Income and Employment of Patients at the Start of and During Follow-up After Palliative Radiation Therapy for Bone Metastasis.

Purpose: The aim of this study was to understand the income and employment status of patients at the start of and during follow-up after palliative radiation therapy for bone metastasis. Methods and Materials: From December 2020 to March 2021, a prospective multi-institutional observational study was conducted to investigate income and employment of patients at the start of administration of radiation therapy for bone metastasis and at 2 and 6 months after treatment. Of 333 patients referred to radiation therapy for bone metastasis, 101 were not registered, mainly because of their poor general condition, and another 8 were excluded from the follow-up analysis owing to ineligibility. Results: In 224 patients analyzed, 108 had retired for reasons unrelated to cancer, 43 had retired for reasons related to cancer, 31 were taking leave, and 2 had lost their jobs at the time of registration. The number of patients who were in the working group was 40 (30 with no change in income and 10 with decreased income) at registration, 35 at 2 months, and 24 at 6 months. Younger patients (P = 0), patients with better performance status (P = 0), patients who were ambulatory (P = .008), and patients with lower scores on a numerical rating scale of pain (P = 0) were significantly more likely to be in the working group at registration. There were 9 patients who experienced improvements in their working status or income at least once in the follow-up after radiation therapy. Conclusions: The majority of patients with bone metastasis were not working at the start of or after radiation therapy, but the number of patients who were working was not negligible. Radiation oncologists should be aware of the working status of patients and provide appropriate support for each patient. The benefit of radiation therapy to support patients continuing their work and returning to work should be investigated further in prospective studies.

The Relationship Between Symptoms and Job Loss among Japanese Workers During the COVID-19 Pandemic: A Prospective Cohort Study

ObjectivesThe aim of this study was to clarify which workers symptoms led to unemployment during the COVID-19 pandemic. MethodsThis was a prospective cohort study using questionnaires about COVID-19 administered to Japanese workers. A baseline survey conducted in December 2020 was used to determine workers health history. Unemployment since the baseline survey was ascertained with a follow-up survey in December 2021. The odds ratios (ORs) of unemployment were estimated using a multilevel logistic model with adjusted covariates nested in prefecture of residence. ResultsMales (n = 8,682) accounted for 58.2% of the total sample (n = 14,910), and the mean age was 48.2 years. Multivariate analysis showed that workers with "pain-related problems," "limited physical movement and mobility," "fatigue, loss of strength or appetite, fever, dizziness, and moodiness," "mental health problems," or "sleep" had a greater probability of resigning for health reasons, resigning for all reasons other than retirement, and being unemployed. Those with "skin, hair, and cosmetic concerns" or "eye-related matters" had a greater probability of becoming unemployed. ConclusionsWe identified an association between workers symptoms and resignation or unemployment, with different symptoms having different ORs. Furthermore, there were differences in the associations among the effects of symptoms, work dysfunction, resignation/unemployment, and attitudes of others. Preventive interventions to help workers resolve or improve their symptoms could prevent their becoming unemployed or resigning.

Sociodemographic factors affecting not receiving COVID-19 vaccine in Japan among people who originally intended to vaccinate: a prospective cohort study

BackgroundVaccine hesitancy is a major issue for acquiring herd immunity. However, some individuals may go unvaccinated owing to inhibitory factors other than vaccine hesitancy. If there is even a small number of such people, support is needed for equitable vaccine distribution and acquiring herd immunity. We investigated sociodemographic factors that affected not undergoing COVID-19 vaccination in Japan among individuals who initially had strong intention to vaccinate. MethodsWe conducted this prospective cohort study on workers aged 20-65 years from December 2020 (baseline), to December 2021 using a self-administered questionnaire survey. There were 27,036 participants at baseline and 18,560 at follow-up. We included 6,955 participants who answered yes to this question at baseline: "Would you like to receive a COVID-19 vaccine as soon as it becomes available?" We applied multilevel logistic regression analyses to examine the association between sociodemographic factors and being unvaccinated at follow-up. ResultsIn all, 289 participants (4.2%) went unvaccinated. The odds ratios (ORs) for being unvaccinated were significantly higher for participants aged 30-39 and 40-49 than those aged 60-65 years. Being divorced, widowed, or single, having low income, and having COVID-19 infection experience also had higher ORs. ConclusionsWe found that some participants who initially had strong intention to vaccinate may have gone unvaccinated owing to vaccine side effects and the financial impact of absenteeism due to side effects. It is necessary to provide information repeatedly about the need for vaccination as well as social support to ensure that those who intend to vaccinate are able to do so.

