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A correction is presented to the article "ANZCA Annual Scientific Meeting (ASM) Faculty of Pain Medicine (FPM) Best Free Paper Award Session Abstracts" published in November 29, 2022 issue.

Background: Contact tracing (CT) is a pillar of infection control during outbreaks and its implementation has been great ally in the context of the COVID-19 pandemic that pressured national health systems. Digital CT (DCT) aids manual CT by logging proximity contacts and timely notifying contacts of positive cases, contributing to greater epidemic. We aim to systematically review and critically appraise the available evidence on adoption, effectiveness, acceptance and barriers to access of available CT apps. Methods: We conducted a systematic literature review by means of Pubmed, Embase, Cochrane and Web of Science and applying the PRISMA guidelines. We classified studies according to selected characteristics (eg, original data, mathematical models, policy papers, overview of the experience with national CT apps) in order to better outline our results. Results: Our queries yielded 1201 articles, of which 790 remained after duplicates’ removal. After applying a priori selected inclusion criteria, 428 (54.17%) were eliminated after screening by title and abstract. 362 records were included in our study: of them 33.7% were original studies, 54.1% were opinion papers not reporting quantitative data, 14.91% were mathematical models, 6% were systematic reviews on DCT-related topics. Among original studies, 11.47% described national experiences and 25.40% discussed adoption dynamics. Conclusions: DCT adoption still faces several cultural, normative and technical barriers, ranging from adoption mandates to privacy issues, to device compatibility. Overall, scant evidence is available on the impact of DCT in controlling infection spread and wide heterogeneity persists within studies in term of design and assessed outcomes Future research is needed based on shared evaluation frameworks. Key messages: Digital contact tracing apps are a powerful but underestimated tool to counter epidemiological emergencies. Future epidemiological challenges will require a shared implementation and evaluation protocol for digital contact tracing apps. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of COVID-19 has created global transmission. While effective at reducing the spread, public health measures implemented may impact individuals differently leaving them susceptible to the detrimental effects on their health and wellbeing. Therefore this review aims to synthesise the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID-19 pandemic. Methods: A three-step search strategy was used to find both published and unpublished papers. The databases searched included: MEDLINE, CINAHL, EMBASE, and Google Scholar. Following the search, all identified citations were uploaded into Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed independently by two reviewers, with meta-synthesis conducted in accordance with JBI methodology. Results: Fifteen papers were included. Three synthesized conclusions were established a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID-19 including mortality; b) Gender inequalities and family violence have been exacerbated by COVID-19, leading to diminished wellbeing among women; and c) COVID-19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to healthcare, housing instability, homelessness and difficulties in social distancing. Conclusions: Vulnerable population groups have been disproportionately impacted by COVID-19, including health outcomes such as hospitalisations and mortality. The COVID-19 pandemic has highlighted the need for action on health inequalities and the social determinants of health. Reflection on social and health policies implemented are necessary to ensure that the COVID19 pandemic does not exacerbate health inequalities into the future. [ABSTRACT FROM AUTHOR]

Background: In the first wave of COVID-19, the UK Government relied heavily on digital channels to provide information to the public. This disproportionately excluded older people - one of the groups with least access to (or experience of) using the internet. Approximately 11.5 million people in the UK lack digital skills and 4.8 million people never go online, with around half (51%) of these being aged over 65. The Greater Manchester (GM) response was to work collaboratively with a number of key Ageing groups to develop Keeping Well at Home, a booklet providing evidence based health and wellbeing information and advice for older people during COVID-19 restrictions. Methods: An evaluation of the booklet was undertaken during summer 2020 by the Healthy Ageing team at the Applied Research Collaboration GM. As national restrictions on movement remained in place at the time, a postal questionnaire was distributed to a sample of older adults in GM. Results: Nearly 500 questionnaires were returned. The response was overwhelmingly positive; 92% found the information helpful; 90% agreed the booklet would help older people stay healthy during lockdown; 74% had used the home exercises section; 78% found the tips for keeping their mind well helpful. Around 50% of respondents did not have internet access. Paper based resources was the preferred choice for 92% of respondents with only 6% opting for digital versions. Conclusions: The evidence from the evaluation challenges the growing trend towards communicating just through digital channels, and emphasises the need for tailored paper-based materials for older adults. The Keeping Well at Home booklet also shows the value of working with older adults to ensure the content and design are inviting to readers. Information, support and services must be made available in an offline equivalent and proactively disseminated to reach those who otherwise would not have access to it. Key messages: Print-based communications are preferred over digital for some groups; ensuring inclusivity is critical as the ‘digital by default’ approach excludes large numbers of our population. Including target group representatives as co-editors to advise on content and stylistic design is key to ensure content is relevant and useful. [ABSTRACT FROM AUTHOR]

Background Advance care planning (ACP) is an ongoing conversation where healthcare professionals explore patients' and families' wishes in order to act within their best interests. The COVID19 pandemic continues to highlight the importance of timely ACP, namely while our patients have capacity. We noted that despite advancing age, accumulating co-morbidities and high clinical frailty scores (CFS); ACP discussions were not taking place within our elderly department. We aimed to increase ACP conversations and ensure documentation on ReSPECT forms to allow continuity within primary care. Methods 10 patients per ward were randomly selected. 69 patients met inclusion criteria (over 65 with CFS ≥5 or any patient with dementia). We reviewed electronic and paper records and defined evidence of ACP as ReSPECT form including preferred place of death (PPoD), or discussion with patient or relative in medical notes. We randomly selected a pilot ward and applied interventions over 4 weeks: • Small group teaching to junior doctors • Visiting ward MDTs to identify appropriate patients for ACP • Presenting baseline data to geriatricians • Visual aids from the palliative care team and prompt sheets for doctors. Results Prior to our interventions, 22% of our sample had evidence of advance care planning, 33% of discussions documented on ReSPECT form. Following our intervention period we reviewed medical notes on our pilot ward. 58% patients now had evidence of ACP, with 66% documented on a ReSPECT form. Conclusion We achieved a significant increase in advance care planning within our elderly medicine department, and are therefore better equipped to provide personalised care alongside our patients' wishes and values. Next steps: • Expanding teaching across the multi-disciplinary team • ACP 'champions' to highlight appropriate patients • Expansion of initial interventions across the department We hope to embed and maintain this change through education, training and inspiring others. [ABSTRACT FROM AUTHOR]

