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Background: The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. Methods: The data collected from 479 Belgian practices during 2020–2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. Results: Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. Conclusions: Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disrupted societies globally. Public health institutions were tasked with responding to the pandemic in a dynamic and uncertain context. This paper sheds light on the experiences of COVID-19 response actors as they navigated multi-dimensional crises associated with the pandemic in general and vaccine hesitancy in particular. This research was conducted during the initial phase of the COVID-19 vaccine rollout in Flanders, Belgium. Participants included informants across all levels of the COVID-19 vaccination strategy including but not limited to those producing scientific knowledge, providing policy input, or implementing public health directives locally. 'Crisis' was identified as a recurring theme in interviews with informants. The paper highlights multi-dimensional crises experienced by informants such as the: (i) crisis of prioritization, (ii) crisis of communication, (iii) crisis of the changing image of science, (iv) crisis of epistemic agency and autonomy, and (v) crisis of trust. [ABSTRACT FROM AUTHOR]

This paper assesses the impact on household incomes of the COVID‐19 pandemic and governments' policy responses in April 2020 in four large and severely hit EU countries: Belgium, Italy, Spain and the UK. We provide comparative evidence on the level of relative and absolute welfare resilience at the onset of the pandemic, by creating counterfactual scenarios using the European tax‐benefit model EUROMOD combined with COVID‐19‐related household surveys and timely labor market data. We find that income poverty increased in all countries due to the pandemic while inequality remained broadly the same. Differences in the impact of policies across countries arose from four main sources: the asymmetric dimension of the shock by country, the different protection offered by each tax‐benefit system, the diverse design of discretionary measures and differences in the household level circumstances and living arrangements of individuals at risk of income loss in each country. [ABSTRACT FROM AUTHOR]

Background: Non-pharmaceutical interventions (NPIs) were adopted in Belgium in order to decrease social interactions between people and as such decrease viral transmission of SARS-CoV-2. With the aim to better evaluate the impact of NPIs on the evolution of the pandemic, an estimation of social contact patterns during the pandemic is needed when social contact patterns are not available yet in real time. Methods: In this paper we use a model-based approach allowing for time varying effects to evaluate whether mobility and pre-pandemic social contact patterns can be used to predict the social contact patterns observed during the COVID-19 pandemic between November 11, 2020 and July 4, 2022. Results: We found that location-specific pre-pandemic social contact patterns are good indicators for estimating social contact patterns during the pandemic. However, the relationship between both changes with time. Considering a proxy for mobility, namely the change in the number of visitors to transit stations, in interaction with pre-pandemic contacts does not explain the time-varying nature of this relationship well. Conclusion: In a situation where data from social contact surveys conducted during the pandemic are not yet available, the use of a linear combination of pre-pandemic social contact patterns could prove valuable. However, translating the NPIs at a given time into appropriate coefficients remains the main challenge of such an approach. In this respect, the assumption that the time variation of the coefficients can somehow be related to aggregated mobility data seems unacceptable during our study period for estimating the number of contacts at a given time. [ABSTRACT FROM AUTHOR]

This paper reports the first publicly available results of Belgium's newly created Digital Payment Barometer. The results show that, as in other countries, the COVID-19 pandemic triggered a shift towards contactless and, to a lesser extent, mobile payments at the point of sale. Strikingly, however, the biggest jumps in the use of contactless payments are observed in the 65–74 and 75+ age groups. There are also indications that these shifts in behaviour may well outlast the pandemic, as consumer preferences have also changed markedly. [ABSTRACT FROM AUTHOR]

Governments and public health authorities use seroprevalence studies to guide responses to the COVID-19 pandemic. Seroprevalence surveys estimate the proportion of individuals who have detectable SARS-CoV-2 antibodies. However, serologic assays are prone to misclassification error, and non-probability sampling may induce selection bias. In this paper, non-parametric and parametric seroprevalence estimators are considered that address both challenges by leveraging validation data and assuming equal probabilities of sample inclusion within covariate-defined strata. Both estimators are shown to be consistent and asymptotically normal, and consistent variance estimators are derived. Simulation studies are presented comparing the estimators over a range of scenarios. The methods are used to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in New York City, Belgium, and North Carolina. [ABSTRACT FROM AUTHOR]

Background: Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. Methods: We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. Results: Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. Conclusion: The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period. [ABSTRACT FROM AUTHOR]

Background: Survey data were needed to assess the mental and social health, health related behaviors and compliance with preventive measures of the population during the COVID-19 pandemic. Yet, the pandemic challenged classical survey methods. Time and budgetary constraints at the beginning of the pandemic led to ad hoc recruitment of participants and easily manageable data collection modes. This paper describes the methodological choices and results in terms of participation for the COVID-19 health surveys conducted in Belgium. Methods: The COVID-19 health surveys refer to a series of ten non-probability web surveys organized between April 2020 and March 2022. The applied recruitment strategies were diverse including, amongst others, a launch through the website and the social media of the organizing research institute. In addition, the survey links were shared in articles published in the national press and participants were requested to share the surveys in their network. Furthermore, participants were asked consent to be re-contacted for next survey editions using e-mail invitations. Results: These mixed approaches allowed to reach a substantial number of participants per edition ranging from 49339 in survey 1 to 13882 in survey 10. In addition, a longitudinal component was created; a large share of the same individuals were followed up over time; 12599 participants completed at least 5 surveys. There were, however, sex, age, educational level and regional differences in participation. Post-stratification weighting on socio-demographic factors was applied to at least partly take this into account. Conclusion: The COVID-19 health surveys allowed rapid data collection after the onset of the pandemic. Data from these non-probability web surveys had their limitations in terms of representativeness due to self-selection but were an important information source as there were few alternatives. Moreover, by following-up the same individuals over time it was possible to study the effect of the different crisis phases on, amongst others, the mental health. It is important to draw lessons from these experiences: initiatives in order to create a survey infrastructure better equipped for future crises are needed. [ABSTRACT FROM AUTHOR]