Workplace infection control measures and perceived organizational support during the COVID-19 pandemic in Japan: a prospective cohort study

ObjectiveWe investigated whether workplace infection control measures during the COVID-19 pandemic could increase perceived organizational support (POS). MethodsThis prospective cohort study was conducted in Japan from December 2020 to December 2021 using a questionnaire survey. There were 18,560 respondents at follow-up; we investigated 4,971 who rated low POS at baseline. The participants were asked a single question about POS and nine about workplace infection control measures. We determined the odds ratios (ORs) of high POS at follow-up using multilevel logistic regression analysis. ResultsThe groups of 5-6 (OR=1.29; 95% confidence interval [CI], 1.05-1.57; P=0.014) and 7-9 workplace infection control measures (OR=1.54; 95% CI, 1.28-1.85; P<0.001) had significantly higher ORs than the group with 0-2 measures. ConclusionsHealth support for employees through workplace infection control measures can increase POS.

COVID-19 vaccination coverage by company size and the effects of socioeconomic factors and workplace vaccination in Japan: a cohort study

BackgroundVaccination is considered the most effective control measure against COVID-19. Vaccine hesitancy and equitable vaccine allocation are important challenges to disseminating developed vaccines. To promote COVID-19 vaccination coverage, the government of Japan established the workplace vaccination program. However, while it appears that the program was effective in overcoming vaccine hesitancy, the program may have hindered the equitable allocation of vaccines because it mainly focused on employees of large companies. We investigated the relationship between company size and COVID-19 vaccination completion status of employees and the impact of the workplace vaccination program on this relationship. MethodsWe conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021. The data were collected using a self-administered questionnaire survey. Briefly, 27,036 workers completed the questionnaire at baseline and 18,560 at follow-up. After excluding ineligible respondents, we finally analyzed the data from 15,829 participants. At baseline, the participants were asked about the size of the company they worked for, and at follow-up they were asked about the month in which they received their second COVID-19 vaccine dose and the availability of a company-arranged vaccination opportunity. ResultsIn each month throughout the observation period, the odds of having received a second COVID-19 vaccine dose were significantly lower for small-company employees than for large-company employees in the sex- and age-adjusted model. This difference decreased after adjusting for socioeconomic factors, and there was no significant difference after adjusting for the availability of a company-arranged vaccination opportunity. ConclusionsThe workplace vaccination program implemented in Japan to control the COVID-19 pandemic may have been effective in overcoming vaccine hesitancy in workers; however, it may have caused an inequitable allocation of vaccines between companies of different sizes. Because people who worked for small companies were less likely to be vaccinated, it will be necessary to enhance support of vaccination for this population in the event of future infectious disease outbreaks. Trial registrationNot applicable.

Workplace infection control measures and romantic activities of workers during COVID-19 pandemic: a prospective cohort study in Japan

BackgroundDue to the COVID-19 pandemic, non-married people are at high risk of loneliness. With social interactions restricted, it is important for non-married people to acquire a new romantic partner for their mental health and quality of life. We hypothesized that infection control efforts in the workplace influence peoples social interactions, including romantic activities. MethodsWe conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021, using self-administered questionnaires. Briefly, 27,036 workers completed the questionnaires at baseline, and when followed up after one year, 18,560 (68.7%) participated. A total of 6,486 non-married individuals with no romantic relationship at baseline were included in the analysis. At baseline they were asked about the implementation of infection control measures in the workplace, and at follow-up they were asked about activities they performed with a view to romantic relationships during the period from baseline to follow-up. ResultsCompared to workers in workplaces with no infection control measures, the OR associated with romance-related activities for those in workplaces with seven or more infection control measures was 1.90 (95% CI: 1.45-2.48, p<0.001), and the OR associated with having a new romantic partner was 1.79 (95% CI: 1.20-2.66, p=0.004). ConclusionsUnder the COVID-19 pandemic, the implementation of infection control measures in the workplace and the expressed satisfaction with those measures promoted romantic relationships among non-married, single individuals.

