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Background:Methods:Results:Conclusion:Identifying factors impacting vaccination and testing for COVID-19 is crucial to reduce health disparities, especially for rural/agricultural, low access and high poverty Latino communities disproportionately affected by the pandemic. This study examined differences in perceived barriers and facilitators (such as values, beliefs, and concerns) to COVID-19 vaccine uptake and testing intention by vaccination status and testing hesitancy among rural Latino community members in Southwest Florida.Rural Latino community members (N = 493) completed a cross-sectional survey in Spanish (86.0%) or English (14.0%) on perceived COVID-19 vaccine/testing barriers and facilitators, as well as demographics, mental health, medical history, health perceptions, and health literacy.At the time of the survey, approximately 43% of participants were unvaccinated and 46.4% were testing hesitant. Significantly more vaccinated participants acknowledged keeping their family (d = .25), community (d = .27), and themselves (d = .22) safe as facilitators to vaccination (ps < .001). Among the unvaccinated participants, the most common concerns for getting vaccinated were side effects (d = −.53) and lack of knowledge about how the vaccine works (d = −.35, ps < .001). Testing hesitant participants reported concerns including not knowing where to get tested (d = −.25, p = 0.01) and less confidence in a positive test result (d = −.40, p < 0.001). Doctors and faith leaders were ranked as the most trusted information sources across groups. In logistic regression models, vaccination was linked to age, gender, education, and protecting others, while concerns about needles and side effects reduced odds; testing was driven by education, anxiety, hope, and safety concerns.Promoting family and community safety may be effective facilitators influencing vaccine and testing intention in rural Latino communities. Enhanced education by trusted information sources, such as doctors and faith leaders may alleviate associated concerns. Our findings may inform actions for future pandemics. Further studies should determine the generalizability of our findings across other rural migrant communities and other vaccines. [ABSTRACT FROM AUTHOR]

Objective: To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID‐19 pandemic and compare experiences in high‐income countries (HICs) with non‐HICs. Methods: Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID‐19 infections, the effect of COVID‐related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non‐HICs and HICs were compared using non‐parametric Chi‐square tests. Results: Two thousand one hundred and five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non‐HICs and HICs reported COVID‐19 infection (7%). Those in HICs were more likely to report that COVID‐19 measures had affected their health (32% vs. 23%; p < 0.001). There was no difference between non‐HICs and HICs in the proportion who reported difficulty in obtaining help for epilepsy. HCWs in non‐HICs were more likely to report COVID‐19 infection than those in HICs (18% vs 6%; p = 0.001) and that their clinical work had been affected by concerns about contracting COVID‐19, lack of personal protective equipment, and the impact of the pandemic on mental health (all p < 0.001). Compared to pre‐pandemic practices, there was a significant shift to remote consultations in both non‐HICs and HICs (p < 0.001). Significance: While the frequency of COVID‐19 infection was relatively low in these data from early in the pandemic, our findings suggest broader health consequences and an increased psychosocial burden, particularly among HCWs in non‐HICs. Planning for future pandemics should prioritize mental healthcare alongside ensuring access to essential epilepsy services and expanding and enhancing access to remote consultations. Plain Language Summary: We asked people with epilepsy about the effects of COVID‐19 on their health and healthcare. We wanted to compare responses from people in high‐income countries and other countries. We found that people in high‐income countries and other countries had similar levels of difficulty in getting help for their epilepsy. People in high‐income countries were more likely to say that their general health had been affected. Healthcare workers in non‐high‐income settings were more likely to have contracted COVID‐19 and have the care they deliver affected by the pandemic. Across all settings, COVID‐19 associated with a large shift to remote consultations. [ABSTRACT FROM AUTHOR]

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy. [ABSTRACT FROM AUTHOR]