B World Conference on Social Science Studies b I March 26-29, 2021 i I Paris, France i The World Conference on Social Sciences Studies is a leading interdisciplinary conference that features the most relevant and insightful research in the discipline. Due to the global pandemic of COVID-19, some of the publicized events may be postponed or moved from place-based to online format. The Eleventh International Conference on Religion & Spirituality in Society calls for research addressing the following special focus: "Modeling Traditions from the Margins: Non-Canonical Writings in Religious Systems.". [Extracted from the article]

Background: Most of the countries in the world adopted isolation measures during the COVID-19 pandemic. According to Kola L. et. al (2021), ‘‘in most settings in low and middle-income countries (LMICs), ongoing in-person mental health services have been disrupted and patients with severe mental conditions and substance abuse disorders are often unable to obtain medications, attend to treatment centres, or receive social services’’. The aim of this paper is to describe the effects of the COVID- 19 pandemic on the demand for attention in a mental health service as reported by healthcare workers. Methods: A quantitative cross-sectional descriptive study was conducted and a survey designed by the Secretarı´a de Polı´ticas Integrales sobre Drogas de la Nacio´n Argentina was applied to a total of 29 healthcare workers of a mental health centre in the Province of Co´ rdoba, Argentina, during the month of November, 2020. Results: The perception of healthcare workers towards the demand for attention shows that the 3 main reasons for consultation during the first three months of isolation measures were drug abuse (50%), request for treatment (10.3%), and order for medication (10.3%). During the three subsequent months, the reasons for consultation were drug abuse (62.1%), request for treatment (44.8%) and remote treatment modality (24.1%). Healthcare workers state that drug abuse consultations increased 65.5% and the self-inflicted violence consultations increased 44.8%. Conclusions: The isolation measures generate a change in the demand for attention. There are differences between various phases of the isolation measures, where an increase in the drug abuse consultations and remote treatment modality could be observed. Key messages: · To develop predictability according to the variations in the demand for attention produced during public health crisis. · To train healthcare workers in order to make interventions in public health crisis. [ABSTRACT FROM AUTHOR]

Background: Healthcare decision-makers need comprehensive evidence to mitigate surges in the demand for human resources for health (HRH) during infectious disease outbreaks, in terms of both short- and longer-term impacts. This study aimed to assess the state of the evidence to address HRH surge capacity during COVID-19 and other outbreaks of global significance in the 21st century. Methods: We systematically searched eight bibliographic databases to extract primary research articles published between 01/2000- 06/2020, capturing temporal changes in HRH requirements and responses surrounding viral respiratory infection pandemics. A systems approach was used, considering providers in hospitals, out-of-hospital systems, emergency medical services, and public health. We narratively synthesized the evidence following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) standard. Results: Of the 1,155 retrieved records, 16 studies met our inclusion criteria; of these, 5 focused on COVID-19, 3 on H1N1, and 8 on a hypothetical pandemic. Different training, mobilization, and redeployment options to address pandemic-time health system capacity were assessed. Few governance scenarios drew on observational HRH data allowing for comparability across contexts. Notable evidence gaps included occupational and psychosocial factors affecting healthcare workers’ absenteeism and risk of burnout, gendered considerations of HRH capacity, evaluations in low- and lower-middle income countries, and policy-actionable assessments to inform post-pandemic recovery and sustainability of services for noncommunicable disease management. Conclusions: This research emphasized the critical need for timely, internationally comparable, and equity-informative HRH data and research to enhance preparedness, response, and recovery policies for this and future pandemics. Full paper is available at: https://doi.org/10.1002/hpm.3137 Key messages: The COVID-19 pandemic has highlighted the critical need for enhanced health workforce data and research, including better tracking of demographics, exposures, infections and deaths of health workers. Although women comprise 70% of the health workforce in many countries, gender-blindness persists in the global literature on health workforce research and governance in public health emergencies./bodyt [ABSTRACT FROM AUTHOR]