Purpose: Following the outbreak of coronavirus disease 2019 (COVID-19), many forms of bottom-up civic action emerged as ways to collectively "flatten the curve" and tackle the crisis. In this paper, the authors examine to what extent local online and offline social integration contributes to civic participation, above and beyond typical predictors such as news consumption and civic talk. Design/methodology/approach: An online survey was administered among 7,137 users of the online neighbourhood network (ONN) Hoplr in Flanders (i.e. the Dutch-speaking part of Belgium) from 8 May to 18 May 2020. Regression analyses were used to examine how local social integration, in addition to news consumption, civic talk and political antecedents, predict different types of civic participation. Findings: The results show consistent positive associations between news consumption, civic talk and civic participation during the COVID-19 pandemic. Moreover, the role of political antecedents varied across different forms of civic participation. Further, the results point to the importance of both offline and online local social integration in explaining civic participation. Originality/value: This study provides much-needed insight in the societal and democratic consequences of the COVID-19 pandemic. The results confirm the importance of local social integration in explaining civic participation, while also advancing theoretical understanding of more established predictors of civic participation, such as news consumption and interpersonal communication. Peer review: The peer review history for this article is available at https://publons.com/publon/10.1108/OIR-08-2020-0379. [ABSTRACT FROM AUTHOR]

This paper explores the supply chain (SC) disruption impacts to the performance outcomes of a semiconductor company during the Covid-19 pandemic and proposes appropriate risk mitigation strategies to overcome the crisis. The research uses a single case study methodology and 24 SC employees from Belgium and Germany who take part in the survey. To measure the effect of SC disruptions to the firm's financial performance, some quarterly financial statement data are used from 2018 to 2021. The regression analysis results show that there is no significant impact of SC disruptions to the firm's productivity and non-financial performance. The paired samples t-test suggests that there is no significant change in the firm's financial performance before and during Covid-19 either due to the market's political and economic stability or the semiconductor company develops effective SC risk management strategies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of an e-learning online event, created for supporting resident's training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue. Methods: An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30–500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents. Results and limitations: Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents' general perception towards web-based learning programs. Conclusions: The paper confirms residents' satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. Methods: Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. Results: Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated. Conclusions: In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population. [ABSTRACT FROM AUTHOR]

COVID-19 impacts the daily lives of millions of people. This radical change in our daily activities affected many aspects of life, but acted as well as a natural experiment for research into the spatial distribution of 911 calls. We analyse the impact of the COVID-19 measures on the spatial pattern of police interventions. Crime is not uniformly distributed across street segments, but how does COVID-19 affect these spatial patterns? To this end, Gini coefficients are calculated and a proportion differences spatial point pattern test is applied to compare the similarity of the patterns of incidents before, during, and after the first lockdown in Antwerp, Belgium. With only essential mobility being allowed, the emergency call pattern has not significantly changed before, during or after this lockdown, however, a qualitative shift in police officer's daily work may have had an effect on the daily operation of the Antwerp police force. [ABSTRACT FROM AUTHOR]

We use population-wide data from linked administrative registers to study the distributional pattern of mortality before and during the first wave of the Covid-19 pandemic in Belgium. Over the March-May 2020 study period, excess mortality is only found among those aged 65 and over. For this group, we find a significant negative income gradient in excess mortality, with excess deaths in the bottom income decile more than twice as high as in the top income decile for both men and women. However, given the high inequality in mortality in normal times, the income gradient in all-cause mortality is only marginally steeper during the peak of the health crisis when expressed in relative terms. Leveraging our individual-level data, we gauge the robustness of our results for other socioeconomic factors and decompose the role of individual vs. local effects. We provide direct evidence that geographic location effects on individual mortality are particularly strong during the first wave of the Covid-19 pandemic, channeling through the local number of Covid infections. This makes inference about the income gradient in excess mortality based on geographic variation misguided. [ABSTRACT FROM AUTHOR]

Objective: This is a rapid systematic review concerning taste alterations in 27,687 individuals infected with SARS-CoV-2, published in the worldwide literature. Material and methods: Of the 485 articles recovered, 67 eligible studies (27,687 confirmed COVID-19 cases) were included in this analysis. We analysed the prevalence of the taste alterations in patients considering the country of origin of the studies. Results: The results show strong important differences in the overall reported prevalence of taste alterations among the different countries (from 11% of Korea to 88.8% of Belgium). Conclusions: These data highlight that there is a different geographical distribution of taste alterations in COVID-19 patients. Gustatory dysfunction seems to be an understudied symptom of COVID-19 and this may explain the inconsistencies of diagnostic criteria for COVID-19 case definition. Furthermore, this diagnostic underestimation can lead to an increased risk of contagion for the whole population and for the working classes most at risk, including the dental one. [ABSTRACT FROM AUTHOR]

Abstract:Background: During the COVID-19 pandemic, governments worldwide issued lockdown and social-distancing measures, which triggers psychological distress and may increase the occurrence of domestic violence (DV). We examined the role of the LGBT+ status in the relationship between risk factors of DV and its occurrence during the pandemic. Methods: In this cross-sectional study (n = 5,148), an online self-report questionnaire was administered to a non-probabilistic sample of participants living in Belgium, Germany, and Portugal between March and June 2020. Participants were sampled through national media, social media, and snowballing procedures. Results: LGBT+ persons reported significantly higher levels of perceived stress, more acute stress symptoms, and more illegal drug use during the first weeks of the lockdown compared to non-LGBT+ persons. DV in LGBT+ persons was not more prevalent than in the non-LGBT under COVID-19 lockdown measures. No significant evidence was found indicating that identifying as LGBT+ itself increases the risk of DV exposure. Conclusion: LGBT+ persons were more at risk of DV compared to non-LGBT+ persons prior to but not during COVID-19 lockdown measures. The increased risk for DV can be linked to socio-demographic characteristics, levels of stress, and illegal drug use which are more prevalent in LGBT+ persons than in non-LGBT+ persons. [ABSTRACT FROM AUTHOR]

The goal of tracing, testing, and quarantining contacts of infected individuals is to contain the spread of infectious diseases, a strategy widely used during the COVID-19 pandemic. However, limited research exists on the effectiveness of contact tracing, especially with regard to key performance indicators (KPIs), such as the proportion of cases arising from previously identified contacts. In our study, we analyzed contact tracing data from Belgium collected between September 2020 and December 2021 to assess the impact of contact tracing on SARS-CoV-2 transmission and understand its characteristics. Among confirmed cases involved in contact tracing in the Flemish and Brussels-Capital regions, 19.1% were previously identified as close contacts and were aware of prior exposure. These cases, referred to as 'known' to contact tracing operators, reported on average fewer close contacts compared to newly identified individuals (0.80 versus 1.05), resulting in fewer secondary cases (0.23 versus 0.28). Additionally, we calculated the secondary attack rate, representing infections per contact, which was on average lower for the 'known' cases (0.22 versus 0.25) between December 2020 and August 2021. These findings indicate the effectiveness of contact tracing in Belgium in reducing SARS-CoV-2 transmission. Although we were unable to quantify the exact number of prevented cases, our findings emphasize the importance of contact tracing as a public health measure. In addition, contact tracing data provide indications of potential shifts in transmission patterns among different age groups associated with emerging variants of concern and increasing vaccination rates. [ABSTRACT FROM AUTHOR]