In response to the SARS-CoV-2 pandemic, the United States declared a state of emergency and implemented large-scale shutdowns and public health initiatives to prevent overwhelming public resources. The success of these prevention methods remains unresolved as restrictions and implementation varied from national, state, and local levels. Despite national and local regulations, individual adherence to preventative guidelines presented an additional layer of variability. Cases of COVID-19 continued to rise and fall over a two-year period on a national level, despite masking recommendations, ease of testing, and availability of vaccines. The Ysleta del Sur Pueblo is a Native American tribal community and sovereign nation located in El Paso, Texas. Speaking Rock Entertainment Center is a major business operated by the tribe, employing many tribal and non-tribal members from the El Paso area. Following nationwide re-openings of non-essential businesses, Speaking Rock implemented an infection control program with strict adherence to recommendations provided by the Center for Disease Control and Prevention (CDC) and additional disease control. This response would result in a fully vaccinated workforce within the wider community of El Paso, where the vaccination rate was less than 80%. Herein, we examine the efficacy of these measures and report on the success of the program resulting in zero hospitalizations or deaths compared with rates of 1 in 250 and 1 in 40, respectively, in the surrounding community. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession and Patient Care Impact Reporting Method Patient or Public Contribution What does this Paper Contribute to the Wider Global Clinical Community? To describe vaccination roles of primary care nurses during the COVID‐19 pandemic in Canada.This analysis was part of a larger mixed‐methods case study.We conducted semi‐structured qualitative interviews from May 2022 to January 2023 with primary care nurses across four provinces: British Columbia, Ontario, Newfoundland and Labrador, and Nova Scotia. We asked participants to describe their roles during various stages of the pandemic, facilitators and challenges encountered and possible roles that nurses could have played. We used thematic analysis and analysed codes relevant to vaccination.We interviewed a total of 76 nurses and identified four key functions of primary care nurses' roles in COVID‐19 vaccination: (1) education, (2) vaccine administration, (3) outreach and (4) advocacy. Themes outlined nurses' roles with respect to patient education, addressing vaccine hesitancy, partaking in vaccination roles outside of regular primary care practice and supporting accessibility in COVID‐19 vaccination. Specific tasks varied by nursing professions.Primary care nurses fostered trust through existing patient–provider relationships to enhance roles and activities related to education, outreach and advocacy in COVID‐19 vaccination. Some COVID‐19 vaccine‐related roles were more easily integrated into primary care, whereas others competed with routine primary care roles.Findings highlight the vital contributions of primary care nurses towards COVID‐19 vaccination efforts in Canada. Leveraging nursing expertise can enhance future pandemic response efforts and improve patient care by addressing barriers to vaccination and promoting equitable access to vaccination services.This study addresses a knowledge gap by describing the vaccination‐related roles of primary care nurses during the pandemic. Findings illustrate that nurses demonstrated adaptability through their engagement in vaccine education, administration, outreach and advocacy. This research informs resource allocation, policy development and workforce planning for future vaccination efforts during a pandemic response.The authors have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines included in the Empirical Research Qualitative reporting method.No patient or public contribution. Provides insight into the pivotal roles of primary care nurses during the COVID‐19 vaccination efforts in Canada, highlighting their diverse contributions towards education, vaccine administration, outreach and advocacy. Offers implications for future pandemic planning by informing resource allocation, policy development and workforce planning for vaccination efforts. [ABSTRACT FROM AUTHOR]

Informed by the social ecological model, which asserts that health behaviors and beliefs are the result of multiple levels of influence, we examined factors related to parents' support for in-school COVID-19 mitigation strategies. Using data from a survey of 567 parents/caregivers of public elementary and middle school students in eight Maryland counties, we employed regression models to examine relationships between parent-, child-, family-, school-, and community-level factors and acceptability of mitigation strategies. Acceptance of COVID-19 mitigation strategies was positively correlated with child- and family-level factors, including child racial identity (parents of Black children were more accepting than those of White children, odds ratio [ OR ]: 2.5, 95% confidence interval [CI] = [1.5, 4.1]), parent receipt of the COVID-19 vaccine (OR : 2.4, 95% CI = [1.5, 3.7]), and parent Democrat or Independent political affiliation (compared with Republican affiliation, OR : 4.2, 95% CI = [2.6, 6.7]; OR : 2.2, 95%CI = [1.3, 3.8], respectively). Acceptance was also positively associated with parents' perceptions of their school's mitigation approach, including higher school mitigation score, indicating more intensive mitigation policies (OR : 1.1, 95% CI = [1.0, 1.1]), better school communication about COVID-19 (OR : 1.7, 95% CI = [1.4, 1.9]) and better school capacity to address COVID-19 (OR : 1.9, 95% CI = [1.5, 2.4]). Community-level factors were not associated with acceptance. Child- and parent-level factors identified suggest potential groups for messaging regarding mitigation strategies. School-level factors may play an important role in parents' acceptance of in-school mitigation strategies. Schools' capacity to address public health threats may offer an underappreciated and modifiable setting for disseminating and reinforcing public health guidance. [ABSTRACT FROM AUTHOR]