Association between willingness to receive the COVID-19 vaccine and sources of health information among Japanese workers: a cohort study

BACKGROUND@#It is important to achieve herd immunity by vaccinating as many people as possible to end the COVID-19 pandemic. We investigated the relationship between willingness to receive vaccination and sources of health information among those who did not want to be vaccinated against COVID-19.@*METHODS@#This prospective cohort study collected data using a self-administered questionnaire survey. The baseline survey was conducted during December 22-25, 2020, and the follow-up survey during February 18-19, 2021. Participants were aged 20-65 years and worked at the time of the baseline survey (N = 33,087). After excluding 6,051 invalid responses, we included responses from 27,036 participants at baseline. In total, 19,941 people responded to the follow-up survey (74% follow-up rate). We excluded 7,415 participants who answered "yes" to the question "If a COVID-19 vaccine becomes available, would you like to get it?" in the baseline survey. We finally analyzed 12,526 participants.@*RESULTS@#The odds ratio for change in willingness to be vaccinated from "no" to "yes" differed by source of health information. Compared with workers that used TV as a source of information, significantly fewer people who reported getting information from the Internet and friends/colleagues were willing to get the vaccine.@*CONCLUSIONS@#It is important to approach workers who do not watch TV when implementing workplace vaccination programs. It is likely that willingness to be vaccinated can be increased through an active company policy whereby the top management recommend vaccination, coupled with an individual approach by occupational health professionals.@*TRIAL REGISTRATION@#Not applicable.

Sociodemographic factors and self-restraint from social behaviors during the COVID-19 pandemic in Japan: a cross-sectional study

The control of human flow has led to better control of COVID-19 infections. Japans state of emergency, unlike other countries, is not legally binding but is rather a request for individual self-restraint; thus, factors must be identified that do not respond to self-restraint, and countermeasures considered for those factors to enhance its efficacy. We examined the relationship between sociodemographic factors and self-restraint toward going out in public during a pandemic in Japan. This cross-sectional study used data for February 18-19, 2021, obtained from an internet survey; 19,560 participants aged 20-65 were included in the analysis. We identified five relevant behaviors: (1) taking a day trip; (2) eating out with five people or more; (3) gathering with friends and colleagues; (4) shopping for other than daily necessities; (5) shopping for daily necessities. Multilevel logistic regression analyses were used to examine the association between sociodemographic factors and self-restraint for each of the behaviors. Results showed that for behaviors other than shopping for daily necessities, women, those aged 60-65, married people, highly educated people, high-income earners, desk workers and those who mainly work with interpersonal communication, and those with underlying disease reported more self-restraint. Older people had less self-restraint than younger people toward shopping for daily necessities; an underlying disease had no effect on the identified behavior. Specialized interventions for these groups that include recommendations for greater self-restraint may improve the efficacy of the implementing measures that request self-restraint.

Relationship Between Alcohol Consumption and Telecommuting Preference-Practice Mismatch During the COVID-19 Pandemic.

IntroductionThis study examined the association between increased alcohol consumption and telecommuting, comparing employees who expressed a preference for telecommuting and those who did not. MethodsWe conducted an internet monitor survey. Responses from 20,395 of the 33,302 participants were included in the final sample. Participants were asked about their desire for and frequency of telecommuting, and about changes in alcohol consumption under the COVID-19 pandemic. Data were analyzed by logistic regression analysis. ResultsParticipants who telecommuted despite preferring not to do so reported significantly increased alcohol consumption, as revealed by a multivariate analysis (OR=1.62, 95% CI 1.25-2.12). Participants who expressed a preference for telecommuting showed no such increase. ConclusionsUnder the COVID-19 pandemic, telecommuting that involves a mismatch with employee preference for way of working may be a new risk factor for problematic drinking.

