Interruptions in HIV and Behavioral Health Care for Criminal-Legal Involved People Living with HIV Following Implementation of Decarceration and Shelter in Place in San Francisco, California.

Decarceration policies, enacted for SARS-CoV-2 mitigation in carceral settings, potentially exacerbated barriers to care for people living with HIV (PWH) with criminal legal involvement (CLI) during Shelter-in-Place (SIP) by limiting opportunities for engagement in provisions of HIV and behavioral health care. We compared health care engagement for PWH with CLI in San Francisco, California before and after decarceration and SIP using interrupted time series analyses. Administrative data identified PWH booked at the San Francisco County Jail with at least one clinic encounter from 01/01/2018-03/31/2020 within the municipal health care network. Monthly proportions of HIV, substance use, psychiatric and acute care encounters before (05/01/2019-02/29/2020) and after (03/01/2020-12/31/2020) SIP and decarceration were compared using Generalized Estimating Equation (GEE) log-binomial and logistic regression models, clustering on the patient-level. Of 436 patients, mean age was 43 years (standard-deviation 11); 88% cisgender-male; 39% white, 66% homeless; 67% had trimorbidity by Elixhauser score (medical comorbidity, psychotic disorder or depression, and substance use disorder). Clinical encounters immediately dropped following SIP for HIV (aOR = 0.77; 95% CI: 0.67, 0.90) and substance use visits (aRR = 0.83; 95% CI: 0.70, 0.99) and declined in subsequent months. Differential reductions in clinical encounters were seen among Black/African Americans (aRR = 0.93; 95% CI: 0.88, 0.99) and people experiencing homelessness (aRR = 0.92; 95% CI: 0.87, 0.98). Significant reductions in care were observed for PWH with CLI during the COVID-19 pandemic, particularly among Black/African Americans and people experiencing homelessness. Strategies to End the HIV Epidemic must improve engagement across diverse care settings to improve outcomes for this key population.

Evaluating the effects of shelter-in-place policies during the COVID-19 pandemic.

We estimate the effects of shelter-in-place (SIP) orders during the first wave of the COVID-19 pandemic. We do not find detectable effects of these policies on disease spread or deaths. We find small but measurable effects on mobility that dissipate over time. And we find small, delayed effects on unemployment. We conduct additional analyses that separately assess the effects of expanding versus withdrawing SIP orders and test whether there are spillover effects in other states. Our results are consistent with prior studies showing that SIP orders have accounted for a relatively small share of the mobility trends and economic disruptions associated with the pandemic. We reanalyze two prior studies purporting to show that SIP orders caused large reductions in disease prevalence, and show that those results are not reliable. Our results do not imply that social distancing behavior by individuals, as distinct from SIP policy, is ineffective.

Dementia and mild cognitive impairment screening in an emergency homeless shelter.

INTRODUCTION: Older adults represent the fastest growing segment of the homeless community. Little is known about the prevalence of dementia and mild cognitive impairment (MCI) in this population. METHODS: Dementia and MCI screening using the Montreal Cognitive Assessment (MoCA) was incorporated into the standard senior evaluation for adult clients aged ≥ 55 in a large emergency homeless shelter. RESULTS: In a 6-week period, 104 of 112 (92.9%) assessments were positive for dementia or MCI using a standard cutoff of 26, and 81 (72.3%) were positive using a conservative cutoff of 23. There was no significant difference in MoCA scores based on sex or education level, and no significant correlation between age and MoCA score. DISCUSSION: Older adults experiencing homelessness may have a high likelihood of dementia or MCI. Routine MoCA screening in older adults experiencing homelessness is feasible and can help to identify services needed to successfully exit homelessness.

The Pent-Up Demand for Breastfeeding Among US Women: Trends After COVID-19 Shelter-in-Place.

Objectives. To estimate changes in national breastfeeding trends immediately before and after COVID-19‒related workplace closures in early 2020. Methods. The implementation of shelter-in-place policies in early 2020, when 90% of people in the United States were urged to remain at home, represents a unique natural experiment to assess the pent-up demand for breastfeeding among US women that may be stymied by the lack of a national paid leave policy. We used the 2017-2020 Pregnancy Risk Assessment Monitoring System (n = 118 139) to estimate changes in breastfeeding practices for births occurring before and after shelter-in-place policies were implemented in the United States. We did this in the overall sample and by racial/ethnic and income subgroups. Results. There was no change in breastfeeding initiation and a 17.5% increase in breastfeeding duration after shelter-in-place, with lingering effects through late 2020. High-income and White women demonstrated the largest gains. Conclusions. The United States ranks worse than similar countries when it comes to breastfeeding initiation and duration. This study suggests that this is partly attributable to inadequate access to postpartum paid leave. This study also demonstrates inequities introduced by patterns of remote work during the pandemic. (Am J Public Health. 2023;113(8):870-873. https://doi.org/10.2105/AJPH.2023.307313).