Background: Mental health, particularly among young adults, has been severely affected during the COVID-19 pandemic, partially because of both forced social isolation measures and loneliness. Numerous papers on the short-term consequences of lockdown measures reported high psychological distress, as well as an increase of depressive and anxiety symptoms and psychotropic drug use. This study evaluated potential risk and protective factors, such as resilience, loneliness, social and family context, in order to detect vulnerable individuals. Methods: This prospective longitudinal study was carried out in a two phase survey: the first one, during lockdown in Spring 2020 (T1), and, the second one, in Summer 2020 (T2), when restrictive measures were slackened. The main outcomes included the Resilience Scale for Adults (RSA) and the University of California Los Angeles (UCLA) Loneliness Scale. The secondary outcomes included mental health care needs (MHCN), use of psychotropic drugs and family and social contacts. Results: This study evaluated risks and protective factors in mental health in 825 emerging adults aged from 18 to 25 years old in Belgium and in Italy. Participants were divided into three groups according to their MHCN before and after lockdown measures. 5% of the participants experienced an increase in MHCN at T1, including the start of a psychotropic treatment. At T1, statistically significant differences were found in mean RSA total scores and RSA Perception of Self scores between groups. At T2, the group who experienced an increase in MHCN displayed a significant decrease of mean loneliness scores compared with the other groups. This decrease is linearly correlated with resilience competencies. Conclusions: The COVID-19 pandemic and its associated restrictive measures cause a negative impact on youth’s mental health, particularly among vulnerable individuals. Resilience and social contacts are protective factors that need to be taken into account. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe the impact of the pandemic on injuries. Data from National Injury Surveillance System of Norway and Portugal during Covid-19 period were analyzed. In Norway hospital data on injury diagnoses were collected from a national emergency preparedness register established during the pandemic. The number of injured patients per day in the period 1 January-30 June 2020 were identified. The change in patient volumes over two three-week periods before and during the lockdown by sex, age, level of care, level of urgency, type of contact and type of injury were analysed. In Portugal we described the temporal trend in 2020 of the Home and Leisure Accidents(HLA) among vulnerable groups(0- 19years, 65years+), who needed attendance in Emergency Department(ED) of the National Health Service Hospitals. In 2019 and 2020, 240 538 HLA episodes were recorded in the age groups of interest. In Norway, there was an overall reduction of 43% in injured patients during the first three weeks of lockdown. The decrease in patient contacts did not differ by sex, but was most pronounced among young people. Substantial reductions were observed for both acute and elective treatment and across all levels of care and types of contact, with the exception of indirect patient contacts. The change in patient contacts varied considerably by injury type, with the largest reduction observed for dislocations/sprains/ strains and a lower decrease for burns/corrosions/poisoning. Similar trend was observed in Portugal on home and leisure accidents episodes rate registered in children and young people up to 19 years decreased by 24,0% during the 2020 year. In groups of 10-14 years the greatest significant decrease of 35,2% was observed, followed by groups of 5-9 years with a decrease of 24,1%. In 65-74 years an increase of 13,2% was recorded, with the highest increase(19,1%) among people aged 75+. Implications for the health systems and health policy planning will be discussed. [ABSTRACT FROM AUTHOR]

Background: Asylum seekers and refugees risk poorer public health information and difficulties to follow measures during the COVID-19 pandemic because of language, cultural, administrative barriers and social insecurity. We investigate their attitudes and knowledge about COVID-19 measures. Methods: A cross-sectional survey conducted between August and October 2020 in the canton of Vaud, Switzerland. The 24 questions covered health literacy, perception of the pandemic, understanding of health measures and adherence to conspiracy theories. The questionnaire was translated into the ten most common languages. It was distributed online through social networks of charitable and public organisations and in paper in asylum centres. Associations between participants responses and their characteristics were studied using multivariable logistic regressions. Results: The 242 respondents had a mean age of 33 years, 63% were men and 42% had low health literacy. They were 16% asylum seekers, 45% temporarily admitted persons, 12% refugees and 26% rejected asylum seekers. All languages were used. Self-reported adherence to recommendations was 82%. Respectively, 39% and 31% of participants reported sleep disorders or fear of dying. Adjusted for age, gender, health literacy and French language skills, rejected asylum seekers were less worried about the pandemic (aOR 0.37, p = 0.007) and more sensitive to conspiracy theories (aOR 3.47, p = 0.006) than other respondents. They also reported lower adherence to recommendations (aOR 0.45, p = 0.034). Conclusions: We contribute new knowledge about a varied group of vulnerable persons under precarious conditions during the COVID-19 pandemic. The network based multi-language survey combining online and center based distribution was useful but also tedious. Our results highlight the low health literacy of asylum seekers and refugees and their deep concerns about the pandemic. Public health messages should be adapted to rejected asylum seekers. [ABSTRACT FROM AUTHOR]

The coronavirus disease 19 (COVID-19) pandemic is a disaster that has impacted lives globally. The purpose of this paper is to understand the linkage between the COVID 19 disaster and its impact on mental health of older people 70+. To reach this aim we reviewed the literature on disasters, COVID and mental conditions of older people (70+). The mental responses of the COVID disaster are multidimensional and potentially long-lasting. Rates of mental conditions of older persons vary widely due to exposure to COVID, country, population groups and methods used when conducting the study. We identified a multitude of factors contributing to mental conditions in older people, in general. We identified COVID-19 specific factors which have an impact such as threat to own life and threat to life of loved ones, interruption of behaviors and services, and physical as well as social isolation. Additionally, in older age, life events and feelings of being a burden contribute to mental conditions. To better understand the long impact of the COVID disaster on older people's mental health we need to understand also the impact of past life events which may exacerbate the impact of the COVID disaster on mental conditions as well the impact of the current exposure to the pandemic. [ABSTRACT FROM AUTHOR]

The SARS-COV-02 pandemic has globally resulted in a number of policies and interventions to address and reduce the transmission of the disease throughout the population. Mitigation measures have ranged from 'Staying at Home' or 'Lockdowns' to social distancing policies and requirements to work from home when you can. Whilst there are a number of papers which discuss the effects of home or remote working on employees and their families the large scale shift, accelerated pace and wider impacts of such a shift has not been well explored in the literature or has been focussed on specific topics, for example, productivity. HIA is promoted as a beneficial tool to identify the wider impacts of a policy, plan or intervention across a population and as such is well placed to examine and articulate who in a population may be affected and how, and the inequalities that may be created by an intervention such as home working. Using the lens of social determinants and equity focussed-HIA, this work examines the wider impact of home working in Wales during the COVID-19 pandemic. It provides a coherent overview of the major impacts on health and the particular populations affected. It articulates the process followed, the key evidence based findings, discusses the gaps in the evidence base that require further exploration and the impact and influence it has had to date. Finally, it shares the transferable learning, which will be of use to researchers, policy and decision makers, organisations and public health agencies. [ABSTRACT FROM AUTHOR]