In a previous study in Belgian nursing homes (NH) during the first wave of the COVID-19 pandemic, we found a SARS-CoV-2 seroprevalence of 17% with a large variability (0–45%) between NH. The current exploratory study aimed to identify nursing home-specific risk factors for high SARS-CoV-2 seroprevalence. Between October 19th, 2020 and November 13th, 2020, during the second COVID-19 wave in Belgium, capillary blood was collected on dried blood spots from 60 residents and staff in each of the 20 participating NH in Flanders and Brussels. The presence of SARS-CoV-2-specific IgG antibodies was assessed by ELISA. Risk factors were evaluated using a questionnaire, filled in by the director or manager of the NH. Assessed risk factors comprised community-related factors, resident-related factors, management and performance features as well as building-related aspects. The relation between risk factors and seroprevalence was assessed by applying random forest modelling, generalized linear models and Bayesian linear regression. The present analyses showed that the prevalence of residents with dementia, the scarcity of personal protective equipment (surgical masks, FFP2 masks, glasses and face shields), and inadequate PCR test capacity were related to a higher seroprevalence. Generally, our study put forward that the various aspects of infection prevention in NH require more attention and investment. This exploratory study suggests that the ratio of residents with dementia, the availability of test capacity and personal protective equipment may have played a role in the SARS-CoV-2 seroprevalence of NH, after the first wave. It underscores the importance of the availability of PPE and education in infection prevention. Moreover, investments may also yield benefits in the prevention of other respiratory infections (such as influenza). [ABSTRACT FROM AUTHOR]

Experts and industry reports agree that the COVID-19 crisis spurred the adoption of new retail technologies, like mobile payment. However, empirical academic evidence that compares their adoption and usage before, during, and after the crisis remains scarce. So far, academic mobile payment research has focussed almost entirely on the different building blocks of technological acceptance models, like perceived usefulness and ease of use, and their role in explaining intention to use. We need to learn more about the profile of the actual user. In this Belgian study, we investigate the evolution in mobile adoption based on survey data from 2019 to 2020 (2019: N = 897; 2020: N = 895). We examine differences in the profile of mobile payers in terms of their socio-demographics, retail, and social media behaviours. The pandemic triggered a clear uplift in mobile payment users between 2019 to 2020. Nonetheless, striking differences in socio-demographic profile and retail patronage remain. Our data shows that there is still inequality in adoption, related to age and social grade. We also observe a clear association between general impulse buying tendency and mobile payment. The link between internet/online shopping and mobile payment is firmly established. Finally, mobile adoption is related to the use of Instagram and Facebook. Consequences for retailers, researchers and public officers are further discussed. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, the CoMix study, a longitudinal behavioral survey, was designed to monitor social contacts and public awareness in multiple countries, including Belgium. As a longitudinal survey, it is vulnerable to participants' "survey fatigue", which may impact inferences. Methods: A negative binomial generalized additive model for location, scale, and shape (NBI GAMLSS) was adopted to estimate the number of contacts reported between age groups and to deal with under-reporting due to fatigue within the study. The dropout process was analyzed with first-order auto-regressive logistic regression to identify factors that influence dropout. Using the so-called next generation principle, we calculated the effect of under-reporting due to fatigue on estimating the reproduction number. Results: Fewer contacts were reported as people participated longer in the survey, which suggests under-reporting due to survey fatigue. Participant dropout is significantly affected by household size and age categories, but not significantly affected by the number of contacts reported in any of the two latest waves. This indicates covariate-dependent missing completely at random (MCAR) in the dropout pattern, when missing at random (MAR) is the alternative. However, we cannot rule out more complex mechanisms such as missing not at random (MNAR). Moreover, under-reporting due to fatigue is found to be consistent over time and implies a 15-30% reduction in both the number of contacts and the reproduction number ( R 0 ) ratio between correcting and not correcting for under-reporting. Lastly, we found that correcting for fatigue did not change the pattern of relative incidence between age groups also when considering age-specific heterogeneity in susceptibility and infectivity. Conclusions: CoMix data highlights the variability of contact patterns across age groups and time, revealing the mechanisms governing the spread/transmission of COVID-19/airborne diseases in the population. Although such longitudinal contact surveys are prone to the under-reporting due to participant fatigue and drop-out, we showed that these factors can be identified and corrected using NBI GAMLSS. This information can be used to improve the design of similar, future surveys. [ABSTRACT FROM AUTHOR]

Background: In this study, we investigate how socio‐demographic characteristics (age, gender and education) and informal care relationship characteristics (e.g., time spent on care, number of informal caregivers, professional care) are linked with informal care burden during the COVID‐19 pandemic. In addition, we expect this burden to differ by personality characteristics, degree of resilience, and—in this specific context—perceived the COVID‐19 threat. Method: We used the fifth wave of a longitudinal study to identify 258 informal caregivers. These online survey data came from a five‐wave longitudinal study in Flanders, Belgium that ran from April 2020 to April 2021. Data were representative of the adult population by age and gender. Analyses include t‐tests, ANOVA, SEM and binomial logistic regression. Results: We found that the informal care burden was strongly linked with a socio‐economic gradient, time investment changes in care since the start of the pandemic, and whether there was more than one informal caregiver. Personality traits such as agreeableness and openness to experience, and the perceived threat of COVID‐19 were also related to care burden. Conclusions: During the pandemic, informal caregivers were put under extra considerable pressure: restrictive government measures sometimes led to the temporary suspension of some or all professional care for persons with care needs, which may have resulted in a growing psychosocial burden. We recommend that, in the future, the focus should be on supporting the mental wellbeing and social participation of caregivers along with measures to protect caregivers and their relatives from COVID‐19. Support structures for informal caregivers should be kept running during crises now and in the future, but it is also important to adopt a case‐by‐case basis to consider support for informal caregivers. [ABSTRACT FROM AUTHOR]

