Contact-Tracing Apps as Boundary Objects of Pandemic Governance: The State-by-State Approach to Contain the Spread of COVID-19 in the United States

Digital contact tracing has been claimed as imperative to controlling the spread of COVID19. However, the state-by-state approach in the United States led to divergences in contact tracing. This study analyzed contact-tracing apps as "boundary objects" through which each state worked toward the governance of the pandemic without having a formal consensus. Through media coverage and walkthrough analyses of three digital contacttracing apps in Alabama, California, and New York, we closely investigated both convergences and divergences of the apps. In the process, we located the implications of Google/Apple's Bluetooth-based exposure notification system for digital contact tracing within and beyond state boundaries. Our findings suggest that the development of apps shared the notion of an ideal contact-tracing method-exposure notification-while each state was also situated in their local experiences of the pandemic as reflected in distinct app features. We further discuss the implications of techno-solutionist standardization of such digital contact-tracing apps.

Dual Evolutionary Foundations of Political Ideology Predict Divergent Responses to COVID-19

Political conservatives' opposition to COVID-19 restrictions is puzzling given the well-documented links between conservatism and conformity, threat sensitivity, and pathogen aversion. We propose a resolution based on the Dual Foundations Theory of ideology, which holds that ideology comprises two dimensions, one reflecting trade-offs between threat-driven conformity and individualism, and another reflecting trade-offs between empathy-driven cooperation and competition. We test predictions derived from this theory in a UK sample using individuals' responses to COVID-19 and widely-used measures of the two dimensions - 'right-wing authoritarianism' (RWA) and 'social dominance orientation' (SDO), respectively. Consistent with our predictions, we show that RWA, but not SDO, increased following the pandemic and that high-RWA conservatives do display more concerned, conformist, pro-lockdown attitudes, while high-SDO conservatives display less empathic, cooperative attitudes and are anti-lockdown. This helps explain paradoxical prior results and highlights how a focus on unidimensional ideology can mask divergent motives across the ideological landscape.

Evaluating the Relationship between Cycle Threshold Values and Reported COVID-19 Symptoms among Healthcare Workers

Background: SARS-CoV-2 detected by reverse transcription polymerase chain reaction (RT-PCR) can persist for weeks to months in some individuals. Cycle threshold (Ct) values represent the number of cycles needed to amplify viral ribonucleic acid (RNA) to reach a detectable level. As such, Ct values are inversely related to the amount of virus in a sample. As knowledge of SARS-CoV-2 viral dynamics continues to evolve, understanding the relationship between Ct values, type of symptoms, and timing of symptom onset can help determine when infected individuals are most likely to be infectious. Methods: We conducted a retrospective cohort study of 1,027 healthcare workers (HCWs) who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal specimens between June 27, 2020, and September 21, 2020. All HCWs were interviewed within 72 hours of their diagnosis for symptom history. Due to multiple PCR platforms being in use in our facility, only 360 HCWs (35%) had Ct values available for analysis. Multivariate linear regression models examined the effect of COVID-19–related symptoms and timing of symptom onset to test on Ct values. Results: The most frequently reported symptoms were congestion (55.6%), cough (50.3%), and headache (46.7%). Other symptoms less commonly reported were fatigue (36.7%), loss of taste or smell (36.4%), fever (35.4%), muscle aches (33.3%), sore throat (27.4%), and diarrhea (26.7%). Symptomatic HCWs (88.3% of sample) had lower Ct values (ORF-1 M = 22.66, SD = 5.17;E-Gene M = 24.34, SD = 6.60) than asymptomatic individuals (ORF-1 M = 25.46, SD = 6.06;E-Gene M = 29.34, SD = 7.96). Of all symptoms measured, only presence of fever, congestion, and muscle aches predicted significantly lower Ct values. Mean Ct values decreased 2 days prior to symptom onset, were lowest the day of symptom onset, then increased in a curvilinear fashion. There were no significant 2-way interactions between symptoms and time of symptom onset to testing. Conclusions: The curvilinear pattern of Ct values over time from symptom onset are consistent with disease progression patterns and support current understanding of infectivity being highest 2 days prior to symptom onset through day 8. Presence of fever, congestion, and muscle aches are significantly correlated with lower Ct values, suggesting that these symptoms are associated with higher viral load. Although Ct values are not without limitations, our findings support the current understanding that presymptomatic and symptomatic individuals, particularly those with fever, congestion, and muscle aches, may pose higher risk of transmission to others.Funding: NoDisclosures: NoneFigure 1.Figure 2.Table 1.

