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Objectives: Limited data are available on how the closure of pediatric dental clinics because of the COVID-19 pandemic affected hospital pediatric emergency department (ED) visits in the United States. We evaluated changes in dental-related visits at a pediatric ED and associated urgent care centers (UCCs) after the shutdown of a large pediatric dental clinic because of the COVID-19 pandemic. Methods: We conducted a single-center retrospective medical record review of 811 patients aged 0 to 17 years who presented to a pediatric ED or associated UCC at Rady Children's Hospital–San Diego for dental-related concerns from March 19, 2019, through January 17, 2021. Patients were classified into 3 periods: before shutdown, during shutdown, and after shutdown. We collected data on demographic characteristics; International Classification of Diseases, Tenth Revision codes; dental diagnosis; treatment; and COVID-19 test results. We compared the frequency and proportion of patients seen for dental-related concerns, dental diagnosis, and treatment during the 3 periods. Results: The proportion of dental-related concerns in the ED doubled during the shutdown (0.7%) and was 1.5 times higher after the shutdown (0.6%) compared with before the shutdown (0.4%; P <.001). Significantly more patients were seen in EDs than in UCCs during and after the shutdown than before the shutdown (P =.005). During and after the shutdown, admission to the hospital for antibiotic treatment increased significantly to 6.5% and 7.9%, respectively, compared with before the shutdown (2.8%; P =.022), and nonaerosolized procedures and ED/UCC discharge increased to 13.4% and 9.3%, respectively, compared with before the shutdown (6.2%; P =.015). Conclusions: Mitigating future closures of dental offices is important given the shifted burden of dental care to the ED. [ABSTRACT FROM AUTHOR]

Objective: Employment is a well-documented social determinant of physical and mental health and can be used to determine who is disproportionately affected by public health emergencies. We examined trends in unemployment overall and by gender, by race or ethnic group, and by their interaction for 2 public health emergencies (the COVID-19 pandemic and the 2020 California wildfires). Methods: We obtained summary data files on the number of initial unemployment insurance (IUI) claims made in all 58 California counties from January 2018 through December 2021. We fit fixed-effects Poisson regression models to county data on weekly IUI claims cross-classified by gender and race or ethnic group. We used models to evaluate the overall effect of COVID-19, whether this effect changed over time increasing under compounding emergencies, and whether the overall and compounding effects of COVID-19 differed by gender and race or ethnic group. Results: During the COVID-19 pandemic, weekly IUI claims rates increased to as much as 10 times their prepandemic level. The increase in IUI claims for COVID-19 weeks, compared with weeks from the same month in the 2 years prior, was greater for women than for men of all race or ethnic groups, except for Black women. The higher rates of IUI claims for most women during COVID-19 entailed a reversal of prepandemic gender differences in claims that persisted through 2021. Conclusion: Public health officials should consider using IUI claims for surveillance of social determinants of health, particularly in the context of emergencies, which we show can have a persisting effect on the social patterning of social determinants. Future research is needed to forecast these affects and inform public health and policy mitigation and prevention strategies. [ABSTRACT FROM AUTHOR]

San Francisco implemented one of the most intensive, comprehensive, multipronged COVID-19 pandemic responses in the United States using 4 core strategies: (1) aggressive mitigation measures to protect populations at risk for severe disease, (2) prioritization of resources in neighborhoods highly affected by COVID-19, (3) timely and adaptive data-driven policy making, and (4) leveraging of partnerships and public trust. We collected data to describe programmatic and population-level outcomes. The excess all-cause mortality rate in 2020 in San Francisco was half that seen in 2019 in California as a whole (8% vs 16%). In almost all age and race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, with markedly diminished excess mortality among people aged >65 years. The COVID-19 response in San Francisco highlights crucial lessons, particularly the importance of community responsiveness, joint planning, and collective action, to inform future pandemic response and advance health equity. [ABSTRACT FROM AUTHOR]

Objectives: People involved in commercial sex work during the COVID-19 pandemic, particularly those compelled to sell sex, faced multiple challenges to their safety and well-being. We explored, in real time, the impact of the COVID-19 pandemic on people involved in commercial sex work and the broader commercial sex industry. Methods: Using a participatory action research approach, we interviewed 159 English- and Spanish-speaking adults who had engaged in commercial sex work under the direction of a third party in Sacramento County, California, within the past 5 years (approximately 2017-2022). As part of a larger study, our interview protocol included 1 question about the COVID-19 pandemic: "Has COVID-19 changed anything about your experience with sex work?" We transcribed and analyzed interviews using QSR-NVivo, a qualitative coding software. Results: Participants described the effects of increased isolation, decreased demand, difficulty accessing social services, fear of contracting COVID-19, difficulty in following public health guidance on social distancing and wearing face masks, and how the pandemic resulted in some people entering or exiting commercial sex work. Most participants were familiar with recommended public health safety measures, but lack of agency and financial need limited their ability to comply with all recommendations. A lack of access to social services added stress to those most in need of emergency housing or substance use treatment and left them vulnerable to continued abuse. Conclusions: Stress and financial insecurity generally increased among people involved in commercial sex work during the pandemic, and no efforts were made to understand and mitigate the hardships that this population faced. Future research should address how to maintain social service availability during times of public health emergencies and other crises. [ABSTRACT FROM AUTHOR]

Objective: We quantified the association between public compliance with social distancing measures and the spread of SARS-CoV-2 during the first wave of the epidemic (March–May 2020) in 5 states that accounted for half of the total number of COVID-19 cases in the United States. Methods: We used data on mobility and number of COVID-19 cases to longitudinally estimate associations between public compliance, as measured by human mobility, and the daily reproduction number and daily growth rate during the first wave of the COVID-19 epidemic in California, Illinois, Massachusetts, New Jersey, and New York. Results: The 5 states mandated social distancing directives during March 19-24, 2020, and public compliance with mandates started to decrease in mid-April 2020. As of May 31, 2020, the daily reproduction number decreased from 2.41-5.21 to 0.72-1.19, and the daily growth rate decreased from 0.22-0.77 to –0.04 to 0.05 in the 5 states. The level of public compliance, as measured by the social distancing index (SDI) and daily encounter-density change, was high at the early stage of implementation but decreased in the 5 states. The SDI was negatively associated with the daily reproduction number (regression coefficients range, –0.04 to –0.01) and the daily growth rate (from –0.009 to –0.01). The daily encounter-density change was positively associated with the daily reproduction number (regression coefficients range, 0.24 to 1.02) and the daily growth rate (from 0.05 to 0.26). Conclusions: Social distancing is an effective strategy to reduce the incidence of COVID-19 and illustrates the role of public compliance with social distancing measures to achieve public health benefits. [ABSTRACT FROM AUTHOR]