV-2 (study group) to those without the infection (control group). Patients were recruited at Bucur Maternity Hospital from March 2020 to March 2022. We evaluated expenses for the entire period of hospitalization, treatment, medical supplies, and medical investigations. The study included 600 pregnant women, divided equally into two groups of 300 each. Significant cost differences were observed between the COVID-19 and non-COVID-19 groups: medication costs (664.56 EUR vs. 39.49 EUR), administrative costs (191.79 EUR vs. 30.28 EUR), and medical investigation costs (191.15 EUR vs. 29.42 EUR). The costs for a severe case of COVID-19 were about two times higher than a mild case and 70 times higher than a non-COVID-19 case (P <0.001). We identified a significant cost increase due to SARS-CoV-2 infection in our unit. The expenses were augmented by the time of hospitalization, medication, and medical investigations. COVID-19 had a significant impact on healthcare costs, mostly among pregnant women with severe disease. The strategy of operating exclusively as a COVID-19 unit proved to be inefficient and highly costly to our hospital.

The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden-The CAMP cohort study.

BACKGROUND: This study examined manual therapy business owners' perception of official recommendations during the COVID-19 pandemic and the impact on their clinics' economic performance, including clinic activity hours and business turnover. MATERIALS AND METHODS: In a longitudinal study design, data were collected in November 2021 (baseline), and after three months, six months, and 12 months. Participants were manual therapists who were business owners. A growth curve model was used to analyze differences in clinical activity trajectories. Multinomial logistic regression analysis was used to assess the relationship between perceived disruptions in business and turnover. Qualitative text analysis was used to examine participants' responses to open-ended questions concerning economic measures taken to sustain their business during the pandemic. RESULTS: This study of 443 manual therapy business owners found that clinics were initially active with minimal variation, but activity changed following COVID-19 recommendations. Business owners perceived that the disruptions had no significant impact on turnover during the initial stages of the official recommendations. Economic support and the previous decrease in turnover increased the likelihood of experiencing a decreased turnover at 12 months. Business owners implemented cost-cutting measures and diversified income sources to navigate COVID-19 challenges and sustain their businesses. CONCLUSION: The official recommendations in Sweden had an impact on manual therapists' businesses as the COVID-19 pandemic lingered. Some business owners were concerned at the early stages about lower turnover but showed financial resilience by cutting costs and finding new revenue sources to overcome COVID-19 challenges.

The public health and economic burden of long COVID in Australia, 2022-24: a modelling study.

OBJECTIVE: To estimate the number of people in Australia with long COVID by age group, and the associated medium term productivity and economic losses. STUDY DESIGN: Modelling study: a susceptible-exposed-infected-recovered (SEIR) model to estimate the number of people with long COVID over time following single infections, and a labour supply model to estimate productivity losses as a proportion of gross domestic product (GDP). SETTING: Australia, 2022-2024. MAIN OUTCOME MEASURES: Estimated number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during 2022-2023 (based on serosurvey data) who have long COVID, 2022-2024, by age group; estimated GDP loss during 2022 caused by reduced labour supply attributable to long COVID. RESULTS: Our model projected that the number of people with long COVID following a single infection in 2022 would peak in September 2022, when 310 341-1 374 805 people (1.2-5.4% of Australians) would have symptoms of long COVID, declining to 172 530-872 799 people (0.7-3.4%) in December 2024, including 7902-30 002 children aged 0-4 years (0.6-2.2%). The estimated mean labour loss attributable to long COVID in 2022 was projected to be 102.4 million (95% confidence interval [CI], 50.4-162.2 million) worked hours, equivalent to 0.48% (95% CI, 0.24-0.76%) of total worked hours in Australia during the 2020-21 financial year. The estimated mean GDP loss caused by the projected decline in labour supply and reduced use of other production factors was $9.6 billion (95% CI, $4.7-15.2 billion), or 0.5% of GDP. The estimated labour loss was greatest for people aged 30-39 years (27.5 million [95% CI, 16.0-41.0 million] hours; 26.9% of total labour loss) and people aged 40-49 years (24.5 million [95% CI, 12.1-38.7 million] hours; 23.9% of total labour loss). CONCLUSION: Widespread SARS-CoV-2 infections in Australia mean that even a small proportion of infected people developing long COVID-related illness and disability could have important population health and economic effects. A paradigm shift is needed, from a sole focus on the immediate effects of coronavirus disease 2019 (COVID-19) to preventing and treating COVID-19 and treating long COVID, with implications for vaccine and antiviral policy and other mitigation of COVID-19.