Background: Pre-existing racial/ethnic disparities in health, sustained by intersecting socio-economic and structural inequities, have widened due to the COVID-19 pandemic. Yet, little attention has been paid to the lived experiences of people in ethnic/racialised minority communities, and to the causes and effects underlying the COVID-19-related burden. This hinders tailored responses. This study explores Sub-Saharan African (SSA) communities' needs, perceptions, and experiences of the COVID-19 pandemic and its control measures in Antwerp (Belgium) in 2020. Methods: This qualitative study using an interpretative ethnographical approach adopted an iterative and participatory methodology: a community advisory board advised on all stages of the research process. Interviews and a group discussion were conducted online, through telephone, and face-to-face. We analysed the data inductively using a thematic analytical approach. Results: Our respondents, who mostly used social media for information, struggled with misinformation about the new virus and prevention measures. They reported to be vulnerable to misinformation about the origin of the pandemic, risk of infection with SARS-CoV-2, and the prevention measures. Not only did the epidemic affect SSA communities, but to a larger extent, the control strategies did—especially the lockdown. Respondents perceived the interaction of social factors (i.e. being migrants, being undocumented, having experienced racism and discrimination) and economic factors (i.e. working in temporary and precarious jobs, not being able to apply for unemployment benefit, crowded housing conditions) as increasing the burden of COVID-19 control measures. In turn, these experiences influenced people's perceptions and attitudes, and may have partially impaired them to follow some public health COVID-19 prevention guidelines. Despite these challenges, communities developed bottom-up initiatives to react quickly to the epidemic, including translation of prevention messages, food distribution, and online spiritual support. Conclusion: Pre-existing disparities influenced the perceptions of and attitudes towards COVID-19 and its control strategies among SSA communities. To better design support and control strategies targeted to specific groups, we need to not only involve communities and address their specific needs and concerns, but also build on their strengths and resilience. This will remain important in the context of widening disparities and future epidemics. [ABSTRACT FROM AUTHOR]

The unprecedented COVID-19 pandemic took the form of successive variant waves, spreading across the globe. We wanted to investigate any shift in hospitalised patients' profiles throughout the pandemic. For this study, we used a registry that collected data automatically from electronic patient health records. We compared clinical data and severity scores, using the National Institute of Health (NIH) severity scores, from all patients admitted for COVID-19 during four SARS-CoV-2 variant waves. Our study concluded that patients hospitalised for COVID-19 showed very different profiles across the four variant waves in Belgium. Patients were younger during the Alpha and Delta waves and frailer during the Omicron period. 'Critical' patients according to the NIH criteria formed the largest fraction among the Alpha wave patients (47.7%), while 'severe' patients formed the largest fraction among Omicron patients (61.6%). We discussed host factors, vaccination status, and other confounders to put this into perspective. High-quality real-life data remain crucial to inform stakeholders and policymakers that shifts in patients' clinical profiles have an impact on clinical practice. [ABSTRACT FROM AUTHOR]

Building up on pre-existing vulnerabilities and social exclusions, refugees and migrants are disproportionately suffering from the negative effects of the COVID-19 outbreak. Insecure legal status is an additional stressor that may accentuate social cleavages and ultimately impair their trust in host society and institutions. Based on a diverse sample of refugees and migrants in Belgium (N = 355), the present study investigates direct and indirect effects of legal status--measured as the type of residence permit held by participants--on social and political trust during the COVID-19 outbreak. Secured legal status was positively associated with social and political trust directly, and indirectly via a serial mediation composed by two cumulative stages. First, participants with a more secured legal status experienced less material difficulties to cope with the pandemic (i.e., first material stage). Second, participant who experienced less material difficulties identified more with the host society (i.e., second symbolic stage). In turn, reduced material difficulties and increased identification with the host society were both positively associated with social and political trust. Our findings advocate for securing legal status of refugees and migrants to help societies cope cohesively with the long-lasting effects of the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic provides a unique opportunity to study which factors drive compliance and how the evolving context in society –virus fluctuations and changing government measures – changes the impact of these factors. Extant literature lists many factors that drive compliance – notably enforcement, trust, legitimacy. Most of these studies, however, do not look across time: whether a changing context for citizens changes the impact of factors driving compliance. In this study, we use Lindenberg's Goal Framing Theory to explain the dynamics of these drivers of compliance during the COVID‐19 pandemic. We formulate hypotheses for pro‐socialness, trust in government, observed respect for rules, rule effectiveness, rule appropriateness, fear of COVID‐19 (severity and proximity), opportunities for pleasure and happiness, as well as worsened income position. We test our hypotheses with data collected at three different moments during the beginning of the COVID‐19 crisis in Flanders, Belgium. Findings show that over time the constellations of factors that drive compliance change and, later in the pandemic, more distinct groups of citizens with different motivations to comply are identified. The overall conclusion is that the voluntary basis for compliance becomes more fragile over time, with a more differentiated pattern of drivers of compliance emerging. Public policy and communication need to adapt to these changes over time and address different groups of citizens. [ABSTRACT FROM AUTHOR]

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To limit the spread of COVID-19, public authorities have recommended sanitary behaviors such as handwashing, mask-wearing, physical distancing, and social distancing. We recruited a large sample of higher education students in Belgium (N = 3201-3441) to investigate the role of sociodemographic variables, mental health, previous COVID-19 infections, academic involvement, and risk perception on adherence to these sanitary behaviors. This cross-sectional study took place during the second COVID-19 wave in Belgium, between February and March 2021. Analyses showed that living alone, being female, later in the academic curriculum, having higher general and health anxiety, higher academic involvement, and higher risk perception were positively associated with adherence to the four aforementioned sanitary behaviors. Conversely, previous infection with COVID-19 and having been quarantined were negative predictors. Our results show a set of predictors highly similar for the four sanitary behaviors. We discuss potential initiatives to increase adherence to sanitary behaviors in this group of highly educated youngsters. [ABSTRACT FROM AUTHOR]