Association of alcohol consumption and frequency with loneliness: A cross-sectional study among Japanese workers during the COVID-19 pandemic

BackgroundThere are increasing concerns that prevention measures against coronavirus disease 2019 (COVID-19) such as social distancing and telework are leading to loneliness and poor lifestyle habits like increased alcohol consumption. The purpose of this study was to assess whether loneliness reported among workers during the COVID-19 pandemic is associated with changes in alcohol consumption. MethodsThe study comprised a cross-sectional, online survey of 27,036 workers between December 22 and 26, 2020. A questionnaire was used to assess loneliness, usual alcohol consumption and whether that consumption had changed. The odds ratios (ORs) were estimated by logistic regression analysis. ResultsA total of 2831 (10.5%) workers indicated they had increased alcohol consumption during the pandemic. Increased alcohol consumption was significantly associated with loneliness (OR=1.94, 95%CI 1.70-2.21). This association held true for those who indicated they were drinking two or more days per week (OR=1.98 95%CI 1.71-2.30) and those who drank less than one day per week (OR=1.51 95%CI 0.71-3.25). In contrast, there was no association between increased drinking and loneliness among those who indicated they hardly ever drank (OR=1.22 95%CI 0.55-2.72). ConclusionsAmong those with a drinking habit, increased alcohol consumption is associated with loneliness.

Internet-based health survey on loneliness and sleep-related problems among the working-age population in Japan during COVID-19

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has been linked to a rise in loneliness. Loneliness is associated with sleep-related problems, which in turn can be a risk factor for various psychiatric disorders. However, it is unclear whether loneliness is linked to sleep-related problems during the pandemic. Here, we studied the association between loneliness and sleep-related problems during the COVID-19 pandemic in Japan. MethodsA total of 33,302 individuals who indicated they were employed were surveyed online. The survey responses of 27,036 participants were analyzed. Odds ratios (ORs) were estimated using univariate and multiple logistic regression analyses. ResultsOf those analyzed, 2,750 (10.2%) experienced feelings of loneliness. Further, sleep-related problems were significantly more common among those who felt lonely both in the short term (more than 3 days) and the long term (more than 3 months). The OR was much weaker after adjusting for factors related to interpersonal connections, such as family and friendships, than after adjusting for factors related to socioeconomic status. ConclusionsLoneliness may be a risk factor for sleep-related problems in the COVID-19 pandemic. Having connections with family and friends may have a moderating effect on the occurrence of sleep-related problems.

Association between long working hours and psychological distress: The effect of sick leave criteria in the workplace during the COVID-19 pandemic

ObjectiveThis study investigated the effect of sick leave criteria on the association between long working hours and psychological distress. MethodsWe conducted a cross-sectional survey in December 2020, and 27,032 workers completed the questionnaire. First, after testing the interaction effect of overtime work hours and sick leave criteria on psychological distress, we conducted stratified analyses using sick leave criteria. ResultsA significant interaction effect was found. When we conducted stratified analyses, the odds ratios increased with longer working hours, both with and without sick leave criteria groups; however, the risk was greater in the without sick leave criteria group, compared with the criteria group. ConclusionWe revealed that working without sick leave criteria could strengthen the association between long working hours and psychological distress during the COVID-19 pandemic. Clinical significanceWorkers working without sick leave criteria had a significantly higher risk of psychological distress due to long working hours than those who worked with the criteria. Our findings contribute to preventing the deterioration of mental health during the COVID-19 pandemic.

Factors associated with acceptance of a digital contact tracing application for COVID-19 in the Japanese working-age population

ObjectiveThis study aimed to determine factors associated with acceptance of a Digital Contact Tracing (DCT) app for Coronavirus Disease 2019 (COVID-19) in the Japanese working-age population. MethodsA cross-sectional study was performed for 27,036 full-time workers registered with an internet survey company during December 2020 in Japan. ResultsThe rate of downloading the DCT app was 25.1%. The DCT app was more likely to be accepted by people with married status, university graduation or above, higher income, and occupations involving desk work. Fear of COVID-19 transmission, wearing a mask, using hand disinfection, willingness to be vaccinated against COVID-19, and presence of an acquaintance infected with COVID-19 were also associated with a greater likelihood of adopting the app. ConclusionsThe present findings have important implications for widespread adoption of DCT apps in working-age populations in Japan and elsewhere.