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco.

In this study, we consider the patient, provider, and public health repercussions of San Francisco's (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020-2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.

The impact of COVID-19 shelter-in-place policy responses on excess mortality.

As a way of slowing COVID-19 transmission, many countries and U.S. states implemented shelter-in-place (SIP) policies. However, the effects of SIP policies on public health are a priori ambiguous. Using an event study approach and data from 43 countries and all U.S. states, we measure changes in excess deaths following the implementation of COVID-19 shelter-in-place (SIP) policies. We do not find that countries or U.S. states that implemented SIP policies earlier had lower excess deaths. We do not observe differences in excess deaths before and after the implementation of SIP policies, even when accounting for pre-SIP COVID-19 death rates.

Evidence for Sex Differences in Depression, Sexual Attitudes, and Impulsivity as Predictors of Breaking Shelter-in-Place Orders During the COVID-19 Pandemic.

Although the call to understand how sexual behaviors have been impacted by the COVID-19 pandemic has been established as an important area of study, research examining the extent to which gender, sexual attitudes, impulsivity, and psychological distress predicted breaking shelter-in-place (SIP) orders to engage in sexual behaviors with partners residing outside the home is undefined. Obtaining a deeper examination of the variables which predict risky sexual behaviors during SIP has important implications for future research at the intersection of public health, sexuality, and mental health. This study addressed the gap in the literature by considering how partnered sexual behaviors may be used during the COVID-19 pandemic to alleviate stress, as measured by breaking SIP orders for the pursuit of sexual intercourse. Participants consisted of 186 females and 76 males (N = 262) who predominately identified Caucasian/White (n = 149, 57.75%) and heterosexual/straight (n = 190, 73.64%) cultural identities with a mean age of 21.45 years (SD = 5.98, range = 18-65). A simultaneous logistic regression was conducted to examine whether mental health symptoms, sexual attitudes, and impulsivity predicted participants' decision to break SIP orders to engage in sexual intercourse. Based on our results, breaking SIP orders to pursue sexual activities with partners residing outside the home during the COVID-19 pandemic may be understood as an intentional strategy among men with less favorable birth control attitudes to mitigate the effects of depression. Implications for mental health professionals, study limitations, and future areas of research are additionally provided.

Poor Environmental Conditions Created the Acute Health Deteriorations in Evacuation Shelters after the 2016 Kumamoto Earthquake.

When disasters occur, affected people in evacuation shelters may experience health problems, such as exacerbation of chronic diseases or development of new diseases. This study examined the factors contributing to sudden illness in evacuation shelters used for the 2016 Kumamoto Earthquake. The subjects were evacuees of the Kumamoto Earthquake who were transported to hospitals from evacuation shelters by ambulance. Data on patients transported from evacuation shelters were obtained from emergency transport records at the Kumamoto City Fire Department and from medical institutions. The assessment of the living conditions in the shelter was obtained from the Emergency Medical Information System. A total of 576 patients were transported by ambulance from evacuation shelters in Kumamoto City. Of these, 300 patients for whom detailed information was obtained from medical institutions were included in the analysis. The median age was 71 years, and 213 patients (71%) were over 60 years old. There were 235 patients (78%) with pre-existing medical conditions. The most common reasons for emergency transport were falls and dyspnea, followed by fever, disturbance of consciousness, and abdominal pain. The most common final diagnosis at the medical institutions was trauma due to falls, followed by cardiovascular disease, infectious disease, and cerebral neurological disease. A survey of living conditions in the shelters identified problems with scarcity of space and provision of medical care and food. In order to prevent adverse health outcomes in evacuation shelters, the provision of appropriate living conditions and medical care is important from the acute phase of a disaster.

The Impact of the COVID-19 Shelter-in-Place Order on Traumatic Brain Injuries in San Francisco, California.

BACKGROUND: In response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma. OBJECTIVES: Our objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP. METHODS: We reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology. RESULTS: There were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003). CONCLUSIONS: Understanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.

Phylogenomics of Severe Acute Respiratory Syndrome Coronavirus 2 in Emergency Shelters for People Experiencing Homelessness.