According to the ‘‘Urban Health Rome Declaration’’ at European meeting ‘‘G7 Health’’ that defines the strategic aspects and actions to improve Urban, Environmental and Public Mental Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about ‘‘Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable’’, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): ‘‘Health is the precondition of urban sustainable development and the first priority for urban planners’’. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of individual health protection and promotion, but a collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The ‘‘Health in All Policies’’ strategy, clearly underlines how health depend by the quality of outdoor and indoor living environments. In this scenario, the on-going COVID-19 pandemic is a strong reminder that urbanization has changed the way individuals and communities live, work, and interact, and that it’s urgent to make the urban systems and local communities resilient, to prevent the spread of infectious diseases today and tomorrow. Certainly, the on-going urbanization is achieving an increasing attractiveness/appeal, considering that the urban population is expected to rise to the forecasted 70% by 2050 as stated by the UN Population Division Department. The increase in building density will be one of the main global trends, with significant impacts on Public Health and the increase in risk factors affecting the contemporary city, creating a gap between built and green environments, in terms of alarming living conditions. The COVID-19 pandemic is also an accelerator, revelator and amplifier of the on-going urban emergencies in terms of environmental sustainability and Urban Health, with particular reference to the social, environmental and digital issues. Aim of the skills building seminar titled ‘‘(re)FORMING CITIES DUE TO THE COVID CHALLENGE’’, organized by the three EUPHA Section URB+MEN+ENV, it would like to be to build the capacity and knowledge between participants about the main topics and urban features capable to have relevant Public and Mental Health outcomes, with a specific focus about the COVID-19 pandemic period. For this purpose, after the three presentations, 30minutes will be used to create a discussion with the audience, using digital systems (like MENTIMETER, SOCRATIVE, etc.) to collect opinions and create a live discussion about a specific set of questions and topics. The qualitative approach of the second part of this skills building seminar is opposed to the first part, in which the three presentations will share scientific-evidences and data; both approaches can be further summarized in the drafting of a Position Paper. Key messages: • The WP would build the capacity and knowledge between the audience about the main topics and urban features capable to have relevant ENV, URB & MEN outcomes, focusing the COVID-19 pandemic period. • The COVID-19 pandemic accelerated the on-going urban emergencies in terms of sustainability, Urban and Public Mental Health, with particular reference to social, environmental and digital issues. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has reinforced the centrality of health workers at the core of a well performing and resilient health system. It has concomitantly exposed the risks of staffing and skills shortages and the importance of protecting the health workforce. This paper focuses on highlighting some of the lessons learnt, challenges and future needs of the health workforce in Europe in the context of COVID-19. Methods: We use secondary sources and expert information. Results: During the pandemic innovative and flexible approaches were implemented to meet increasing demand for health workers and new skills and responsibilities were adopted over a short period of time. We have seen the rapid adaptation and use of new technologies to deliver care. The pandemic has underlined the importance of valuing, protecting and caring for our health workforce and the need to invest appropriately and adequately in the health workforce to have sufficient, capable and wellmotivated health workers. Some of the main challenges that lie ahead of us include the imperative for better investment, to need to improve recruitment and retraining whilst better retaining health workers, a focus on domestic sustainability, redeploying and developing new skills and competences among health workers, enabling more effective multi-professional collaboration and team work, improving the quality of education and training, increasing the public health focus and promoting ethical and sustainable international recruitment of health workers. Conclusions: The WHO European Region through its European Programme of Work 2020-2025 is fully committed to support countries in their efforts to continue to respond to COVID-19 and whilst addressing upcoming health workforce challenges. [ABSTRACT FROM AUTHOR]

Health-care workers (HCWs) on the frontlines of the 2019 Coronavirus Disease 2019 (COVID-19) have a high risk of acquiring and dying from the disease. Brazil is a country with high morbimortality and ranks highest in general mortality from COVID-19. A large proportion of medical doctors (MDs) is dying, impacting in the workforce. As part of the research by Fiocruz on working conditions among HCWs, we have conducted this study of death among MDs. We analyzed data from Federal Council of Medicine, the only national platform with details about deaths in MDs. A broad search of other sources, including the Ministry of Health, was done, but unfortunately, the data does not exist. A total of 622 MDs died from March 2020 to March 2021: 87.6% male and 75% over age 60. The Southeast had the highest percentage (34.7%), followed by the Northeast (27.2%), and rankings by state showed Rio de Janeiro (15.8%), followed by São Paulo, Pará, Paraná and Paraíba, totalizing 50.1%. The specialties with highest mortality were gynecology (12.2%), pediatrics (10.0%), internal medicine (9.3%), general surgery (7.8%) and cardiology (7.6%). May 2020 was the month of worst mortality (16.9%) followed by July and June. A slow decline was observed until October, when Brazil begun to experience the ‘‘second wave’’. The vaccination of MDs began at the end of January 2021 and has not been sufficient time to evaluate the impact on morbimortality. The results of a study of 50 professional categories are under analysis and will be published soon as well as a study of ‘‘invisible’’ HCWs, who do not have specific training but are essential to supporting health care system, from primary care units to high-complexity hospitals. We hope that the results of these studies will improve links among managers, those who define public policies, and union leaders, achieving better workplace and living conditions, minimizing health and socioeconomic disparities. Key messages: This study is about death by COVID-19 among medical doctors in Brazil, as part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ. This stdy is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ. [ABSTRACT FROM AUTHOR]

At the onset of the COVID-19 pandemic, health care providers had to abruptly change their way of providing care in order to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Even the most wellresourced health systems faced pressures from new challenges brought on by COVID-19, and every country had to make difficult choices about how to maintain access to essential care while treating a novel communicable disease. Using the information available on the HSRM platform from the early phases of the pandemic, we analyze how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and outpatient settings. Many country responses displayed striking similarities despite very real differences in the organization of health and care services. These include transitioning the management of COVID-19 mild cases from hospitals to outpatient settings, increasing the use of remote consultations, and cancelling or postponing non-urgent services during the height of the first wave. In the immediate future, countries will have to continue balancing care for COVID-19 and nonCOVID-19 patients to minimize adverse health outcomes, ideally with supporting guidelines and COVID-19-specific care zones. Many countries expect to operate at lower capacity for routinely provided care, which will impact patient access and waiting times. Looking forward, policymakers will have to consider whether strategies adopted during the COVID-19 pandemic will become permanent features of care provision. [ABSTRACT FROM AUTHOR]

The article highlights developments in public health in Europe as of October 2022. Topics mentioned include the acquisition of an operating grant by European Public Health Association from the European Commission, the lessons about health emergencies that can be learned from COVID-19 pandemic, and the advocacy of Association of Schools of Public Health in the European Region for public health.