A longitudinal study on impact of emergency cash transfer payments during the COVID pandemic on coping among Australian young adults.

The coronavirus (COVID-19) pandemic has caused financial hardship and psychological distress among young Australians. This study investigates whether the Australian Government's emergency cash transfer payments-specifically welfare expansion for those unemployed prior to the pandemic (known in Australia as the Coronavirus Supplement) and JobKeeper (cash support for those with reduced or stopped employment due to the pandemic)-were associated with individual's level of coping during the coronavirus pandemic among those with and without mental disorders (including anxiety, depression, ADHD and autism). The sample included 902 young adults who participated in all of the last three waves (8, 9C1, 9C2) of the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Modified Poisson regression models were used to assess the impact of emergency cash transfer payments on 18-22-year-old's self-rated coping level, stratifying the analysis by those with and without mental disorders. All models were adjusted for gender, employment, location, family cohesion, history of smoking, alcohol intake, and COVID-19 test result. Of the 902-person sample analysed, 41.5% (n = 374) reported high levels of coping, 18.9% (n = 171) reported mental disorders, 40.3% (n = 364) received the Coronavirus Supplement and 16.4% (n = 148) received JobKeeper payments. Analysing the total sample demonstrated that participants who received the JobKeeper payment were more likely to have a higher level of coping compared to those who did not receive the JobKeeper payment. Stratified analyses demonstrated that those with pre-existing mental disorder obtained significant benefit from the JobKeeper payment on their level of coping, compared to those who did not receive JobKeeper. In contrast, receipt of the Coronavirus Supplement was not significantly associated with higher level of coping. Among those with no mental health disorder, neither the Coronavirus Supplement nor JobKeeper had a statistically significant impact on level of coping. These findings suggest the positive impacts of cash transfers on level of coping during the pandemic were limited to those with a pre-existing mental disorder who received JobKeeper.

COVID-19 and Mental Health: A "Pandemic Within a Pandemic".

The COVID-19 pandemic has brought significant changes in daily life for humanity and has had a profound impact on mental health. As widely acknowledged, the pandemic has led to notable increases in rates of anxiety, depression, distress, and other mental health-related issues, affecting both infected patients and non-infected individuals. COVID-19 patients and survivors face heightened risks for various neurological and psychiatric disorders and complications. Vulnerable populations, including those with pre-existing mental health conditions and individuals living in poverty or frailty, may encounter additional challenges. Tragically, suicide rates have also risen, particularly among young people, due to factors such as unemployment, financial crises, domestic violence, substance abuse, and social isolation. Efforts are underway to address these mental health issues, with healthcare professionals urged to regularly screen both COVID-19 and post-COVID-19 patients and survivors for psychological distress, ensuring rapid and appropriate interventions. Ongoing periodic follow-up and multidimensional, interdisciplinary approaches are essential for individuals experiencing long-term psychiatric sequelae. Preventive strategies must be developed to mitigate mental health problems during both the acute and recovery phases of COVID-19 infection. Vaccination efforts continue to prioritize vulnerable populations, including those with mental health conditions, to prevent future complications. Given the profound implications of mental health problems, including shorter life expectancy, diminished quality of life, heightened distress among caregivers, and substantial economic burden, it is imperative that political and health authorities prioritize the mental well-being of all individuals affected by COVID-19, including infected individuals, non-infected individuals, survivors, and caregivers.

Impact of Supply Chain Disruptions on Economic Growth: Insights From a Major Public Health Crisis.

Supply chain disruptions caused by major public health crises will severely impact the economic growth. The main purpose of this paper is to examine the above proposition, taking the strict lockdown policy and supply chain disruption in Hubei Province at the beginning of the COVID-19 epidemic as a case, to provide decision-making reference for the government in supply chain management under major public health crisis. To achieve this goal, this paper firstly measures the supply chain network of Hubei province via the multi-region and multi-sector value-added model; then empirically studies the impact of lockdown policy and supply chain disruption on provincial economic growth, with the monthly data of 31 provinces covering January 2018 to December 2022, by the Difference in Difference method. The results show that: the lockdown policy and supply chain disruption under the Covid-19 epidemic negatively affected provincial economic growth; moreover, supply chain disruptions make provinces closer to Hubei more vulnerable to economic shocks. The results are significant in the placebo test, and are further supported in the robustness test of alternative variables and data. We further discussed the Business Cycle Co-movement between Hubei and other provinces, and the probable impact mechanism of supply chain interruption on economic growth in the Covid-19 epidemic. This study shows that supply chain network plays an important role in the transmission of interregional economic shocks, as well as its importance for economic growth, especially in major public health crises.

