Lessons learned from COVID-19: provider suggestions for improving service delivery in sexual violence resource centers and children's advocacy centers in Kentucky

The COVID-19 pandemic has presented unique challenges for human service providers, especially as face-to-face services were limited by both formal and informal efforts to protect public health. Telehealth has emerged as a main strategy to ensure continuity of care. This study explored adaptations to services in child advocacy centers (CACs) and sexual violence resource centers (SVRCs) across the Commonwealth of Kentucky, particularly using telehealth. This study highlights respondents' suggestions about improving these service delivery systems and the particular emphasis on challenges and strengths of telehealth for reaching those in rural areas.

SARS-CoV-2 RNA abundance in wastewater as a function of distinct urban sewershed size

During the COVID-19 pandemic, wastewater-based epidemiology has emerged as a promising approach for monitoring SARS-CoV-2 prevalence on a community-level. Despite much being known about the utility of making these measurements in large wastewater treatment plants, little is known about the correlation with finer geographic resolution, such as those obtained through sewershed sub-area catchments. This study aims to identify community wastewater surveillance characteristics between sewershed areas that affect the strength of the association of SARS-CoV-2 RNA detection in a metropolitan area. For this, wastewater from 17 sewershed areas were sampled in Louisville/Jefferson County, Kentucky (USA), from August 2020 to April 2021 (N = 727), which covered approximately 97% of the county's households. Solids were collected from the treatment plants from November 2020 to December 2020 (N = 42). Our results indicate that the sewersheds differ in SARS-CoV-2 trends;however, high pairwise correlation spatial trends were not observed, and the mean SARS-CoV-2 RNA concentrations of smaller upstream community sewershed areas did not differ from their respective treatment centers. Solid samples could only be collected at treatment plants, therefore not allowing us to evaluate SARS-CoV-2 abundance as a function of the sewershed scale. The population size sensitivity of SARS-CoV-2 concentration detection is non-linear: at low population levels the measures are either too sensitive and generate a high level of variability, or at high population levels the estimates are dampened making small changes in community infection levels more difficult to discern. Our results suggest selecting sampling sites that include a wide population range. This study and its findings may inform other system-wide strategies for sampling wastewater for estimating non-SARS-CoV-2 targets.

Social determinants of health and COVID-19 infection in North Carolina: a geospatial analysis

Study Objectives: The COVID-19 pandemic has demonstrated that social determinants of health (SDOH) are profoundly linked to the spread and outcomes of COVID-19. However, the relationships between these SDOH and COVID-19 spatial outbreaks have yet to be determined. We conducted spatial analyses with geographic information systems (GIS) mapping of county-level SDOH and regional COVID-19 infection outbreaks to demonstrate the most impactful SDOH and to provide a pragmatic visual guide to prevent future outbreaks.

Rural rates of hepatitis C within an emergency department-based universal screening program

Study Objective: As a consequence of the opioid epidemic, overall Hepatitis C (HCV) infections have increased in the United States. HCV mortality now surpasses more than 60 other infections (eg, HIV, and TB). The CDC now recommends universal HCV screening, for all adults aged =18 years. Several reports highlight the success of large urban EDs to provide screening and linkage to care for HCV but the ability to utilize rural EDs has not been explored. Our objective was to highlight results of an electronic health record (EHR) driven "opt-out," universal HCV screening program in a small rural community ED that serves the economically disadvantaged, rural/mountainous area of SC, including parts of Appalachia.

COVID connections: lessons from adaptations to COVID-19 as strategies for building food system resilience. (Special Issue: More than disaster: creativity in growing, distributing, and accessing food during covid-19.)

To identify elements of crisis response that might hold lessons for resilience beyond the current moment, we studied a central North Carolina food system during the COVID-19 pandemic. Based on ethnographic interviews with farmers, employees and volunteers of food access organizations, and local government employees, our work found that connection, networking, innovation, and technology adoption were sources of strength and growth. Lessons: food system actors found that their social connections helped them to exchange information and resources, meet increased food needs among SNAP (Supplemental Nutrition Assistance Program) participants and Latina/os immigrants, and combine efforts to adopt technologies and learn from new labor pools. Challenges: while navigating COVID-19, food system actors faced challenges spanning labor, safety, information, government policies, supply shortages, weather, and unreliable information. In addition to lessons and challenges, we offer a series of future research directions that we identified in our study findings. Our study shows that small-scale production and local food organization and government responses are important and dynamic parts of a resilient food system. Regional systems' actors were able to pivot more quickly than large-scale systems and presented a more flexible, locally suitable model that will likely prove adaptive beyond the pandemic.

Correlates of COVID-19 pandemic on anxiety among adults in Appalachia, USA

Background: Anxiety problems have increased in the COVID-19 pandemic worldwide. However, very little is known about the anxiety rates in the new normal phase of the disease when adults have been assumed to be adjusted. The study aimed to find out the difference in anxiety in a convenience sample of Appalachian adults during the new normal phase of the COVID-19 pandemic, examine its association with sociodemographic factors, and compare it with the anxiety levels before the pandemic as recalled by the participants. Study design: A cross-sectional study.

Gis-based vulnerability analysis of the United States to COVID-19 occurrence. (Special Issue: COVID-19 one year on.)

The outbreak of COVID-19 in the United States has resulted in over 11.2 million cases and over 240 thousand deaths. COVID-19 has affected the society in unprecedented way with its socioeconomic impact yet to be determined. This study aimed at assessing the vulnerability of the US at the county-level to COVID-19 using the pandemic data from January to June of the year 2020. The study considered the following critical factors: population density, elderly population, racial/ethnic minority population, diabetics, income, and smoking adults. Pearson's correlation analysis was performed to validate the independence of the factors. Spatial correlations between the COVID-19 occurrence and the factors were examined using Jaccard similarity analysis, which revealed relatively high correlation. A vulnerability to COVID-19 map with a five-level Likert scale was created using Logistic Regression Analysis in ArcGIS. The map showed close agreement in seven representative states, which were selected based on COVID-19 cases including NY, CA, FL, TX, OH, NC, and MT with R2 values between 0.684 and 0.731 with Root Mean Squared Error (RMSE) values between ..0.033 and ..0.057. Furthermore, vulnerability levels from 'High' to 'Very High' were obtained for the top ten counties with the highest COVID-19 cases with residual values less than or equal to 0.04. The method and resulted vulnerability map can aid in COVID-19 response planning, prevention programs and devising strategies for controlling COVID-19 and similar pandemics in the future.

Inequalities in accessing healthcare in the United States of America: a major contributor to the increasing COVID-19 morbidity and mortality

Introduction: Many COVID-19 cases and deaths have been reported from the United States (US). This study aimed to assess the health system inequalities as a determinant of COVID-19 case morbidity and mortality in the US.

Tools for quickly adapting during pandemics, disasters, and other unique events

Amid the current COVID-19 pandemic, Cooperative Extension personnel across the nation are quickly adapting to daily changes while continuing to respond to the needs of clients. This article provides examples of how we in North Carolina State Extension Forestry have responded to the challenges we have faced thus far. The solutions and tools described can be used in the current situation and for future pandemics, disasters, and other unique events that require "alternative" arrangements. The needs of landowners, farmers, youths, and the public at large will not diminish during this unprecedented time;therefore, we should continue to innovate to ensure that our impact is not diminished.