Relationship among work-treatment balance, job stress, and work engagement in Japan: A cross-sectional study

There is a drive to support workers undergoing medical treatment who wish to continue working in Japan, known as the work-treatment balance. It is hoped that this support for the work-treatment balance could boost their mental health. This study examines the relationship among the work-treatment balance, job stress, and work engagement. This study was conducted in December 2020 in Japan, with 27,036 participants. We divided the participants into three groups by the receipt state of support for the work-treatment balance: control group (no need the support), unsupported group, and supported group. The scores of the parameters of the job content questionnaire and the Utrecht Work Engagement Scale (UWES-3) were compared among groups using a multilevel regression with age-sex or multivariate-adjusted models. In the two models, the job control score of the unsupported group was significantly lower than that of the control group. The two social support scores of the supported group were significantly higher than those of the control group. The scores of the UWES-3 of the unsupported group were significantly lower than those of the control group. The support of work-treatment balance for workers could have a positive impact on their mental health.

Effect of workplace infection control practices on workers' psychological distress: a large-scale cohort study during the COVID-19 second state of emergency in Japan

BackgroundThe COVID-19 pandemic has dramatically transformed the work environment and work practices worldwide. Long-term infection control practices may increase the psychological stress on workers, and conversely, inadequate infection control practices at the working place may increase the fear of infection. This study aimed to determine the relationship between infection control practices at the workplace and employee mental health during the COVID-19 pandemic in Japan. MethodsThis study was conducted in December 2020 and February 2021. The participants had undergone a preliminary survey, which revealed that they were in good mental health. Their psychological distress was investigated via a second survey, and the factors associated with distress were studied using a logistic model. ResultsThe results of the second survey indicated that 15.1% of participants demonstrated psychological distress. This was associated with leave-of-absence instructions, instructions for shortening business hours, and requests to avoid the workplace in case of any symptoms. ConclusionThe study found that while some infection control practices reduce workers distress, others worsen it. Employers need to consider infection control practices as well as the worsening mental health of employees following a decrease in income caused by such measures. Follow-up studies may be necessary to clarify the long-term effects on workers mental health.

Association between time spent with family and loneliness among Japanese workers during the COVID-19 pandemic: a cross-sectional study

BackgroundThe current coronavirus (COVID-19) pandemic has had large impacts on society, including people practicing social distancing. This behavioral response has increased loneliness. Loneliness not only increases the risk of psychiatric disorders, but also affects occupational mental health. To avoid the negative effects of isolation, it is important to have social contact with other people, especially family members. Employment and economic instability caused by COVID-19 may have also affected family relationships. It is important to understand the association between family relationships and loneliness in workers under the pandemic. MethodsWe collected usable data from 27,036 Japanese workers who completed an online survey during the COVID-19 pandemic. Participants were asked how long they spend with members of their family during mealtimes or at home, and if they experienced loneliness; the latter was assessed by a single question. Other questions included whether participants lived with their spouse, or with someone in need of care. To estimate the odds ratios (ORs) of time with family associated with loneliness we used a multilevel logistic model nested in the prefecture of residence, with adjustments for age, sex, marital status, presence of a cohabitant requiring care, equivalent income, educational level, frequency of remote work, availability of someone for casual chat, smoking, drinking, time for leisure interests, and cumulative rates of COVID-19 in the prefecture. ResultsTen percent (2,750) of the 27,036 participants reported loneliness. The survey showed a significant negative correlation between time spent with family and loneliness (p<0.001): participants who spent more time with family were less likely to feel loneliness. In addition, not living with a spouse and living with someone in need of care were associated with loneliness (not living with a spouse: p<0.001; living with someone in need of care: p<0.001). ConclusionLoneliness under COVID-19 pandemic conditions was negatively associated with time spent with family members, with the converse result found for participants cohabiting with someone in need of care. These associations suggest the potential value of changes to working practices and interventions to combat loneliness.

Relationship between support for workers with illness and work functioning impairment in Japan during the COVID-19 pandemic

ObjectiveThis study examined the relationship between job accommodations for workers with poor health and work functioning impairment during the COVID-19 pandemic. MethodsAn internet survey was conducted in December 2020. We included 24,429 subjects for analysis. One question was used to determine whether subjects needed job accommodations from their company to continue working in their current health condition. The odds ratios (ORs) of the necessity of job accommodations for sick workers associated with work functioning impairment were estimated using multilevel logistic regression analysis. ResultsThe OR of work functioning impairment among sick workers not receiving job accommodations was 5.75 (95% confidence interval (CI) 5.34-6.20, p<0.001) and those receiving job accommodations was 1.88 (95% CI 1.69-2.08, p<0.001) compared to healthy workers. ConclusionsThis study suggests that providing job accommodations to workers with poor health may improve their work functioning impairment.