A scoping review of the impact of COVID-19 on dentistry: financial aspects.

BACKGROUND: The technological advancements of the past few decades in various aspects that are directly or indirectly related to health, along with the emphasis on public health in societal development, have improved the quality of life. However, the occurrence of pandemics and crises underscores how various aspects of individual life can be impacted. The financial consequences resulting from the COVID-19 pandemic have particularly affected the field of dentistry and public oral health. This study aims to investigate the financial effects of the COVID-19 virus on dentistry through a scoping review. METHODS: A comprehensive literature search was conducted across four databases (Medline through PubMed, Embase, Scopus, and Cochrane Central) using keywords such as COVID-19 and its equivalents, dentistry, oral health, dental education, dental services, dental clinics, financial impact, financial opportunities and economic impact. Articles addressing the financial impact of COVID-19 on dentistry and oral health were then screened and reviewed. RESULTS: Out of 1015 articles related to COVID-19 and dentistry, 84 were focused on the financial impact of COVID-19 on dentistry. The majority of these articles originated from the United States, Brazil, and Saudi Arabia, with a prevalence of cross-sectional and review articles. The review categorized the articles into two main themes: financial problems and proposed solutions. Moreover, the following themes were extracted: the effects of practice closure on dentists and staff, increased treatment costs and impacts on oral health, personal protective equipment and unforeseen costs, psychological effects of financial issues, and financial challenges within the dental education system. CONCLUSIONS: While many high-income countries seem able to mitigate COVID-19-induced financial problems, the economic effects on dentistry might persist despite the pandemic's end. These financial challenges have spurred new opportunities and infrastructure development but can pose significant risks to community oral health. This study aimed to highlight these problems and propose solutions, contributing to efforts to improve the oral health of communities globally. Further research is needed to understand long-term impacts.

Can a Well-Being Economy Save Us?

The COVID-19 pandemic led many countries to consider reforms to their economic policies, in part to better deal with global warming, mass population migration and displacements, and worsening global inequalities. Some health progressive changes have been made, but the world still confronts the contradiction between economic growth and the need to reduce aggregate global consumption. Well-being economies based on valuing human and planetary health have been proposed as a viable option, with more appeal than concepts such as degrowth or postgrowth economics. Some governments are moving in a "well-being economy" direction, but are they moving far and fast enough? What are the policy actions governments must take, and how will they overcome powerful interests opposed to any economic changes that might challenge their privileges? The idea of well-being economies resonates strongly with most cultures; and therein lies its civil society activist potential.

Impact of COVID-19 on Characteristics and Funding of U.S. Healthcare Startups: Retrospective Review.