Emerging at the end of 2019, COVID-19 has become a public health threat to people worldwide. Apart from deaths with a positive COVID-19 test, many others have died from causes indirectly related to COVID-19. Therefore, the COVID-19 confirmed deaths underestimate the influence of the pandemic on society; instead, the measure of 'excess deaths' is a more objective and comparable way to assess the scale of the epidemic and formulate lessons. One common practical issue in analysing the impact of COVID-19 is to determine the 'pre-COVID-19′ period and the 'post-COVID-19′ period. We apply a change point detection method to identify any change points using excess deaths in Belgium. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic. Objective: This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic. Methods: This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs' adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool. Results: GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues. Conclusions: The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study. [ABSTRACT FROM AUTHOR]

Although the employment of the value of a statistical life (VSL) is a cornerstone of USA governmental risk analysis, many argue that the VSL is flawed when evaluating proposed regulations. The VSL is only an estimate of the willingness to accept wage versus risk, which may be inaccurate for policies that mitigate large risks in pandemics, such as COVID-19. The VSL is revisited using a different approach and utilized in measuring the total value of loss from deaths caused by COVID-19 for 48 selected countries. The modified theory of the demand for health by Gary Becker is utilized to measure the VSL resulting from consumer optimization of utility, subject to constraints and investments in health made to change their survivorship at different ages. Estimates show that the VSL for an average American is around $7.2 million compared to the world VSL of about $1.3 million. Switzerland has the highest VSL of approximately $9.4 million. The total value of loss from deaths caused by COVID-19 is around 6.1% of the USA GDP, compared to the global loss of 1.2% of the world's GDP, while Belgium has the highest value of loss with 9.7% of its GDP. The best possible data and procedures are necessary to make robust and reliable public health decisions while responding to the COVID-19 pandemic. The VSL measure introduced here can be applied to a specific individual, group, or population. It is comprehensive, straightforward, generalizable, and provides a consistent measure with the most popular methods. More importantly, it provides an added value to the existing methods that enable us to break down the VSL into two main components, one that accounts for working time. The other accounts for leisure time and different diminishing consumption and discount rates. [ABSTRACT FROM AUTHOR]

Aims The coronavirus disease-2019 (COVID-19) pandemic poses significant challenges to many groups within societies, and especially for people with chronic health conditions. It is, however, unknown whether and how the pandemic has thus far affected the physical and mental health of patient populations. Therefore, we investigated how the pandemic affected the lives of adults with congenital heart disease (CHD), compared pre- and peri-pandemic patient-reported outcome measures (PROMs) and a patient-reported experience measure (PREM), and investigated whether having had COVID-19 impacted pre-/peri-pandemic differences of the PROMs and PREM. Methods and results As part of the ongoing APPROACH-IS II project, we longitudinally surveyed 716 adults with CHD from Belgium, Norway, and South Korea. Pre-pandemic measures were administered from August 2019 to February 2020 and the peri-pandemic surveys were completed September 2020–April 2021. The majority of patients indicated that their social lives (80%), mental health (58%), and professional lives/education (51%) were negatively impacted by the pandemic. Patients felt worried (65%), were afraid (55%), reported the pandemic felt 'close' to them (53%), and were stressed (52%). However, differences between pre- and peri-pandemic scores on the PROMs and PREM were negligibly small (Cohen's d < 0.20). Across measures, 5.8–15.8% of patients demonstrated changes (improved or worsened scores) that exceeded the minimal clinically important difference. There were no difference-in-differences for PROMs and PREM between patients who did vs. did not have COVID-19. Conclusions Although the COVID-19 pandemic has been disruptive in many ways, pre- to peri-pandemic changes in PROMs and PREM of adults with CHD were negligibly small. [ABSTRACT FROM AUTHOR]

In view of the grave situation during the first two waves of SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2), nursing homes (NHs) were prioritised for vaccination once vaccines became available in Belgium. The aim of this study was to assess the effect of the COVID-19 (Coronavirus Disease 2019) vaccination campaign on COVID-19 cases, hospital admissions, and deaths among residents living in Belgian NHs. All 1545 Belgian NHs were invited to participate in a COVID-19 surveillance program. In Belgium, before vaccination, COVID-19 morbidity and mortality rates were driven by the situation in the NHs. Shortly after the COVID-19 vaccination campaign, and later the booster campaign, the number of hospital admissions and deaths among NH residents dropped, while clear peaks could be observed among the general population. The impact of vaccination on virus circulation was less effective than expected. However, due to the high vaccination coverage, NH residents remain well protected against hospital admission and death due to COVID-19 more than one year after being vaccinated. [ABSTRACT FROM AUTHOR]

Aims: To estimate the prevalence of burnout risk among nurses during the peak of the first wave of the COVID‐19 pandemic in Belgium and to identify risk groups and protective and risk factors. Background: Nurses are at high risk of burnout, and this can have negative consequences for them, patients and health care systems. The pandemic may have changed their working conditions and increased their risk of burnout. Methods: The risk of burnout was assessed through the Maslach Burnout Inventory Scale. Information on socio‐demographic and working conditions during the pandemic was also collected. We obtained 4552 respondents through convenience sampling. Results: A high risk of burnout was found in 70% of respondents. The main risk factors of burnout were the lack of personal protective equipment, changes in perceived workload and working with COVID‐19 patients. Conclusions: An uneven workload for nurses is an underlying problem during the COVID‐19 pandemic and a significant risk factor for their burnout. The decreased workload is a risk factor for burnout as important as increased workload and repeated exposure to COVID‐19. Implications for Nursing Management: Burnout prevention and treatment interventions must target the correct risk factors and identify nurses at risk to be cost‐effective. [ABSTRACT FROM AUTHOR]

The COVID-19 crisis focused attention on how experts from different scientific fields provided advice to governments through expert committees and task forces. We compared experiences in two federal democracies, Belgium and Australia, by applying a mixed methods approach (literature review, media review, policy documents analysis). This comparative study found that expertise was institutionalized in different ways and its processes and priorities shifted over time. The policy coordination challenges inherent in federalism were largely overcome in Australia through strongly embedded health advisory processes. In Belgium, the advisory process was less stable, with advisory councils being abandoned, replaced, expanded, or downgraded during the course of the crisis. [ABSTRACT FROM AUTHOR]

