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With the introduction of COVID-19 vaccines, many colleges and universities decided to mandate vaccination for all students and employees. The objective of this paper is to empirically investigate the effect of the mandate policy on Fall 2021 COVID-19 cases in institutions of higher education. We construct a unique dataset of a sample of 94 colleges and universities in the east and southeast regions of the United States, 41 of which required vaccination prior to Fall 2021. A difference-in-differences analysis is conducted, considering vaccine requirement as a policy implemented only in a sub-group of these institutions. We control for several factors, including state-level case per capita and student population. Our analysis shows that mandatory vaccination substantially decreased cases in institutions of higher education by 1,473 cases per 100,000 student population (95 CI: 132, 2813). The results suggest that a COVID-19 vaccine requirement is an effective policy in decreasing cases in such institutions, leading to a safer educational experience. [ABSTRACT FROM AUTHOR]

COVID-19 is the most devastating pandemic that affected humanity and the world economy. This paper aimed to study the time-varying connectedness between the COVID-19 vaccination, infection rate (INFR), and the case fatality ratio (CFR) in the United States and the stock market returns. We used COVID-19 daily confirmed number of infections, deaths, and vaccinations and the daily US stock market index return. A wavelet coherence approach was used to assess the co-movement of the US stock market with the COVID-19 vaccination, INFR, and the CFR. The COVID-19 vaccination, INFR, and CFR have a positive and significant influence on S&P 500 returns at the majority of business cycle frequencies with an in-phase relation. The wavelet coherence analysis uncovers strong and significant connectedness between COVID-19 vaccination rate and S&P 500 return. From an economic perspective, the US government should continue its intervention with their vaccination strategy, as it is beneficial for fighting the pandemic. This may lead to the recovery of the stock market as well as to the whole economy. [ABSTRACT FROM AUTHOR]

In many parts of the world nursing home residents have experienced a disproportionate risk of exposure to COVID-19 and have died at much higher rates than other groups. There is a critical need to identify the factors driving COVID-19 risk in nursing homes to better understand and address the conditions contributing to their vulnerability during public health crises. This study investigates the characteristics associated with COVID-19 cases and deaths among residents in U.S. nursing homes from 2020 to 2021, with a focus on geospatial and racial inequalities. Using data from the Centers for Medicare and Medicaid Services and LTCFocus, this paper uses zero-inflated negative binomial regression models, Kruskal-Wallis tests, and Local Moran's I to generate statistical and geospatial results. Our analysis reveals that majority Hispanic facilities have alarmingly high COVID-19 cases and deaths, suggesting that these facilities have the greatest need for policy improvements in staffing and financing to reduce racial inequalities in nursing home care. At the same time we also detect COVID-19 hot spots in rural areas with predominately White residents, indicating a need to rethink public messaging strategies in these areas. The top states with COVID-19 hot spots are Kentucky, Pennsylvania, Illinois, and Oklahoma. This research provides new insights into the socio-spatial contexts and inequities that contribute to the vulnerability of nursing home residents during a pandemic. • Geographic and racial inequalities are important indicators of covid-19 risk. • Covid-19 cases & deaths are high among facilities with majority Hispanic residents. • Facilities with majority Hispanic residents have high covid-19 vaccination rates. • Most covid-19 hot spots of cases & deaths are in predominantly White, rural areas. • The top states with covid-19 hot spots of cases & deaths are KY, PA, IL, and OK. [ABSTRACT FROM AUTHOR]

Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling , social processes , and direct behavior change. Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p <.05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p <.05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p <.05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p <.05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings. • Covid-19 vaccine uptake among advanced practice providers and nurses was lower than in physicians. • Vaccine confidence and social norms explained the difference in Covid-19 vaccine uptake. • Recommendations from employers and providers suppressed some differences in vaccination. • Behavioral nudges – invitation and incentives – were associated with more vaccine uptake. • Offers directions and contexts for future vaccination interventions and programs in the U.S. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) has been shown to have more severe health outcomes in older people specifically in relation to mortality and disability. Vaccination seems to be efficacious and safe for preventing the negative consequences of COVID-19, but vaccine hesitancy seems to be high in older adults. We therefore aimed to investigate the prevalence of unwillingness and the uncertainty to vaccinate against COVID-19 in older people and the factors that can be associated with the unwillingness to vaccinate. For this work, we searched several databases until 18th June 2021 for studies reporting the prevalence of unwillingness and the uncertainty to vaccinate against COVID-19 in people aged >60 years. A meta-analysis of the prevalence, with the correspondent 95% confidence intervals (CIs), was proposed. Factors that can be associated with the unwillingness to vaccinate against COVID-19 were explored through multivariable analyses and reported as odds ratios (ORs). Among 662 papers initially screened, we included 15 studies for a total of 9753 older adults. The prevalence of unwillingness to vaccinate against COVID-19 in older people was 27.03% (95%CI: 15.10–38.95%), whilst the correspondent figure of uncertainty was 19.33% (95%CI: 12.28–26.39). The risk of being unvaccinated was significantly higher in Hispanics (OR=1.197; 95%CI: 1.010–1.418) and in case of low education (OR=1.678; 95%CI: 1.170–2.408) and low income (OR=1.287; 95%CI: 1.127–1.469). In conclusion, the hesitancy for COVID-19 vaccination is a relevant problem in older people, particularly in those with a low income, a low level of education, and in Hispanics living in the United States. • COVID-19 is considered a geriatric syndrome people. • vaccine hesitancy in older people can affect vaccine uptake. • The prevalence of unwillingness and uncertainty seems to be higher in older adults compared to younger persons. • The risk of being unvaccinated was significantly higher in Hispanics and in case of low education and low income. [ABSTRACT FROM AUTHOR]

Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies. In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic. Cross-sectional study. Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019. Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies. 35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique. Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]