BACKGROUND: The rise of telehealth and telemedicine during the pandemic allowed patients and providers to develop a sense of comfort with telehealth, which may have increased the demand for virtual-first care solutions with spillover effects into venture capital funding. OBJECTIVE: We aimed to understand the size and type of digital health investments occurring in the prepandemic and pandemic periods. METHODS: We examined health care companies founded from March 14, 2019, to March 14, 2020 (prepandemic) versus those founded from March 15, 2020, to March 14, 2022, after pandemic onset. Data were obtained from Crunchbase, a publicly available database that catalogs information about venture capital investments for companies. We also compared companies founded prepandemic to those founded after the first year of the pandemic (pandemic steady-state). We performed a Wilcoxon rank sum test to compare median funding amounts. We compared the 2 groups of companies according to the type of funding round raised, geography, health care subcategory, total amount of funding per year since founding, and number of founders. RESULTS: There were 2714 and 2218 companies founded prepandemic and during the pandemic, respectively. The companies were similarly distributed across geographies in the prepandemic and pandemic periods (P=.46) with no significant differences in the number of founders (P=.32). There was a significant difference in total funding per year since founding between prepandemic and pandemic companies (US $10.8 million vs US $20.9 million; P<.001). The distribution of funding rounds differed significantly for companies founded in prepandemic and pandemic periods (P<.001). On excluding data from the first year of the pandemic, there were 581 companies founded in the pandemic steady-state period from March 14, 2021, to March 14, 2022. Companies founded prepandemic had a significantly greater mean number of founders than those founded during the pandemic (P=.02). There was no significant difference in total funding per year since founding between prepandemic and steady-state pandemic companies (US $10.8 million vs US $14.4 million; P=.34). The most common types of health care companies included wellness, biotech/biopharma, and software companies. Distributions of companies across health care subcategories were not significantly different before and during the pandemic. However, significant differences were identified when data from the first year of the pandemic were excluded (P<.001). Companies founded during the steady-state pandemic period were significantly more likely to be classified as artificial intelligence (7.3% vs 4.7%; P=.005), software (17.3% vs 12.7%; P=.002), and insurance (3.3% vs 1.7%; P=.003), and were significantly less likely to be classified as health care diagnostics (2.4% vs 5.1%; P=.002). CONCLUSIONS: We demonstrate no significant changes in the types of health care companies founded before versus during the pandemic, although significant differences emerge when comparing prepandemic companies to those founded after the first year of the pandemic.

Impact of the COVID-19 pandemic on the financial performance of hospitals according to hospital characteristics in Korea: An observational study.

The coronavirus disease-19 (COVID-19) pandemic had a profound effect on society and various industries. Moreover, hospitals experienced huge financial losses owing to COVID-19 prevention efforts. This study aims not only to comprehensively inspect the financial impact of the pandemic on Korean hospitals but also to consider financial performance by hospital characteristics. Data were collected from 255 general hospitals that uploaded their income statements on the website, and 1530 data points were collected from 2016 to 2021. We used the paired t-test, linear mixed-effects (LME) model in R software (Ver. 4.3.2). We then selected operating margin ratio (OMR) and total margin ratio (TMR) to measure financial performance and used location, type of hospital, and ownership as hospital characteristics. We found that OMR and TMR worsened after COVID-19 breakout, and the labor and management cost ratios increased. According to the LME model with hospital characteristics, the OMR of hospitals located in the capital area worsened more than that of hospitals in noncapital areas (ß5 = -6.3, P < .01). Regarding type of hospitals, tertiary general hospitals maintained a surplus and recorded a better OMR than general hospitals during the pandemic (ß6 = 9.5, P < .01). The OMR of public hospitals worsened more than that of private hospitals during the pandemic (ß7 = -25.4, P < .01), but the TMR of public hospitals increased compared to that of private hospitals (ß7 = 3.9, P < .01). We confirmed that the COVID-19 pandemic had a negative impact on the financial status of hospitals. Considering hospital characteristics, the impact of the pandemic on hospital financial performance differed based on location, type of hospital, and ownership. As the contributions of this study, the government could establish support policies such as government subsidies based on hospital characteristics and hospital administrators could set a contingency plan to mitigate national disasters.

Examining media's coverage of COVID-19 vaccines and social media sentiments on vaccine manufacturers' stock prices.

Introduction: The COVID-19 pandemic caused a widespread public health and financial crisis. The rapid vaccine development generated extensive discussions in both mainstream and social media, sparking optimism in the global financial markets. This study aims to explore the key themes from mainstream media's coverage of COVID-19 vaccines on Facebook and examine how public interactions and responses on Facebook to mainstream media's posts are associated with daily stock prices and trade volume of major vaccine manufacturers. Methods: We obtained mainstream media's coverage of COVID-19 vaccines and major vaccine manufacturers on Facebook from CrowdTangle, a public insights tool owned and operated by Facebook, as well as the corresponding trade volume and daily closing prices from January 2020 to December 2021. Structural topic modelling was used to analyze social media posts while regression analysis was conducted to determine the impact of Facebook reactions on stock prices and trade volume. Results: 10 diverse topics ranging from vaccine trials and their politicization (note: check that we use American spelling throughout), to stock market discussions were found to evolve over the pandemic. Although Facebook reactions were not consistently associated with vaccine manufacturers' stock prices, 'Haha' and 'Angry' reactions showed the strongest association with stock price fluctuations. In comparison, social media reactions had little observable impact on trading volume. Discussion: Topics generated reflect both actual events during vaccine development as well as its political and economic impact. The topics generated in this study reflect both the actual events surrounding vaccine development and its broader political and economic impact. While we anticipated a stronger correlation, our findings suggest a limited relationship between emotional reactions on Facebook and vaccine manufacturers' stock prices and trading volume. We also discussed potential technical enhancements for future studies, including the integration of large language models.