Objective: A Phase II trial was conducted to determine if nasal disinfection with a commercial Good Manufacturing Practice‐manufactured 0.5% povidone‐iodine nasal spray (Nasodine®) may be a useful adjunct in the management of COVID‐19 by reducing viral shedding and prevention of transmission of SARS‐CoV‐2. The aim was to confirm the results from a human single‐dose pilot study by assessing repeated and frequent doses on nasal shedding of SARS‐CoV‐2 from adult subjects with confirmed COVID‐19. Methods: A multicenter, randomized, double‐blinded, placebo‐controlled Phase II clinical trial involving adults with early COVID‐19 symptoms. Baseline nasal swabs were collected to quantify pretreatment SARS‐CoV‐2 nasal viral load, followed by Nasodine treatment eight times daily over 3 calendar days. Daily nasal swabs were collected post‐dose to assess the impact of treatment on nasal viral load, measured by log10 TCID50 in quantitative culture. Results: Nasodine subjects exhibited significantly improved reduction in viral load (log10 TCID50) on Days 2–4 compared to placebo recipients (p = 0.028), rate of nasal clearance of viable virus (p = 0.032), and complete (100%) nasal and throat clearance of the virus by Day 5. No difference was seen in antigen shedding as measured by time transition from Rapid Antigen Test (RAT) positivity to RAT negativity. Conclusion: A total of 20 doses of Nasodine® nasal spray administered over 2.5 days significantly reduced the titers of viable SARS‐CoV‐2 virus in the nasal passages of COVID‐19 subjects. This is the first study demonstrating the efficacy of a tolerable intranasal formulation of povidone‐iodine on viral shedding in COVID‐19 subjects. Nasal disinfection may diminish viral transmission to others. Level of Evidence: 2 Laryngoscope, 134:3947–3952, 2024 [ABSTRACT FROM AUTHOR]

Abstract Objective To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID‐19 pandemic and compare experiences in high‐income countries (HICs) with non‐HICs. Methods Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID‐19 infections, the effect of COVID‐related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non‐HICs and HICs were compared using non‐parametric Chi‐square tests. Results Two thousand one hundred and five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non‐HICs and HICs reported COVID‐19 infection (7%). Those in HICs were more likely to report that COVID‐19 measures had affected their health (32% vs. 23%; p

Introduction: We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1–August 1, 2022.Case Series: We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2–16 hours, median 4 hours) and test turnaround time (range 1–11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat.Conclusion: Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.

Abstract Background As a measure to slow down the transmission of Coronavirus disease (COVID-19), governments around the world placed their countries under various stringent lockdown measures. Uganda is one of the countries that had a strict lockdown in Africa. This qualitative study explored the social and economic impacts of the COVID-19 lockdown in both an urban (Kampala) and rural (Wakiso) setting in Central Uganda. Methods The study used focus group discussions (FGDs), household interviews, and key informant interviews (KIIs). 14 FGDs were conducted among several stakeholders including community health workers, health professionals, and members of the community. 40 household interviews were conducted among low, middle, and high-income households, while 31 KIIs were held among policy makers, non-governmental organisations, and the private sector. Data were analysed thematically in NVivo 2020 (QSR International). Results Findings from the study are presented under six themes: family disruption; abuse of children’s rights; disruption in education; food insecurity; impact on livelihoods; and violation of human rights. The study found that the COVID-19 lockdown led to family breakups, loss of family housing, as well as increased both caring responsibilities and gender-based violence especially towards females. Children’s welfare suffered through increased child labour, sexual exploitation, and early marriages. The extended closure of schools led to delayed educational milestones, poor adaptation to home-based learning, and increased school drop-out rates. Increased food insecurity led to changes in feeding patterns and reduced food varieties. Livelihoods were negatively affected hence people depleted their savings and capital. Unlawful detention and beating by law enforcement officers increased during the lockdown. Conclusion Future pandemic planning needs to consider the consequences of lockdown on the social and economic wellbeing of communities hence put in place appropriate mitigation measures during and after the outbreak.

The COVID-19 outbreak has impacted many daily activities and services we depend on. Due to changes in waste quantity and types, solid waste management (SWM) services such as waste collection, transportation, and treatment/disposal suffered. Global rules and mandates were issued to address these changes and the COVID-19 pandemic. This mini review examines seven countries and summarises the pandemic’s effects on municipal solid waste (MSW) and medical waste (MW) generation in terms of amount and composition, the SWM sector’s challenges, and government or other SWM guidelines and management measures. The data are analysed to provide suggestions for stakeholders on SWM worker protection, waste segregation, and recycling. This article identified that extending MW incineration, separating infectious waste at the source, and discontinuing recycling for infection control are the best ways to manage solid waste. The waste management system’s readiness was crucial to the pandemic response. Thus, countries like China, which has a robust SWM system, were able to contain the crisis and restrict danger, while others with weaker systems struggled. Additionally, the study highlights the importance of revising waste management policies and developing crisis response strategies that integrate flexible, innovative solutions to adapt quickly to changing waste demands and ensure public health and environmental protection during global health crises.