Association between work attendance when experiencing fever or cold symptoms and company characteristics and socioeconomic status in the COVID-19 pandemic in Japanese workers: a cross-sectional study

ObjectiveThis study investigated the association between attending work while experiencing fever or cold symptoms and workers socioeconomic background and company characteristics during the COVID-19 pandemic. MethodsA cross-sectional online survey was performed. Of a total of 33,302 participants, 3,676 workers who experienced fever or cold symptoms after April 2020 were included. The odds ratios (ORs) of attending work while sick associated with workers socioeconomic background and company characteristics were evaluated using a multilevel logistic model. ResultsThe OR of attending work while sick associated with a lack of policy prohibiting workers from working when ill was 2.75 (95%CI: 2.28-3.20, P<0.001). ConclusionThis study suggests that clear company policies on work and illness can be effective for preventing employees from attending work while sick.

Dietary differences by job type and industry among workers in Japan during the COVID-19 pandemic: A cross-sectional study

BackgroundThe COVID-19 pandemic requires people to change their lifestyles. This study aimed to examine the differences in dietary behaviors during the pandemic across job types and industries. MethodsA cross-sectional study was conducted using data from the Novel-coronavirus and Work Project. Job type and industry were classified into 3 and 22 groups, respectively. Dietary behaviors were assessed using self-reported questionnaires regarding eating breakfast, frequency of meals, and eating fast foods. Changes in eating breakfast during the pandemic were also evaluated. Logistic regression analysis nested in the workplace prefecture was carried out and adjusted for gender, age, body mass index, presence of family members, educational background, and household income. ResultsWorkers involved in jobs that require communicating with people were more likely to skip breakfast (OR 1.17, 95%CI 1.10-1.24) and had a lower frequency of meals (OR 1.25, 95%CI 1.17-1.34) than workers engaged in desk work. Manual workers were more likely to eat fast food or meals (OR 1.10, 95%CI 1.03-1.17) than workers engaged in desk work. Workers engaged in newspaper, magazine, television, radio, advertising, and other mass media industries were more likely to skip breakfast (OR 2.43, 95%CI 1.82-3.24) and have a lower frequency of meals (OR 3.90, 95%CI 2.87-5.28) than workers in public offices and organizations. ConclusionThe tendencies of dietary behaviors across job types/industries during the pandemic were shown, partially consistent with a trend reported before the pandemic. Further studies should clarify the causes of differences in dietary behaviors among workers.

Effect of familiarity with COVID-19 infection--history of infection or close contact--on outing behaviors when a state of emergency is declared

BackgroundRestricting the movement of the public to gathering places and limiting close physical contact are effective measures against COVID-19 infection. In Japan, states of emergency have been declared in specific prefectures to reduce public movement and control COVID-19 transmission. We investigated how COVID-19 infection related experiences including people with a history of infection, people with a history of close contact, and people whose acquaintances have been infected, affected self-restraint related to outing behaviors during the second state of emergency in Japan. MethodsA prospective cohort study was conducted among workers aged 20-65 years using data from an internet survey. The baseline survey was conducted on December 22-25, 2020, and a follow-up survey was on February 18-19, 2021. There were 19,941 participants who completed both surveys and were included in the final analysis. We identified eight outing behaviors: (1) eating out (4 people or fewer); (2) eating out (5 people or more); (3) gathering with friends and colleagues; (4) day trip; (5) overnight trip (excluding visiting home); (6) visiting home; (7) shopping for daily necessities; and (8) shopping for other than daily necessities. We set self-restraint regarding each outing behavior after the second state of emergency was declared in January 2021 as the dependent variable, and COVID-19 infection related experiences as independent variables. Odds ratios were estimated using multilevel logistic regression analyses. ResultsSignificant differences by COVID-19 infection related experiences were identified: compared to people without COVID-19 related experiences, people with a history of COVID-19 were less likely self-restraint from most outing behaviors. People whose acquaintance had been diagnosed with COVID-19 were significantly more likely to refrain from most outing behaviors. There was no significant difference in any outing behaviors for people with a history of close contact only. ConclusionsTo maximize the effect of a state of emergency, health authorities should disseminate information for each person in the target population, taking into account potential differences related to the COVID-19 infection related experiences.