BACKGROUND: Residents and staff of emergency shelters for people experiencing homelessness (PEH) are at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The importance of shelter-related transmission of SARS-CoV-2 in this population remains unclear. It is also unknown whether there is significant spread of shelter-related viruses into surrounding communities. METHODS: We analyzed genome sequence data for 28 SARS-CoV-2-positive specimens collected from 8 shelters in King County, Washington between March and October, 2020. RESULTS: We identified at least 12 separate SARS-CoV-2 introduction events into these 8 shelters and estimated that 57% (16 of 28) of the examined cases of SARS-CoV-2 infection were the result of intrashelter transmission. However, we identified just a few SARS-CoV-2 specimens from Washington that were possible descendants of shelter viruses. CONCLUSIONS: Our data suggest that SARS-CoV-2 spread in shelters is common, but we did not observe evidence of widespread transmission of shelter-related viruses into the general population.

US shelter in place policies and child abuse Google search volume during the COVID-19 pandemic.

The COVID-19 pandemic has led to unemployment, school closures, movement restrictions, and social isolation, all of which are child abuse risk factors. Our objective was to estimate the effect of COVID-19 shelter in place (SIP) policies on child abuse as captured by Google searches. We applied a differences-in-differences design to estimate the effect of SIP on child abuse search volume. We linked state-level SIP policies to outcome data from the Google Health Trends Application Programming Interface. The outcome was searches for child abuse-related phrases as a scaled proportion of total searches for each state-week between December 31, 2017 and June 14, 2020. Between 914 and 1512 phrases were included for each abuse subdomain (physical, sexual, and emotional). Eight states and DC were excluded because of suppressed outcome data. Of the remaining states, 38 introduced a SIP policy between March 19, 2020 and April 7, 2020 and 4 states did not. The introduction of SIP generally led to no change, except for a slight reduction in child abuse search volume in weeks 8-10 post-SIP introduction, net of changes experienced by states that did not introduce SIP at the same time. We did not find strong evidence for an effect of SIP on child abuse searches. However, an increase in total search volume during the pandemic that may be differential between states with and without SIP policies could have biased these findings. Future work should examine the effect of SIP at the individual and population level using other data sources.

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study.

BACKGROUND: Opioid-related harms, including fatal and non-fatal overdoses, rose dramatically during the COVID-19 pandemic and presented unique challenges during outbreaks in congregate settings such as shelters. People who are deprived of permanent housing have a high prevalence of substance use and substance use disorders, and need nimble, rapid, and portable harm reduction interventions to address the harms of criminalized substance use in an evidence-based manner. CASE STUDY: In February 2021, a COVID-19 outbreak was declared at an emergency men's shelter in Hamilton, Ontario, Canada. Building on pre-existing relationships, community and hospital-based addictions medicine providers and a local harm reduction group collaborated to establish a shelter-based opioid agonist treatment and safer supply program, and a volunteer run safer drug use space that also distributed harm reduction supplies. In the 4 weeks preceding the program, the rate of non-fatal overdoses was 0.93 per 100 nights of shelter bed occupancy. During the 26 days of program operation, there were no overdoses in the safer use space and the rate of non-fatal overdoses in the shelter was 0.17 per 100 nights of shelter bed occupancy. The odds ratio of non-fatal overdose pre-intervention to during intervention was 5.5 (95% CI 1.63-18.55, p = 0.0059). We were not able to evaluate the impact of providing harm reduction supplies and did not evaluate the impact of the program on facilitating adherence to public health isolation and quarantine orders. The program ended as the outbreak waned, as per the direction from the shelter operator. CONCLUSIONS: There was a significant reduction in the non-fatal overdose rate after the safer drug use and safer supply harm reduction program was introduced. Pre-existing relationships between shelter providers, harm reduction groups, and healthcare providers were critical to implementing the program. This is a promising approach to reducing harms from the criminalization of substance use in congregate settings, particularly in populations with a higher prevalence of substance use and substance use disorders.

Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Disproportionately Affects the Latinx Population During Shelter-in-Place in San Francisco.