Background: As a measure to slow down the transmission of Coronavirus disease (COVID-19), governments around the world placed their countries under various stringent lockdown measures. Uganda is one of the countries that had a strict lockdown in Africa. This qualitative study explored the social and economic impacts of the COVID-19 lockdown in both an urban (Kampala) and rural (Wakiso) setting in Central Uganda. Methods: The study used focus group discussions (FGDs), household interviews, and key informant interviews (KIIs). 14 FGDs were conducted among several stakeholders including community health workers, health professionals, and members of the community. 40 household interviews were conducted among low, middle, and high-income households, while 31 KIIs were held among policy makers, non-governmental organisations, and the private sector. Data were analysed thematically in NVivo 2020 (QSR International). Results: Findings from the study are presented under six themes: family disruption; abuse of children's rights; disruption in education; food insecurity; impact on livelihoods; and violation of human rights. The study found that the COVID-19 lockdown led to family breakups, loss of family housing, as well as increased both caring responsibilities and gender-based violence especially towards females. Children's welfare suffered through increased child labour, sexual exploitation, and early marriages. The extended closure of schools led to delayed educational milestones, poor adaptation to home-based learning, and increased school drop-out rates. Increased food insecurity led to changes in feeding patterns and reduced food varieties. Livelihoods were negatively affected hence people depleted their savings and capital. Unlawful detention and beating by law enforcement officers increased during the lockdown. Conclusion: Future pandemic planning needs to consider the consequences of lockdown on the social and economic wellbeing of communities hence put in place appropriate mitigation measures during and after the outbreak. [ABSTRACT FROM AUTHOR]

While many studies have explored the impact of COVID-19 on healthcare workers, there is limited information on the experiences of social workers. This study aimed to examine how social service employees perceived the workplace's pandemic response to identify well-received initiatives and areas for improvement. Data was collected using an anonymous online 21-question survey on REDcap. The forty-participant sample identified as female (57.5%), Asian (85%), and aged 18–34 (55%). Participants worked remote (42.5%), hybrid (40%), or in-person (15%). The organization's pandemic response was perceived positively as effective (40%) or very effective (45%). Factors of pandemic response with the highest efficacy were provision of PPE (55%) and immediacy of efforts (50%). Remote workers had a significantly higher positive assessment of the organization's communication than hybrid or in-person employees (p = 0.0223). Safety was the primary concern among the entire workforce (88.2%). The most frequent source of COVID-19 information was the CDC (35%), and medical professionals (2.5%) were the least. This qualitative study's overall positive evaluation of the pandemic response provides insight into effective measures to prepare organizations for future public health emergencies. Future research investigating an organization's pandemic response can enhance employee well-being and advance quality improvement in pandemic response efforts. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak has impacted many daily activities and services we depend on. Due to changes in waste quantity and types, solid waste management (SWM) services such as waste collection, transportation, and treatment/disposal suffered. Global rules and mandates were issued to address these changes and the COVID-19 pandemic. This mini review examines seven countries and summarises the pandemic's effects on municipal solid waste (MSW) and medical waste (MW) generation in terms of amount and composition, the SWM sector's challenges, and government or other SWM guidelines and management measures. The data are analysed to provide suggestions for stakeholders on SWM worker protection, waste segregation, and recycling. This article identified that extending MW incineration, separating infectious waste at the source, and discontinuing recycling for infection control are the best ways to manage solid waste. The waste management system's readiness was crucial to the pandemic response. Thus, countries like China, which has a robust SWM system, were able to contain the crisis and restrict danger, while others with weaker systems struggled. Additionally, the study highlights the importance of revising waste management policies and developing crisis response strategies that integrate flexible, innovative solutions to adapt quickly to changing waste demands and ensure public health and environmental protection during global health crises. [ABSTRACT FROM AUTHOR]

In this paper, we critically analyse the response to the COVID-19 pandemic, highlighting not only the breadth of knowledge geographers have already contributed to this assessment, but also the surprisingly limited critique within geography, social sciences and the broadly defined 'Academic Left' of the authoritarian dimension of the public health policies of 2020 onwards. We conclude with a number of research questions for the aftermath of the pandemic, with the hope that they will help spur the growth of a new wave of anti-authoritarian Leftist geographical thinking that reaffirms the centrality of human rights and civil liberties to making the world a better place. [ABSTRACT FROM AUTHOR]