Background: As a hard-hit area during the COVID-19 pandemic, Belgium knew the highest mortality among people from sub-Saharan African descent, compared to any other group living in the country. After migration, people often maintain traditional perceptions and habits regarding health and healthcare, resulting in a high prevalence of traditional, complementary and alternative medicine use among different migrant communities in northern urban settings. Despite being the largest community of sub-Saharan African descent in Belgium, little is known on ethnobotanical practices of the Belgian Congolese community. We therefore conducted an exploratory study on the use of medicinal plants in the context of COVID-19 and perceptions on this new disease among members of the Congolese community in Belgium. Methods: We conducted 16 in-depth semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using purposive sampling. Medicinal plant use in the context of COVID-19 was recorded through free-listing. Data on narratives, ideas and perceptions on the origin, cause/aetiology and overall measures against COVID-19 (including vaccination) were collected. Interview transcripts were analysed using thematic analysis. Results: Four overarching themes emerged from our data. Firstly, participants perceived the representation of the severity of COVID-19 by the Belgian media and government—and by extend by all governmental agencies in the global north—as exaggerated. As a result, traditional and complementary treatments were seen as feasible options to treat symptoms of the disease. Fifteen forms of traditional, complementary and alternative medicine were documented, of which thirteen were plants. Participants seem to fold back on their Congolese identity and traditional knowledge in seeking coping strategies to deal with the COVID-19 pandemic. Finally, institutional postcolonial distrust did not only seem to lead to distrust in official messages on the COVID-19 pandemic but also to feelings of vaccination hesitancy. Conclusion: In the context of the COVID-19 pandemic, participants in our study retreated to, reshaped and adapted traditional and culture-bound knowledge. This study suggests that the fragile and sensitive relationship between sub-Saharan African migrant groups and other social/ethnic groups in Belgium might play a role in their sensitivity to health-threatening situations, such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508), the Netherlands (n = 324), Germany (n = 1662) and Italy (n = 794). Many parents reported negative effects of homeschooling for themselves and their child, and many found homeschooling to be of poor quality, with insufficient support from schools. In most countries, contact with teachers was limited, leaving parents with primary responsibility for managing homeschooling. Parents also reported increased levels of stress, worry, social isolation, and domestic conflict. A small number of parents reported increased parental alcohol/drug use. Some differences were found between countries and some negative experiences were more common in families with a child with a mental health condition. However, differences between countries and between families with and without a mental health condition were generally small, indicating that many parents across countries reported negative experiences. Some parents also reported positive experiences of homeschooling. The adverse effects of homeschooling will likely have a long-term impact and contribute to increased inequalities. Given that school closures may be less effective than other interventions, policymakers need to carefully consider the negative consequences of homeschooling during additional waves of the COVID-19 pandemic and future pandemics. [ABSTRACT FROM AUTHOR]

Current public health debate centers on COVID-19 testing methods and strategies. In some communities, high transmission risk may justify routine testing, and this requires test methods that are safe and efficient for both patients and the administrative or health-care workers administering them. Saliva testing appears to satisfy those criteria. There is, however, little documentation on the acceptability of this method among beneficiaries. This article presents the lessons learned from a pilot study on the use of saliva testing for routine screening of nursing home and secondary school personnel in Wallonia (the French-speaking part of Belgium), conducted in December 2020 to April 2021, respectively. Administrators at the facilities in question seemed to think highly of saliva testing and wished to continue it after the pilot study was over. This result reinforces the criteria (the noninvasive aspect, in particular) supporting a key role for saliva testing in monitoring community spread of the virus. Nevertheless, wider-scale deployment of this particular method will only be possible if the testing strategy as a whole takes a health promotion approach. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected people across the world, with important heterogeneity among older adults in how they respond to the challenges associated with this crisis. Relying on a cross-fertilization between Erikson's personality theory and self-determination theory, this study aimed to examine possible sources of resilience (i.e., ego integrity and need satisfaction) and vulnerability (i.e., despair) in older adults' (mal) adjustment, thereby additionally considering the role of multiple risk and protective factors (e.g., gender and marital status). During the second month of the lockdown period in Belgium, 693 older adults (Mage = 70.06, SD = 4.48, range: 65–89 years, 62.1% female) filled out online questionnaires concerning the study variables, while also completing assessments of several important sociodemographic factors. Structural equation modeling suggested that both ego integrity and despair related to indicators of well-being and psychological distress through experienced need satisfaction. Additionally, we found several factors to protect (e.g., higher perceived income) or diminish (e.g., being widowed) older adults' well-being during these challenging times, with little evidence for a moderating role of these factors in associations between the psychological variables. Theoretical and practical implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Soon after SARS-CoV-2 emerged in late 2019, Belgium was confronted with a first COVID-19 wave in March-April 2020. SARS-CoV-2 circulation declined in the summer months (late May to early July 2020). Following a successfully trumped late July-August peak, COVID-19 incidence fell slightly, to then enter two successive phases of rapid incline: in the first half of September, and then again in October 2020. The first of these coincided with the peak period of returning summer travelers; the second one coincided with the start of higher education's academic year. The largest observed COVID-19 incidence occurred in the period 16–31 October, particularly in the Walloon Region, the southern, French-speaking part of Belgium. We examine the potential association of the higher education population with spatio-temporal spread of COVID-19, using Bayesian spatial Poisson models for confirmed test cases, accounting for socio-demographic heterogeneity in the population. We find a significant association between the number of COVID-19 cases in the age groups 18–29 years and 30–39 years and the size of the higher education student population at the municipality level. These results can be useful towards COVID-19 mitigation strategies, particularly in areas where virus transmission from higher education students into the broader community could exacerbate morbidity and mortality of COVID-19 among populations with prevalent underlying conditions associated with more severe outcomes following infection. [ABSTRACT FROM AUTHOR]