Background: The COVID-19 pandemic is accompanied by an infodemic, i.e. a flood of conflicting infor-mation through numerous channels and mis-/disinformation. To cope with these challenges and to make sound health-decisions, people need skills that enable them to access, under-stand, appraise, and use health-related information, i.e. adequate health literacy (HL). Thus, the present study investigates how people in the German-speaking part of Switzerland handle with Corona-specific information, what their difficulties are and what potential improvement measures could be. Methods: Three representative samples of 1’000 individuals each were interviewed online in early sum-mer, autumn and winter 2020 using a modified version of the HLS-EU-Q16 questionnaire. Da-ta were analyzed using descriptive methods and an index for Corona-specific HL was built. Results: In early summer, 55% of the German-speaking Swiss population reported adequate Corona-specific HL, with a tendency to increase with the duration of the pandemic (autumn: 62%; winter: 63%). Nonetheless, a great proportion reported difficulties, especially with assessing the trustworthiness of information from the media. With the progress of the pandemic, partici-pants felt less informed and the proportion of (very) poorly informed increased from 8% in early summer to 16% in winter 2020. Conclusions: Participants often found it difficult to assess the trustworthiness of information on COVID-19 and to derive consequences for their own behavior. Hence, it is important that all relevant stakeholders such as health organizations, authorities and media support the population with tools to facilitate the use of health information and to empower them to take responsibility for their own health as well as for their community. Key messages: People need adequate HL to handle the amount and complexity of COVID-19-related information. Relevant stakeholders need to take over responsibility to empower the population and to enhance their HL. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic presented a wide range of challenges to cancer control. People with possible symptoms of cancer were considered less likely to present for investigation. Patients with cancer were concerned about increased risk of illness or death from this novel virus. Cancer services had to ensure continued delivery of time-sensitive care. Public health skills and leadership have been key to Ireland’s National Cancer Control Programme’s COVID response. The multi-disciplinary skill set within the Programme includes an understanding of health protection principles, experience in rapid service redesign, monitoring of service delivery, patient and public communication, advocacy and guidance development, all of which have been integral to the pandemic response. Specific areas addressed include: rapid turnaround of guidance documents for cancer services, to minimise Covid-19 risk; patient information materials for those on treatment or with a history of cancer; development of novel service delivery mechanisms, such as a virtual national psychooncology service; a media campaign to combat decreased presentations with possible cancer and to reassure those currently on treatment; development of pre-surgical cocooning guidance and testing pathway; advocating for prioritisation of timesensitive cancer diagnosis and treatment, and the wider health & wellbeing needs of those cocooning; advocating for and supporting the implementation of priority vaccination for those undergoing cancer treatment. Cross-sectoral collaboration has been facilitated by existing networks and relationships, allowing rapid responses to be deployed and actioned. The leaner guidance development process employed during the pandemic enabled timely response. A two-way communication system with cancer services allowed swift cascade of information and gathering of intelligence which empowered action. Learning from the cancer setting was transferable to other high-risk groups. Key messages: • The potential impact of the pandemic on non-COVID care was far reaching, including at all stages of the cancer patient journey, from pre-diagnosis to living with or beyond cancer. • The programmatic approach to cancer control in Ireland facilitated concerted efforts to respond to the challenges posed by the pandemic. [ABSTRACT FROM AUTHOR]

COVID-19 has affected health providers economically in two main ways. First, some providers lost income due to postponed services or patients refraining from seeking care. Second, other providers took on new tasks by treating (high volumes of) COVID-19 patients. All providers faced higher costs due to new hygiene and distance requirements. We reviewed if and how countries have adjusted payments to health providers during 2020 using an analytical framework and data from 20 countries. The analysis is based on information collected in the COVID-19 Health System Response Monitor (HSRM) and complemented by grey literature by country representatives who are experts on health policy and have reported the developments and responses to the pandemic since is very onset. We found that payments were not adjusted for many providers whose income did not depend on activity such as salaries, capitations and budgets. Most of the compensatory payments were in the form of new salaries and budgets that substituted activity-based payments, and some higher fees to compensate for activity shortfalls. New FFS payments were created to incentivize virtual services. Payments for COVID-19 related costs included mainly new fees for services. Hospitals also received new budgets to cover the costs of adjusting wards, creating new (ICU) beds, and hiring more workforce. Some countries also created new per diem and DRG tariffs to pay for COVID-19 patients. Consumables such as personal protective equipment and hygiene material were provided in-kind or reimbursed in-cash. Overall, governments bore many COVID19 financial risks. Payment adjustments should be carefully designed in order to protect providers from income shortfalls without undermining productivity, access or quality of care. Payments for COVID-19 services should promote provision without leading to overtreatment or overspending. [ABSTRACT FROM AUTHOR]

Background: In a context of a rapid emerging disease, like the COVID-19 pandemic, we are confronted with clinical uncertainty, evolving epidemiological setting and lacking evidence. Within the context of such a high-priority topic, living systematic reviews (LSRs) are an important systematic review type characterized through regular updating and permanent surveillance of continuously evolving evidence. However, with the new pandemic-related challenges, the standard LSR methodology had to be adapted. Objectives: The objective is to discuss certain challenges that occurred when conducting LSRs in a rapidly emerging disease context. In particular, we give insights in the lessons we have learned from the conduct of two COVID-19 LSRs and highlight emerging methodological aspects. Results: With the evolving knowledge around the virus and its caused disease, we learned that the initial plan for inclusion of study designs, publication types, interventions and comparators, outcomes and the search strategy had to be adapted. The author teams for example had to revise outcome measures or included observational data in addition to evidence from randomized controlled trials, as they provided substantial information on the safety of investigated interventions. For deciding when to update a LSR, additional aspects, such as policy relevance or waiting for important evidence dependent on the individual research question were considered. To avoid biases in the review process, we learned that transparent reporting of any methodological adaptations is highly relevant; between protocol and review, as well as between each review update. Conclusions: Our experience showed that LSRs are highly suitable in a pandemic context, in particular when facing unexpected methodological and clinical challenges. The research question, study designs and the methodology, should be revisited and critically discussed before each update, to be flexible enough for addressing the pandemic context. [ABSTRACT FROM AUTHOR]