Has urban public service equalization reduced regional differences in economic resilience?

We delve into whether the equalization of basic public services can mitigate regional disparities in China's economic resilience. Our analysis reveals that COVID-19 has diminished economic resilience and exacerbated regional differences. Notably, these regional disparities constitute the primary cause of spatial variations in economic resilience. Despite the initially low level of basic public services in Chinese cities, there is a discernible upward trend, indicating a gradual narrowing of regional disparities. Furthermore, we uncover a substantial positive correlation between the equalization of public services and variations in regional economic resilience, thereby offering fresh empirical evidence that the equalization of public services can help bridge the gap in regional economic resilience.

Comparative analysis of financial toxicity between SARS-CoV-2 infection and common comorbidities.

Financial toxicity is common in individuals with COVID-19 and Long COVID. However, the extent of financial toxicity experienced, in comparison to other common comorbidities, is uncertain. Contributing factors exacerbating financial challenges in Long COVID are also unclear. These knowledge gaps are addressed via a cross-sectional analysis utilizing data from the 2022 National Health Interview Survey (NHIS), a representative sample drawn from the United States. COVID-19 cases were identified through self-reported positive testing or physician diagnoses. Long COVID was defined as experiencing COVID-19-related symptoms for more than three months. Comorbidity was assessed based on self-reported diagnoses of ten doctor-diagnosed conditions (Yes/No). Financial toxicity was defined as having difficulty paying medical bills, cost-related medication nonadherence, delaying healthcare due to cost, and/or not obtained healthcare due to cost. A total of 27,492 NHIS 2022 respondents were included in our analysis, representing 253 million U.S. adults. In multivariable logistic regression models, adults with Long COVID (excluding respondents with COVID-19 but not Long COVID), showed increased financial toxicity compared to those with other comorbidities, such as epilepsy (OR [95% CI]: 1.69 [1.22, 2.33]), dementia (1.51 [1.01, 2.25]), cancer (1.43 [1.19, 1.71]) or respiratory/cardiovascular conditions (1.18 [1.00, 1.40]/1.23 [1.02, 1.47]). Long COVID-related financial toxicity was associated with female sex, age <65 years, lack of medical insurance, current paid employment, residence region, food insecurity, fatigue, mild to severe depression symptoms experienced during the survey completion, visits to hospital emergency rooms, presence of arthritis, cardiovascular or respiratory conditions, and social activity limitations. In conclusion, American adults with Long COVID, but not those who had prior COVID-19 infection without Long COVID, exhibited a higher prevalence of financial toxicity compared to individuals with common comorbidities. Vulnerable populations were at greater risk for financial toxicity. These findings emphasize the importance of evaluating strategies to reduce economic burden and increase awareness of the effect of Long COVID-related financial toxicity on patient's healthcare and health status.

A cost-sensitive decision model for efficient pooled testing in mass surveillance of infectious diseases like COVID-19.

The COVID-19 pandemic has imposed significant challenges on global health, emphasizing the persistent threat of large-scale infectious diseases in the future. This study addresses the need to enhance pooled testing efficiency for large populations. The common approach in pooled testing involves consolidating multiple test samples into a single tube to efficiently detect positivity at a lower cost. However, what is the optimal number of samples to be grouped together in order to minimize costs? i.e. allocating ten individuals per group may not be the most cost-effective strategy. In response, this paper introduces the hierarchical quotient space, an extension of fuzzy equivalence relations, as a method to optimize group allocations. In this study, we propose a cost-sensitive multi-granularity intelligent decision model to further minimize testing costs. This model considers both testing and collection costs, aiming to achieve the lowest total cost through optimal grouping at a single layer. Building upon this foundation, two multi-granularity models are proposed, exploring hierarchical group optimization. The experimental simulations were conducted using MATLAB R2022a on a desktop with Intel i5-10500 CPU and 8G RAM, considering scenarios with a fixed number of individuals and fixed positive probability. The main findings from our simulations demonstrate that the proposed models significantly enhance the efficiency and reduce the overall costs associated with pooled testing. For example, testing costs were reduced by nearly half when the optimal grouping strategy was applied, compared to the traditional method of grouping ten individuals. Additionally, the multi-granularity approach further optimized the hierarchical groupings, leading to substantial cost savings and improved testing efficiency.