BACKGROUND: There is an urgent need to understand the dynamics and risk factors driving ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during shelter-in-place mandates. METHODS: We offered SARS-CoV-2 reverse-transcription polymerase chain reaction (PCR) and antibody (Abbott ARCHITECT IgG) testing, regardless of symptoms, to all residents (aged ≥4 years) and workers in a San Francisco census tract (population: 5174) at outdoor, community-mobilized events over 4 days. We estimated SARS-CoV-2 point prevalence (PCR positive) and cumulative incidence (antibody or PCR positive) in the census tract and evaluated risk factors for recent (PCR positive/antibody negative) vs prior infection (antibody positive/PCR negative). SARS-CoV-2 genome recovery and phylogenetics were used to measure viral strain diversity, establish viral lineages present, and estimate number of introductions. RESULTS: We tested 3953 persons (40% Latinx; 41% White; 9% Asian/Pacific Islander; and 2% Black). Overall, 2.1% (83/3871) tested PCR positive: 95% were Latinx and 52% were asymptomatic when tested; 1.7% of census tract residents and 6.0% of workers (non-census tract residents) were PCR positive. Among 2598 tract residents, estimated point prevalence of PCR positives was 2.3% (95% confidence interval [CI], 1.2%-3.8%): 3.9% (95% CI, 2.0%-6.4%) among Latinx persons vs 0.2% (95% CI, .0-.4%) among non-Latinx persons. Estimated cumulative incidence among residents was 6.1% (95% CI, 4.0%-8.6%). Prior infections were 67% Latinx, 16% White, and 17% other ethnicities. Among recent infections, 96% were Latinx. Risk factors for recent infection were Latinx ethnicity, inability to shelter in place and maintain income, frontline service work, unemployment, and household income <$50 000/year. Five SARS-CoV-2 phylogenetic lineages were detected. CONCLUSIONS: SARS-CoV-2 infections from diverse lineages continued circulating among low-income, Latinx persons unable to work from home and maintain income during San Francisco's shelter-in-place ordinance.

Tuberculosis-Associated Hospitalizations and Deaths after COVID-19 Shelter-In-Place, San Francisco, California, USA.

A mandated shelter-in-place and other restrictions associated with the coronavirus disease pandemic precipitated a decline in tuberculosis diagnoses in San Francisco, California, USA. Several months into the pandemic, severe illness resulting in hospitalization or death increased compared with prepandemic levels, warranting heightened vigilance for tuberculosis in at-risk populations.

Predictors of Nursing Home Admission Among a Cohort of Homeless Older Adults Entering Emergency Shelter.

OBJECTIVE: This study examined the extent and timing of nursing home admissions among older adults who had their first visit at an emergency shelter or re-entered after an extended absence. We assessed the relationships between demographic characteristics, health and behavioral health conditions, and health services utilization measures and the risk of nursing home admission. METHODS: We linked administrative data from the emergency shelter system in Boston, MA to claims data from the Massachusetts Medicaid program. Using the linked data, we identified a cohort of 432 adults aged 55 and above who entered the shelter for the first time (or re-entered after an extended absence) between 2012 and 2015. We estimated Kaplan-Meier survival curves and hazard functions to describe the extent and timing of nursing home admissions in this population following the date of their initial shelter entry and Cox proportional hazards regression models to identify predictors of the risk of nursing home admission. RESULTS: Roughly 12% of the study cohort had a nursing home admission within 4 years of their initial shelter entry and risk of shelter admission was highest in the first few months following shelter entry. Older age, diagnoses indicating alcohol use disorder, greater overall disease burden, and a prior history of nursing home admission were all associated with a higher risk of nursing home admission following shelter entry. CONCLUSIONS: Amidst ongoing growth in the number of older homeless adults, our study findings have important implications for efforts to meet the housing and health needs of this population.

Evacuation after the Great East Japan Earthquake is an independent factor associated with hyperuricemia: The Fukushima Health Management Survey.

BACKGROUND AND AIMS: On March 11, 2011, the Great East Japan Earthquake occurred in Japan, with a nuclear accident subsequently occurring at the Fukushima Daiichi Nuclear Power Plant. The disaster forced many evacuees to change particular aspects of their lifestyles. This study assessed the association between evacuation and hyperuricemia based on the Fukushima Health Management Survey from a lifestyle and socio-psychological perspective. METHODS AND RESULTS: This cross-sectional study included 22,812 residents (9391 men and 13,297 women) who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey in fiscal year 2011. Associations between hyperuricemia and lifestyle- and disaster-related factors including evacuation were estimated using a logistic and liner regression analysis. With hyperuricemia defined as uric acid levels >7.0 mg/dL for men and >6.0 mg/dL for women, significant associations were observed between evacuation and hyperuricemia in men (the multivariate-adjusted odds ratio 1.20, 95% confidence interval, 1.05-1.36, p = 0.005), but not in women. In the multivariate-adjusted multiple liner regression analysis, evacuation had significant and positive associations with uric acid levels both in men (ß = 0.084, p = 0.002) and women (ß = 0.060, p < 0.001). CONCLUSION: Evacuation after a natural disaster is an independent factor associated with hyperuricemia.

Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study.

BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.

Lisbon's COVID 19 response: harm reduction interventions for people who use alcohol and other drugs in emergency shelters.