Thinning out spectators: Did football matches contribute to the second COVID-19 wave in Germany?

The COVID-19 pandemic has decelerated substantial parts of economic and human interaction. This paper estimates football matches' contribution to the spread of COVID-19 during Germany's second infection wave in summer and autumn 2020. Exploiting the exogenous fixture schedules of matches across German counties in an event study design, we estimate that one additional match in a county on average raises daily cases by between 0.34 to 0.71 cases per 100,000 inhabitants after three weeks. Hence, this implies an increase of the seven-day incidence per 100,000 inhabitants by around three to seven percent. We do not find qualitatively different results for a subsample of German top league matches with the strictest hygiene regulations or matches with higher occupancy levels. Notably, the found effect is mediated by the incidence level at the day of the match with very few infections for matches at a seven-day incidence below 25. Using mobile phone data, we identify strong increases in the local mobility as an underlying mechanism. We finally show that the ban of away fans successfully limited the spread of COVID-19 beyond county borders. Our results alert that even outdoor mass gatherings can remarkably cause infections.

Home advantage in professional soccer and betting market efficiency: The role of spectator crowds

Fan support has often been considered to be a main driver of the home advantage in sports. Using the “natural exper- iment” of ghost games during the COVID-19 pandemic in German professional soccer and a dataset of 6,120 matches ranging over the seasons 2011/2012 to 2020/2021, we test this claim. Indeed, applying a difference-in-differences setup, we identify a reduction in the home performance - though with much heterogeneity across leagues and teams. We, moreover, observe the home advantage to recover over time. In analysing whether betting markets anticipated this drop in the home advantage and its recovery, we test the efficient market hypothesis. In the short-run, betting odds do not properly reflect the effect of ghost games regarding changes in the home advantage but they suitably account for it in the long-run. Also, league heterogeneity is efficiently captured in the odds. Based on these findings, we show how simple, short-run betting strategies could have exploited the discussed phenomenon. Our findings also have implications for agents' behavior on financial markets in the presence of unforeseen and unfamiliar shocks. © 2022 The Authors. Kyklos published by John Wiley & Sons Ltd.

The 1st year of the COVID-19 epidemic in Estonia: a population-based nationwide sequential/consecutive cross-sectional study.

OBJECTIVES: The objective of this study was to assess the population prevalence of SARS-CoV-2 and changes in the prevalence in the adult general population in Estonia during the 1st year of COVID-19 epidemic. STUDY DESIGN: This was a population-based nationwide sequential/consecutive cross-sectional study. METHODS: Using standardised methodology (population-based, random stratified sampling), 11 cross-sectional studies were conducted from April 2020 to February 2021. Data from nasopharyngeal testing and questionnaires were used to estimate the SARS-CoV-2 RNA prevalence and factors associated with test positivity. RESULTS: Between April 23, 2020, and February 2, 2021, results were available from 34,915 individuals and 27,870 samples from 11 consecutive studies. The percentage of people testing positive for SARS-CoV-2 decreased from 0.27% (95% confidence interval [CI] = 0.10%-0.59%) in April to 0.04% (95% CI = 0.00%-0.22%) by the end of May and remained very low (0.01%, 95% CI = 0.00%-0.17%) until the end of August, followed by an increase since November (0.37%, 95% CI = 0.18%-0.68%) that escalated to 2.69% (95% CI = 2.08%-2.69%) in January 2021. In addition to substantial change in time, an increasing number of household members (for one additional odds ratio [OR] = 1.15, 95% CI = 1.02-1.29), reporting current symptoms of COVID-19 (OR = 2.21, 95% CI = 1.59-3.09) and completing questionnaire in the Russian language (OR 1.85, 95% CI 1.15-2.99) were associated with increased odds for SARS-CoV-2 RNA positivity. CONCLUSIONS: SARS-CoV-2 population prevalence needs to be carefully monitored as vaccine programmes are rolled out to inform containment decisions.