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How did couples in Belgium cope during the early phases of the COVID-19 pandemic? In this study, grounded in relationship science, we investigated in a descriptive manner several factors that could affect how couples perceived individual and relational wellbeing during this time. Specifically, we examined the associations between gender, sexual orientation, parental status, and relationship duration on participants' selfreported individual and relational well-being after the first lockdown (more generally and more specific in response to COVID-19). Additionally, we investigated if relational well-being predicted perceived change in individual well-being from pre- to post-COVID-19 regulations. To test these hypotheses, self-report data was collected during the Summer of 2020 in both the Dutch and French speaking part of Belgium. Data from 679 participants suggested that individual and relational well-being only differed based on parental status (and not by gender nor sexual orientation). Importantly, parents reported lower relational well-being than participants without children, while participants without children reported higher perceived increases in depression. People that had been in a relationship for longer also reported lower relational well-being, but this relationship was explained by other confounding factors. Relational well-being buffered increases in individual distress that people perceived to have occurred pre-COVID-19 regulations to after COVID-19 regulations went into effect. These findings might inform practice and policy for individuals in a romantic relationship during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Belgium is often seen as an outlier in the international experience with the coronavirus disease 2019. We summarize the unfolding of the pandemic in Belgium from February to December 2020, discuss the countermeasures that were implemented and provide some explanations why the numbers indicate a stronger pandemic in Belgium than in its neighbouring countries. To some extent, the seemingly poor performance of Belgium is a measurement artefact. Yet, there were indeed particular factors in Belgium that unnecessarily increased the toll of the pandemic. In the first wave insufficient priority was given to protect care homes. The second wave was larger than necessary due to a failure to timely implement restrictive measures. The latter can, at least partly, be explained by a unique political situation: a temporary, minority government in the middle of a major crisis. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in the Belgian community is mainly estimated based on test results of patients with coronavirus disease (COVID-19)-like symptoms. The aim of this study was to investigate the evolution of the SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) positivity ratio and distribution of viral loads within a cohort of asymptomatic patients screened prior hospitalization or surgery, stratified by age category. Materials/Methods: We retrospectively studied data on SARS-CoV-2 real-time RT-PCR detection in respiratory tract samples of asymptomatic patients screened pre-hospitalization or pre-surgery in nine Belgian hospitals located in Flanders over a 12-month period (1 April 2020–31 March 2021). Results: In total, 255925 SARS-CoV-2 RT-PCR test results and 2421 positive results for which a viral load was reported, were included in this study. An unweighted overall SARS-CoV-2 real-time RT-PCR positivity ratio of 1.27% was observed with strong spatiotemporal differences. SARS-CoV-2 circulated predominantly in 80+ year old individuals across all time periods except between the first and second COVID-19 wave and in 20–30 year old individuals before the second COVID-19 wave. In contrast to the first wave, a significantly higher positivity ratio was observed for the 20–40 age group in addition to the 80+ age group compared to the other age groups during the second wave. The median viral load follows a similar temporal evolution as the positivity rate with an increase ahead of the second wave and highest viral loads observed for 80+ year old individuals. Conclusion: There was a high SARS-CoV-2 circulation among asymptomatic patients with a predominance and highest viral loads observed in the elderly. Moreover, ahead of the second COVID-19 wave an increase in median viral load was noted with the highest overall positivity ratio observed in 20–30 year old individuals, indicating they could have been the hidden drivers of this wave. [ABSTRACT FROM AUTHOR]

We investigate the effect of government support on firm zombification during the COVID-19 crisis for Belgium, Germany, Spain, France, United Kingdom, the Netherlands and the United States. For this purpose, we use a simple model that links insolvency developments at the macro level to GDP developments. We first observe from the data that insolvencies have declined during the crisis despite economic contraction. We then use the model to calculate the total firms saved from insolvency by government intervention and the fraction of which are not healthy, the zombies. It appears that government intervention has been effective in saving firms during the height of the crisis in Q2 of 2020. The impact is smaller in Q3 when the recovery set in. But it comes at a cost of efficiency as it causes significantly higher zombification in the economy. The effect can be seen in both quarters, most notably in Belgium. In Germany and the Netherlands, zombification was low in Q2 but soared in Q3. The reverse effect was visible in Spain as the number of insolvencies picked up in Q3. Therefore, government intervention during the crisis has reinforced the existing trend of zombification there. With government support only gradually withdrawing in the recovery phase of the crisis and probably further pushing up the number of zombie firms, risk management faces the challenging task of detecting them. We offer a few suggestions. These are based on the classification of zombies, including ICR and Tobin's q, as well as research on underlying drivers. Compared to the sector median, zombies appear smaller, less productive, slower growing, with lower investments and higher leverage despite higher equity issues and implied interest rate subsidies. Complementary to this market-based information, more proprietary, higher frequency data such as payment behaviours, revenue growth pace change, credit sourcing, bank covenant compliance and management competencies can be monitored using scorecards. Finally, we recommend a high level of vigilance and an additional provisioning to anticipate any delayed effects of the crisis. [ABSTRACT FROM AUTHOR]

Belgium is considered as a very divided multinational and federal state, with conflicts between representatives of its two main language communities regularly threatening its sheer existence. Moreover, at the outbreak of the COVID 19-crisis, Belgium was in the middle of a political crisis: ten months of failed attempts to form a new federal government left a minority caretaker government to deal with the crisis. When the second wave arrived, a new federal government was formed but its composition was strongly different than the Flemish government, which was lead by the Flemish-nationalist N-VA, a situation of incongruence between governments that generally reinforces political conflicts within Belgium. All this means that a very fragmented, divisive and conflictual COVID-response could be expected. Therefore, it is surprising that the response was largely uniform and national response. There was a political consensus that measures should be the same over the entire territory. This article details the institutions, policies and communication that created this national response and also explains the reasons for it. It also focuses on the problems that the distribution of competences posed to execute the response and what it means for the nationalist movement as well as for possible future constitutional reform. [ABSTRACT FROM AUTHOR]

Older migrants may be one of the most vulnerable populations during the coronavirus pandemic, yet the degree of impact remains largely unknown. This study explores (1) the consequences of the coronavirus pandemic for older Chinese migrants in Belgium and the Netherlands in terms of increased loneliness and its risk factors (reduced in-person contact, decreased social participation, feelings of existential threat) and protective factors (increased non-in-person contact, more individual activities), and (2) which risk and protective factors have contributed to the incidence and prevention of higher loneliness levels. Using quantitative data of a survey among 98 Chinese migrants aged 50 years and older in Belgium (n = 84) and the Netherlands (n = 14), the findings first indicate that the coronavirus pandemic has a significant impact on older Chinese migrants' lives. One in five experienced more loneliness. Second, reduced social participation (measured as less frequent participation in outdoor group activities) and financial insecurity (measured as experiencing financial difficulties) lead to higher than pre-pandemic loneliness levels. Problem-focused coping strategies (measured as increased non-in-person contact, via telephone or social media) and emotion-focused coping (measured as finding distraction through increased participation in individual activities) were not found to protect against increased loneliness in the pandemic. Two practical implications for loneliness interventions for older Chinese migrants are put forward. Organizing COVID-19-safe social participation activities and paying more attention to older Chinese migrants' financial situation can be beneficial when addressing higher levels of loneliness due to the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