The authors reflect on the history of the conferences and exhibitions of the Australian Institute of Occupational Hygienists Inc. (AIOH) and the highlights of the organization's 40th anniversary virtual symposium in 2020. Topics include the AIOH's membership to the Asian Network of Occupational Hygiene (ANOH) and the Occupational Hygiene Training Association (OHTA), and how the virtual symposium was planned and implemented.

The article presents an update on public health in Europe as of October 2021. The need to build back better with women as leaders was emphasized by the World Health Organisation for Europe (WHO EURO) director on International Women's Day. The renewed interest in the digital transformation of health services and public health is attributed to the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus. The 14th European Public Health Conference will be held from November 10 to 12.

The article presents the discussion on impact of coronavirus pandemic on the daily lives. Topics include impacting the annual cycle of cardiovascular conferences and congresses, training course, face-to-face discussion, debate, exchanging ideas, presenting research findings, socializing, and normal interaction; and reducing carbon emissions though at the cost of losing critical face-to-face interactions.

Andrew M. Brunner, M.D., of Massachusetts General Hospital, shared his insights on key practice‐changing research presented at ASH 2020. [ABSTRACT FROM AUTHOR]

This section offers news briefs on European public health as of August 2020. Topics discussed include solidarity amid the Covid-19 pandemic and after the crisis, ways of improving equitable access to medicines and technologies, and decision of the Congress Management Committee to move the 16th World Congress on Public Health (WCPH 2020) into a virtual congress.

An introduction is presented in which the author discusses articles within the issue on topics including ecosystems approach for promoting health-enhancing physical activity, the European Union (EU) Physical Activity Focal Points Network and physical activity interventions in type 2 diabetes management.

The article presents the discussion on link among climate change, poverty, and inequality. Topics include attributed to the effect of climate change related to extreme weather events, changing patterns of disease, and effects on agricultural production; and dots between climate change, water scarcity, energy shortages, global health, food security, and women's empowerment.

Background: The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland’s National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions. Methods: We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages’ from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded. Results: Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest’ stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release. Conclusions: Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts. [ABSTRACT FROM AUTHOR]

Odemira, in the southeast litoral of Portugal, has 33% of migrant citizens, mostly from Southeast Asia, going up to 50% counting transient citizens. Most of them do not speak English, making communication with health services difficult. They tend to live in overcrowded houses with unsanitary conditions. With the emergence of the COVID-19 pandemic, all the above resulted in high incidence and ineffective contact tracing (CT), testing and isolation by the public health teams. It was essential to develop strategies to manage and control outbreaks, and also to achieve health equity. Our experience can be useful for other countries in dealing with their multicultural communities. This intervention started in march 2020 and is still ongoing. The aims were to improve the accuracy of epidemiological surveys (ES) and CT, to more easily stop transmission, to develop the communication skills of health professionals and to improve migrant’s healthcare access. For this, the focus was on digital written communication tools (Whatsapp, translation apps). It was created a toolkit to guide ES and CT tailored to the migrant population, with tips and best practices, and used translated information materials about preventive COVID-19 measures. Workshops were led with health professionals. It was stablished work with local NGOs, creating social media campaigns during crucial events (Holi holliday). As results. it was achieved a better ES output, more accurate CT and better transmission control, with noticeable differences between march 2020 and now. The relationship with this community improved, having better access to services and their needs met. Health professionals reported being more at ease dealing with these patients. Our experience shows it’s possible to communicate effectively despite language and cultural barriers, that cultural knowledge is important in advancing public health goals and that multidisciplinary and intersectoral work is essential to effective interventions. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 is becoming an indicator of inequality in societies. Due to the difficult socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population. The aim of the report is to analyze the impact of the epidemic of COVID-19 and the antiepidemic measures applied among the Roma community in Sliven district, Bulgaria. Material and methods: An exploratory qualitative study design was adopted, combining focus group discussion and qualitative interviews. One focus group with 8 representatives of the Roma ethnic group, and 7 in-depth interviews with specialists working with the Roma community were conducted in November 2020. Data were subjected to thematic analysis. 6 priority topics have been formulated and a hierarchical framework of codes has been built through free software. The experts, assessment of 13 university professors of public health was applied. The COREQ - checklist for reporting quality research was used. Results: A segregated Roma community of about 20 000 people lives in the Nadezhda neighborhood in the town of Sliven. The impressions of the author from the in-depth conducted interviews with the specialists were compared with the summarized view of the experts, reflecting the information received from the Roma population in focus group. Matching the codes of the author and the experts in relation to 5 of the topics such as: work - work; fear - insecurity; healthcare - doctor; ‘closing the neighborhood’ - police; despair, pessimistic views, deterioration of the epidemic situation - disease, misery, famine was found. No coincidences were found regarding future measures to reduce the negative effects of the COVID-19 crisis. Conclusions: The measures taken against the spread of the pandemic further worsen the medical and social situation of the Roma ethnic group in Bulgaria. Our findings pointed to the importance of a multi-sectoral strategy to improve Roma health during and after a COVID-19. [ABSTRACT FROM AUTHOR]