The impact of Covid-19 on publicgenerosity toward cancer-related crowdfunding efforts

Background: Many patients with cancer rely on public crowdfunding platforms to generate financial support towardcosts associated with their medical care. It is unclear how financial uncertainties resulting from the Covid-19pandemic may impact patient need and public support toward routine cancer-focused campaigns. Methods: Using custom code for web scraping, we identified all campaigns that were generated on thecrowdfunding platform GoFundMe.com in the “Medical, Illness and Healing” category between 8/17/2019 and5/8/2020. This date represents six months of fundraising prior to the first official shelter-in-place order on 3/17/2020.We then abstracted campaigns that included the word “cancer,” originated in the United States, and had raised atleast one dollar. Of these cancer-related campaigns, we collected the dollar amount raised in the first 30 days ofcampaign generation and the total raised to date. Campaigns generated between 2/17/2020 and 3/16/2020 were notincluded in pre/post-Covid calculations because these campaigns would potentially include contributions made after3/17/2020 within their first 30-day values. Results: 19,669 cancer campaigns were identified during the study period (16,823 between 8/17/19 and 2/17/20and 2,846 between 3/17/20 and 5/8/20), raising on average 83% of total funds within the first 30 days of campaigngeneration. In the six months prior to the first shelter-in-place order (8/17/19-2/17/20), there were on average 91new cancer campaigns generated daily. Within the first 30 days, these campaigns averaged $4,472 (median$1,815). After 3/17/20, an average of 54 campaigns were generated daily, representing a 40% decline in dailycampaign generation. Within the first 30 days, these campaigns averaged $6,130 (median $2,950), representing a36% and 60% increase from baseline respectively. Conclusion: Public generosity has increased toward cancer fundraising campaigns since the Covid-19 pandemic, but fewer patients are creating new campaigns. Patients can be reassured that they will likely continue to benefitfrom public support and should not feel limited in asking for help during this period of economic uncertainty. Asphilanthropy sometimes increases during disaster periods, it is unclear if continued support will persist as longer-term economic changes take effect.

Impact of the Covid-19 pandemic onmedical oncology utilization at a busy urban academicmedical center

Background: The unprecedented global pandemic of Covid-19 caused major shifts in medical care throughout theworld. Because chemotherapy delays have been shown to lead to worse outcomes, one of the foremost challengesfor health care systems during this crisis was maintaining uninterrupted care for patients with cancer. Methods: The Division of Hematology-Oncology at UCLA Health has 56 medical oncologists working at 17community practices. Using scheduling data stored within our electronic medical record, we defined three distinctperiods related to the intensity of precautions related to the COVID-19 pandemic in LA county;2/3/20-3/15/20 wasbefore stay-at-home orders were announced (baseline), 3/16/20-5/8/20 was during a period of the strict stay-at-home order, and 5/9/20-6/5/20 was during a period of reopening in the new COVID era. Results: In the baseline period, UCLA Health had an average of 4,555 total patient encounters per week, 0% ofwhich were telemedicine encounters (TE). During the strict stay-at-home period, visits dropped to 3,728 per week(an 18% absolute decrease) and an average of 472 (13%) were TE each week. Since reopening was initiated, visitshave increased to an average of 4,433 patient encounters per week (97% of baseline), with 516 (14%) TE per week.In the baseline period, UCLA Health had an average of 115 infusion cancellations per day with 51% being patientinitiated, 35% physician initiated, and 14% for other reasons (i.e., patient hospitalizations, treatment plan changes, or deaths). During the period of strict stay-at-home orders, cancellations increased from 115 to 133 per day (16%increase), with 47% being patient initiated, 41% being physician initiated, and 12% for other reasons. Sincereopening began, UCLA Health has had an average of 98 infusion cancellations per day with 47% being patientinitiated, 37% being physician initiated, and 16% for other reasons. Conclusion: The Covid-19 pandemic led to a significant decrease in patient encounter volume and an uptick inchemotherapy infusion cancellations. Future study will be needed to examine the effect of this on patient outcomes.Compared to national statistics of changes in patient encounter volume, oncology fared better than most otherspecialties, particularly procedural specialties. Upon reopening, there appears to be a rapid return to baselinepatient encounter volumes and fewer chemotherapy cancellations per day. The pandemic appears to have spurredan increase in the use of telemedicine in medical oncology, previously not utilized by medical oncologists at UCLAHealth, as an important adaptation to maintain continuity of care. This trend has continued even after reopening.Alternative visit models, such as telemedicine, hold promise for ensuring patient-centered continuity care in thiscritical patient population.