Financial hardship after COVID-19 infection among US Veterans: a national prospective cohort study.

BACKGROUND: Research suggests an association between COVID-19 infection and certain financial hardships in the shorter term and among single-state and privately insured samples. Whether COVID-19 is associated with financial hardship in the longer-term or among socially vulnerable populations is unknown. Therefore, we examined whether COVID-19 was associated with a range of financial hardships 18 months after initial infection among a national cohort of Veterans enrolled in the Veterans Health Administration (VHA)-the largest national integrated health system in the US. We additionally explored the association between Veteran characteristics and financial hardship during the pandemic, irrespective of COVID-19. METHODS: We conducted a prospective, telephone-based survey. Out of 600 Veterans with COVID-19 from October 2020 through April 2021 who were invited to participate, 194 Veterans with COVID-19 and 194 matched comparators without a history of infection participated. Financial hardship outcomes included overall health-related financial strain, two behavioral financial hardships (e.g., taking less medication than prescribed due to cost), and seven material financial hardships (e.g., using up most or all savings). Weighted generalized estimating equations were used to estimate risk ratios (RR) and 95% confidence intervals (CI) of financial hardship by COVID-19 status, and to assess the relationship between infection and Veteran age, VHA copay status, and comorbidity score, irrespective of COVID-19 status. RESULTS: Among 388 respondents, 67% reported at least one type of financial hardship since March 2020, with 21% reporting behavioral hardships and 64% material hardships; 8% reported severe-to-extreme health-related financial strain. Compared with uninfected matched comparators, Veterans with a history of COVID-19 had greater risks of severe-to-extreme health-related financial strain (RR: 4.0, CI: 1.4-11.2), taking less medication due to cost (RR: 2.9, 95% CI: 1.0-8.6), and having a loved one take time off work to care for them (RR: 1.9, CI: 1.1-3.6). Irrespective of COVID-19 status, Veterans aged < 65 years had a greater risk of most financial hardships compared with Veterans aged ≥ 65 years. CONCLUSIONS: Health-related financial hardships such as taking less medication due to cost and severe-to-extreme health-related financial strain were more common among Veterans with a history of COVID-19 than among matched comparators. Strategies are needed to address health-related financial hardship after COVID-19. TRIAL REGISTRATION: NCT05394025, registered 05-27-2022.

An ecological comparison to inspect the aftermath of post COVID-19 condition in Italy and the United States.

Post COVID-19 Condition (PCC) is a clinical syndrome following COVID-19 disease. PCC symptoms in adults entail significant productivity loss and reduced quality of life. This study aimed at estimating the epidemiological and economic burden of PCC among the working-age population of Italy and the US. This ecological analysis was conducted on data from January 2020 to April 2023, regarding population aged 18-64. PCC incidence for the US was retrieved from publicly reported estimates, while for Italy it was estimated from COVID-19 cases. Prevalence of factors associated with PCC and parameters to calculate temporary productivity losses (TPL) were retrieved. An estimated incidence rate ratio (eIRR) of PCC incidence in Italy and the US was calculated. TPL for reduced earnings and total quality-adjusted life years (QALYs) lost were also estimated. The ecological eIRR Italy/US was 0.842 [95%CI 0.672-1.015], suggesting that, holding COVID-19 cases constant, 15.8% fewer PCC cases have occurred in Italy compared to the US. Overall PCC cases were found to be 12.0 [95%CI 9.9-14.1] million in the US, with 1.9 [95%CI 1.6-2.3] million QALYs lost, and 2.4 [95%CI 1.8-3.0] million in Italy, with 0.4 [95%CI 0.3-0.5] million QALYs lost. Up to April 2023, the TPL was estimated to be Int$7.5 [95%CI 5.8-10.1] billion in Italy and $41.5 [95%CI 34.3-48.7] billion in the US. PCC has had a significant epidemiological and economic impact on the working-age population. The findings from this study may be of use for health planning and policy regarding PCC in working-age adults.