Background: The present crisis offers a unique opportunity to better understanding the specific contribution of the health workforce to health system resilience, and more specifically to the adaptive, absorptive and transformative capacities that influence how health systems respond to the COVID-19 pandemic. Methods: The study examined different capacities in the context of the health system as the central prerequisite of health system resilience. We compared health policies and services responses in Austria, Denmark, Germany, Italy, the Netherlands and the UK. The selection is based on differences in types of health care systems and pandemic burdens in the first wave. Country experts complied descriptive case studies using written secondary and primary sources. Results: During the first wave of the pandemic, the contribution of the health workforce rested on a broad range of capacities. The absorptive capacity concerned the freeing up capacities for newly established Covid-19 wards in hospitals. The adaptive capacity focused on increasing health workers. The transformative capacity concerned new service offerings. The influence of health systems was most visible in relation to the substantive areas of health care delivery at play, and less so in relation to the specific range of capacities of the health workforce. The lack of distinct patterns was striking, considering the inclusion of health systems, which differ on many counts. Conclusions: The study calls for a reconceptualization of the institutional perquisites of health system resilience to grasp more fully the manifold and unique health workforce contribution. Governance is the key to effective health system responses to the COVID-19 crisis, and health professions are part and parcel of governance as frontline workers and collective actors. This requires improving health workforce capacities and strengthening the integration of health professions in health governance. [ABSTRACT FROM AUTHOR]

Background: Social media offer expecting and new mothers a space to discuss birth-related fears, hopes and experiences. This is particularly the case during the Covid-19 pandemic, which has altered delivery of maternity care. Measures to reduce transmission risk in birth facilities and changes in birth plans are likely to have had an impact on new mothers' experiences of birth and birth care. From a feminist epidemiology perspective, seeking to incorporate more the views of the "researched", we explored themes discussed by (expecting) mothers on social media, hoping that those real-life concerns would find echo in the design of future research instruments for data collection. Methods: Using content analysis, we identified key themes in 200+ comments posted on a social media public page as a reaction to the dissemination of a research survey on maternity care during the Covid-19 pandemic in Germany. Results: In the comments, the most mentioned topics were own mask wearing, having a companion of choice during birth, visiting hours, and the possibility to welcome visitors (e.g. siblings of the newborn, other relatives and friends). Those topics also generated the most reactions, revealing compassion from other women and mixed feeling about health measures (from acceptance to anger). Concerns about quality or appropriateness of care were almost absent from the data. Conclusions: Social media content analysis shows clearly that women giving birth during the pandemic are most concerned with a specific set of disrupting and potentially upsetting measures. These spontaneous testimonies differ content-wise from what research surveys tend to ask women about (e.g. care standards). Those discrepancies are to some extent inevitable, but integrating more bottom-up generated topics from social media into research instruments could help move forward toward better care. Key messages: On social media, women were most concerned with own mask wearing, presence of a birth companion and visits from the newborn's siblings. Social media analysis brings valuable insights into what matters the most to women who give birth during the pandemic and could inform future research developments. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic is raising new questions on public health competences and leadership and on health workforce preparedness for global public health emergencies of this magnitude. This study aims to explore the new demand and opportunities for innovation in public health competencies, which were caused by the COVID-19 crisis. Methods: We draw on secondary sources and critically review the public health competency framework recently launched by WHO and ASPHER through the lens of COVID-19. Results: The WHO-ASPHER Competency Framework for Public Health Workforce illustrates an interdisciplinary, inter-professional and lifelong learning approach to public health. Five critical competency areas can be identified in relation to global public health emergencies: (1) flexibility, adaptation, motivation, communication, (2) research, analytical sensitivity, ethics, diversity, (3) epidemiology, (4) preparedness and (5) employability. However, this may not be enough. New models of public health leadership and changes in the health workforce are needed, which transform the silos of professions and policy. Such transformations would include learning, working, leading and governing differently and must stretch far beyond the public health workforce. Innovating public health competences stretches far beyond individual competence development. Moreover, it is about resilience and preparedness and calls for learning, working, leading and governing differently. Critical public health competences are not limited to the public heath workforce, but must become relevant for all healthcare professions. Conclusions: To achieve transformative capacity, critical public health competences must be considered for all healthcare workers on all levels of policymaking, thus becoming the ‘heart’ of health workforce resilience and pandemic preparedness. Key messages: Innovating public health competencies calls for learning, working, leading and governing differently. Public health competences must be considered for all healthcare workers and transform professional silos. [ABSTRACT FROM AUTHOR]

Introduction: During COVID-19 pandemic, health-care workers (HCW) have been exposed to multiple psychosocial stressors. Although the problem of burnout, which overlaps with the symptoms of depression, remains urgent, few studies have addressed it comprehensively. The objective of this study was to determine the prevalence and the factors associated with burnout among HCW. Methodes: We conducted a cross-sectional study on March-April 2021 using a self-administered questionnaire distributed to HCW who were involved in COVID-19 management patients. The 22-item Maslach burnout inventory was performed to measure the prevalence of burnout defined as follows: high score of emotional exhaustion (≥27) plus high score of depersonalization (≥13) or low score of personal accomplishment (≤31). Results: Overall, 250 HCW were included in this study. The sex ratio was 0.17. Their median age was 34 years (interqurtile range (IQR)=[30-40 years]). The average number of work experience was 11.1≤3.4 years. There were 46 cases (18.4%) with a chronic disease. Among the study population, 131 HCW (51.4%) were infected with covid-19. The overall burnout prevalence was 45.6%. Female gender (Odds ratio (OR)=4.3; p<0.001) and unmarried status (OR=3.3; p<0.001) were statistically associated with burnout. Participants in the burnout group had statistically higher number of working hours per day (≤6hours) (OR=3.2; p=0.003), of night shifts per week (4±1 vs 3±1; p=0.04), but lower number of working experience years (7≥0.6 vs 12≤1; p=0.017). History of chronic diseases (OR=1.8;p=0.021), witnessing a COVID-19 death while working (OR=3.1; p<0.001) and suffering from sleep deprivation (OR=1.9; p=0.034) were statistically more frequent in the burnout group of HCW. Conclusions: The findings of this study indicated that the burnout syndrome was highly prevalent among HCW. More psychological support should be provided for this population in order to provide a high-quality of care for patients. [ABSTRACT FROM AUTHOR]