Four emergency shelters were instituted in Lisbon during COVID-19, and are still in operation. Between March and August 2020, they served over 600 people. The shelters host a diverse population, including people experiencing homelessness, foreigners, LGBTI + people, those with reduced mobility, couples, those with pets, and People Who Use Drugs, including alcohol (henceforth PWUD). Individuals are provided care regardless of their immigration or residence status. In order to ensure continuity of care in the shelters and to bring in clients who usually refuse to be sheltered, a range of social and health interventions are integrated into the shelters. Harm reduction services ensure that the most vulnerable populations, PWUD and people experiencing homelessness, have access to the services they need. Innovations in service provision maximize the services impacts and pave the way for the future inclusion and development of these services.

Early warning systems and evacuation: rare and extreme versus frequent and small-scale tropical cyclones in the Philippines and Dominica.

Survey questionnaires were administered among populations affected by Super Typhoon Yolanda in the Philippines in 2013 and Hurricane Maria in Dominica in 2017 to test the efficacy of early warning systems in prompting residents to take appropriate action ahead of severe hazards. Both events were rare and extreme but occurred in locations that regularly experience less severe tropical cyclones. The research assessed if, how, and when residents received warnings, what instructions were given, and where and when people decided to seek safety. In both of the cases under review, residents were aware of the approaching storms, but critical information on their severity and potential impacts was either not received in time or not understood fully, resulting in low levels of evacuation and safety-seeking behaviour. This paper suggests that planning and public communication need to focus on the uncertainty surrounding the severity and multifaceted nature of tropical cyclones and accompanying hazards and their consequences.

Love in the time of COVID-19: A brief report on relationship and individual functioning among committed couples in the United States while under shelter-in-place orders.

The COVID-19 pandemic in the United States has changed many aspects of people's daily life, including increased time at home in response to shelter-in-place orders, heightened stress about health effects of COVID-19, and shifts in other domains of life (e.g., employment). These lifestyle changes are likely to impact the well-being of individuals and their romantic relationships. This investigation examined how COVID-19 influenced couple and individual well-being in real-time during the early phase of the pandemic. Data were collected in early May 2020 during shelter-in-place orders in the United States. Participants in committed relationships (n = 332) completed an online survey assessing their experiences currently and before the pandemic. Results suggested that while couple functioning overall maintained or even improved, individual well-being was more negatively impacted by the pandemic. Moreover, some groups who are at higher risk of a poor health outcome from COVID-19 or experience unique challenges as a result of COVID-19 reported worse outcomes (e.g., those whose employment changed) while others did not decline in their psychological and couple functioning (e.g., Black individuals and older individuals). These findings suggest that the pandemic has had varied impacts on couples and individuals, as well as across different virus-related risk factors. Further research is needed to understand the nuanced effects of this pandemic on couples and individuals across time.

La pandemia de la COVID-19 en los Estados Unidos ha cambiado muchos aspectos de la vida diaria de las personas, por ejemplo, el aumento del tiempo que pasan en sus hogares en respuesta a órdenes de confinamiento, un estrés más elevado por los efectos de la COVID-19 en la salud, y cambios en otros aspectos de la vida (p. ej.: en el empleo). Estos cambios en el estilo de vida probablemente repercutan en el bienestar de las personas y en sus relaciones amorosas. En esta investigación se analizó cómo la COVID-19 influyó en el bienestar de las parejas y de los individuos en tiempo real durante la primera fase de la pandemia. A principios de mayo de 2020 se recopilaron datos durante las órdenes de confinamiento en los Estados Unidos. Los participantes que estaban en relaciones de pareja estables (n=332) contestaron una encuesta en línea donde se evaluaron sus experiencias de ese momento y las anteriores a la pandemia. Los resultados indicaron que, si bien el funcionamiento de la pareja en general se mantuvo o incluso mejoró, la pandemia afectó más negativamente el bienestar individual. Además, algunos grupos que tienen mayor riesgo de resultados desfavorables en la salud como consecuencia de la COVID-19 o enfrentan dificultades singulares como resultado de la COVID-19 informaron peores resultados (p. ej.: aquellos cuyos empleos cambiaron), mientras que otros no tuvieron un empeoramiento de su funcionamiento psicológico y de pareja (p. ej.: las personas de color y las personas mayores). Estos resultados sugieren que la pandemia ha tenido efectos variados en las parejas y en los individuos, así como entre los diferentes factores de riesgo relacionados con el virus. Se necesitan más investigaciones para comprender los efectos sutiles de esta pandemia en las parejas y en los individuos con el transcurso del tiempo.