A wide range of countries decided to go into lockdown to contain the coronavirus disease (COVID-19) pandemic of 2020, a setting separating people and restricting their movements. We investigated how musicians dealt with this sudden restriction in mobility. Responses of 234 people were collected. The majority of respondents (95%) resided in Belgium or the Netherlands. Results indicated a decrease of 79% of live music making in social settings during lockdown compared with before lockdown. In contrast, an increase of 264% was demonstrated for online joint music making. However, results showed that most respondents were largely or even completely unaccustomed with specialized platforms for online joint music making (e.g., JamKazam, Jamulus). Respondents reported to mostly use well-known video-conferencing platforms such as Zoom and Skype when playing together virtually. However, when such video-conferencing platforms were used, they were often not employed for synchronized playing and were generally reported to insufficiently deal with latency issues. Furthermore, respondents depending on music making as their main source of income explored online real-time methods significantly more than those relying on other income sources. Results also demonstrated an increase of 93% in the use of alternative remote joint music-making methods (e.g., recording parts separately and subsequently circulating these digital recordings). All in all, results of this study provide a more in-depth view on joint music making during the first weeks of lockdown induced by the COVID-19 pandemic of 2020, and demonstrate users' perceptions of performance and usability of online real-time platforms as well as alternative methods for musical interaction. [ABSTRACT FROM AUTHOR]

Background: Since the start of the global COVID-19 pandemic, countries have been mirroring each other's policies to mitigate the spread of the virus. Whether current measures alone will lead to behavioral change such as social distancing, washing hands, and wearing a facemask is not well understood. The objective of this study is to better understand individual variation in behavioral responses to COVID-19 by exploring the influence of beliefs, motivations and policy measures on public health behaviors. We do so by comparing The Netherlands and Flanders, the Dutch speaking part of Belgium. Methods and findings: Our final sample included 2,637 respondents from The Netherlands and 1,678 from Flanders. The data was nationally representative along three dimensions: age, gender, and household income in both countries. Our key outcome variables of interest were beliefs about policy effectiveness; stated reasons for complying with public rules; and changes in behavior. For control variables, we included a number of measures of how severe the respondent believed Covid-19 to be and a number of negative side effects that the person may have experienced: loneliness, boredom, anxiety, and conflicts with friends and neighbors. Finally, we controlled for socio-demographic factors: age, gender, income (categorical), education (categorical) and the presence of Covid-19 risk factors (diabetes, high blood pressure, heart disease, asthma, allergies). The dependent variable for each of the estimation models is dichotomous, so we used Probit models to predict the probability of engaging in a given behavior. We found that motivations, beliefs about the effectiveness of measures, and pre-pandemic behavior play an important role. The Dutch were more likely to wash their hands than the Flemish (15.4%, p<0.01), visit family (15.5%, p <.01), run errands (12.0%, p<0.05) or go to large closed spaces such as a shopping mall (21.2%, p<0.01). The Dutch were significantly less likely to wear a mask (87.6%, p<0.01). We also found that beliefs about the virus, psychological effects of the virus, as well as pre-pandemic behavior play a role in adherence to recommendations. Conclusions: Our results suggest that policymakers should consider behavioral motivations specific to their country in their COVID-19 strategies. In addition, the belief that a policy is effective significantly increased the probability of the behavior, so policy measures should be accompanied by public health campaigns to increase adherence. [ABSTRACT FROM AUTHOR]

Background: In response to the ongoing COVID-19 pandemic, several countries adopted measures of social distancing to a different degree. For many countries, after successfully curbing the initial wave, lockdown measures were gradually lifted. In Belgium, such relief started on May 4th with phase 1, followed by several subsequent phases over the next few weeks.Methods: We analysed the expected impact of relaxing stringent lockdown measures taken according to the phased Belgian exit strategy. We developed a stochastic, data-informed, meta-population model that accounts for mixing and mobility of the age-structured population of Belgium. The model is calibrated to daily hospitalization data and is able to reproduce the outbreak at the national level. We consider different scenarios for relieving the lockdown, quantified in terms of relative reductions in pre-pandemic social mixing and mobility. We validate our assumptions by making comparisons with social contact data collected during and after the lockdown.Results: Our model is able to successfully describe the initial wave of COVID-19 in Belgium and identifies interactions during leisure/other activities as pivotal in the exit strategy. Indeed, we find a smaller impact of school re-openings as compared to restarting leisure activities and re-openings of work places. We also assess the impact of case isolation of new (suspected) infections, and find that it allows re-establishing relatively more social interactions while still ensuring epidemic control. Scenarios predicting a second wave of hospitalizations were not observed, suggesting that the per-contact probability of infection has changed with respect to the pre-lockdown period.Conclusions: Contacts during leisure activities are found to be most influential, followed by professional contacts and school contacts, respectively, for an impending second wave of COVID-19. Regular re-assessment of social contacts in the population is therefore crucial to adjust to evolving behavioral changes that can affect epidemic diffusion. [ABSTRACT FROM AUTHOR]

The corona pandemic challenges countries worldwide in many different ways. Due to its magnitude and impact on global health, this health crisis exposes several shortcomings in their health systems and emphasizes their shortcomings and deficiencies. These deficiencies have quickly affected the most frail citizens, such as older people. The first wave of the COVID19 pandemic in Belgium has quickly shown that nursing homes were not prepared for these kinds of crises. The nature, speed and extent gave rise to an accelerated and more extensive collaboration between various nursing homes and Ghent University Hospital. Before this crisis, the level of integrated care between nursing homes and hospitals was mostly limited. But setting up a strong collaboration model and integrated care between nursing homes and hospitals enables the nursing homes to manage this specific and complex care in their own environment. Implications for practice: This case study shows that integrated care is possible and that both the hospital and the nursing homes benefit from such a system. Investments in people, resources, training and guidance concerning transitional care and knowledge exchange between hospitals and nursing homes, are necessary to guarantee a more efficient and robust approach to (pandemic) crises in nursing homes. [ABSTRACT FROM AUTHOR]