Our goal was to study the influence of COVID-19 measures and coinciding changes in activities on the prevalence of severe injuries treated at the Emergency Departments (EDs) in The Netherlands. We performed a retrospective observational study with data from the Dutch Injury Surveillance System (DISS) and compared prevalences of ED-visits during lockdown period (March 16 - May 10 2020) with prevalences in the same period in 2019. We also compared a period from May 11 to July 5 2020, in which the measures were relaxed, with the same period in 2019. To exclude a possible effect of avoiding hospitals and EDs duet o COVID-19, we included only treatments for severe injuries. The prevalence of ED-visits due to severe injuries was 27% lower during lockdown than during the same period in 2019 (6755 vs. 4902, p < 0,05). This decrease was seen among all types of injuries and all age categories, but was largest within sports injuries and among 10-19 year old persons (-55%). Opposite to those decreases we saw increases in specific types of injuries such as doing home maintenace work (+31%), and skeelering or skating. (+233%). Among 0-11 year olds, the prevalence of injuries due to trampoline use increased by 68%. During the relaxation period regarding COVID-19 measures, the prevalence of severe injuries increased by 19% compared to lockdown, but was still 11% lower than compared with the same period in 2019. We concluded that changes in activities due to COVID-19 measures during lockdown have led to changes in the number of severe injuries treated at the ED. Variations in prevalence primarily seem to relate to variations in sports and traffic participation, and stay in and around the home. [ABSTRACT FROM AUTHOR]

Background: Green space has been associated with health and mental health. Given the high prevalence of mental disorders and costs of worldwide mental ill health and the concurrent rise in mental disorders during the pandemic, there is a need of a better understanding of the impact of different types of green space on mental health. The aim of this study was to assess the impact of characteristics of green space on mental health in a population in a rural area of Germany. Methods: We conducted a cross-sectional survey based on face-to-face on an online assessment instrument. The instrument consisted of sociodemographic questions (assessing age, gender, income, education), mental health related question (PHQ - 9). Green space was dichotomized into green space with agrarian features and green space without agrarian features and subsequently geocoded using ATkis TN. Results: In total n=484 persons participated (female: 240 (49, 6%), male: N=239 (49, 9%), n= missing). Mean age was 58,17 years (SD: 18,83) with an age range of 19-96 years. Depression symptoms showed n=122 (54.9%) persons. Green space without agrarian features was associated with lower symptom levels of depression (Beta: 0.045, SE: 0.023, p=0.015). However, green space with agrarian features was not related to depression. Discussion: Characteristics of green spaces are associated with better mental health; however, the clear definition of quality green space needs further elaboration. The sample is a rural sample and results need further validation in an urban sample. Outlook: In the post-pandemic era green space itself seems to have no impact on mental health, however quality green space does. These results need further validation in multinational studies. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic demanded a quick exchange of those persons and institutions who were aiding the national governments in the crisis response. Thus, devoted members of the Joint Action on Health Information already in April ‘20 started to meet regularly online to foster cross-country exchange. In these meetings partners could approach each other for questions and shared views in a trusted environment on an ad-hoc basis. This initiative became an integral part of PHIRI, allowing a quick exchange of data, indicators, good practices and experiences in the COVID-19 crisis response in a structured and efficient way. Methods: The bi-weekly 1h online meetings, in a moderated, structured format, have 2 parts: 1 pre-agreed topic (chosen via a survey ex-ante to each meeting) and ad-hoc questions. Answers (backed up by evidence like national reports, guidelines, etc.) are compiled and shared via a devoted platform immediately after the meeting. Every 6 weeks there is a special edition where experts present relevant findings and recent activities in the field. Attendees are project partners, national experts (advisors to ministers and heads of agency), representatives of expert networks (e.g. Healthy Cloud), EU services (ECDC, JRC) and stakeholders (e.g. ELIXIR). Results: 12 meetings took place between Nov ‘20 and April ‘21 with ±25-30 attendees. Topics covered followed a needs assessment in Europe and not surprisingly were in line with public debates at the time: November meetings concentrated around testing options whereas in early ‘21 vaccination strategies of countries were in the focus. A widely recognised outcome was a survey on the (temporary) cancellation of the use of AstraZeneca’s vaccine among most EU countries. Conclusions: The Rapid Exchange Forum offers a structured and highly appreciated platform for regular quick exchange of fellow countries, policy advisors, Commission services and researchers in the joint efforts to manage the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic and the actions taken to control the spread of the coronavirus have a substantial impact on population health beyond the morbidity and mortality caused by the virus directly. To provide a comprehensive picture of the pandemic’s impact, suitable indicators for signalling and tracking these wider effects should be incorporated into monitoring activities. Therefore, WHO/Euro developed a tool to select indicators for this purpose. Methods: Based on desk research and extensive expert consultation, a framework was developed for the main pathways through which the COVID-19 pandemic influences population health. For each pathway in the framework, underlying mechanisms and related indicator areas were defined. In addition, groups that are particularly vulnerable to the wider effects of the pandemic were identified, as these require specific attention in monitoring exercises. Results: The main pathways through which the pandemic impacts general population health as used in the tool are: Fear of getting infected or spreading infection Impaired healthcare for non-COVID-19 conditions Direct effects of containment measures [ABSTRACT FROM AUTHOR]

COVID-19 was accompanied by an increase in common mood-anxiety disorders in populations worldwide. This increase is consistent with what has been observed after other prior large-scale disasters but is larger in scale, scope, and duration. This has important implications both for our understanding of population mental health, and for how we may mitigate the mental health consequences of large-scale events [ABSTRACT FROM AUTHOR]

Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt. [ABSTRACT FROM AUTHOR]