Background: Pakistan, with its diverse points of entry, faced several challenges with implementing the International Health Regulations (IHR) ethically during the COVID-19 pandemic. Aim: To explore the perceptions of point of entry health workers regarding the ethics challenges in implementing the IHR during the COVID-19 pandemic. Methods: From December 2022 to March 2023, this qualitative study conducted 10 focused group discussions and key informant interviews with 40 participants from 10 points of entry in Pakistan and reviewed COVID-19 containment guidelines. The data generated were transcribed, translated into English and analysed manually. The thematic analysis focused on the core ethics principles, including optimization of population health versus autonomy, distributive justice versus equity, trustworthiness versus privacy and confidentiality, and the impact of sanctions and restrictions on vulnerable populations. Results: The study identified ethics challenges relating to containment policies, public health measures (testing, quarantine and isolation), travel restrictions, equitable resource distribution, and emergency operations. These challenges were grouped under 3 main categories, according to the IHR thematic areas: prevent, detect and respond. Respondents said it was difficult to balance between the public health measures and individual rights, address discrimination and stigmatization, and ensure fairness and justice in vaccine distribution and travel restrictions. Conclusion: Navigating ethics challenges relating to IHR implementation during health emergencies requires transparent communication, cultural sensitivity, and a commitment to equity and justice. It is important to incorporate ethics considerations into national emergency response plans to guide decision-making, safeguard individual rights and promote collective wellbeing. [ABSTRACT FROM AUTHOR]

This study examines excess mortality patterns in 32 European countries during the first three years of the pandemic, offering insights into the pandemic’s toll on each country. Using data from national statistical offices, we calculated monthly excess mortality for 2020–2022. Time series decomposition was employed for trend analysis, followed by clustering countries based on their mortality trends. Then we compared total excess mortality among different clusters. We found that neighboring countries with similar characteristics experienced comparable levels of excess mortality, regardless of the differences in their pandemic trajectories identified by cluster analysis. Other factors, such as healthcare infrastructure and pre-existing health risks, appear to have had a more significant impact on total excess mortality, with various pre-existing regional factors playing significant roles in shaping the pandemic’s final toll. While the timing of peak excess mortality may have been a factor, it was not the primary driver of the overall toll. This study highlights the critical need for comprehensive public health strategies that focus on reinforcing healthcare infrastructure and mitigating pre-existing health risks, essential for effective pandemic preparedness and response. These findings suggest the need for reevaluating current approaches and exploring alternative strategies for managing future health emergencies. [ABSTRACT FROM AUTHOR]

Abstract Background Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians’ (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. Methods As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. Results Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs’ ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. Conclusions Recent primary care system reforms implemented in Canada enhanced FPs’ ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms.

This article focuses on the UK’s pre-COVID 19 pandemic preparedness and its early response to the COVID-19 pandemic (January ‘20 – March ‘20). The aim of this article is to explain the high excess mortality the UK experienced compared to many of its international and European peers in the first wave, which is contrary to the country’s high ranking in pre-COVID-19 preparedness rankings. The article assesses the various components of pre-COVID-19 pandemic preparedness such as pandemic strategy, exercises, and stockpiles, and it covers government decision making processes on the early response, including questions around post-travel quarantining, test and trace, and mobility restrictions. The article concludes that there were important deficiencies in the UK's pandemic preparedness and early response in the COVID-19 pandemic. These include the centrality of the ‘inevitability of spread’-assumption underpinning the UK’s pandemic planning pre-COVID, the insufficient implementation of pandemic exercise recommendations, the lack of early and ‘live learning’ from other countries’ experiences, the lack of adoption of public health advice of the World Health Organisation early on, the late implementation of internal mobility restrictions, the lack of timely consideration of alternative early pandemic response models, and fragilities in the SAGE/governmental interplay.

Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.

The global COVID-19 pandemic had an unprecedented impact on transportation worldwide. Significant decreases in transportation across all modes were evident and sustained as governments worldwide implemented various countrywide closures and quarantine restrictions to slow the spread of the virus. This paper quantifies and assesses daily vehicle counts by Federal Highway Administration (FHWA) vehicle classifications during the COVID-19 pandemic in New York and Florida throughout 2020. The study found that duringMarch and April of 2020, traffic among all investigated FHWA categories was significantly reduced in both Florida and New York. However, commodity carriers in both states were able to recover faster and remained more consistent than passenger vehicles. This pattern was also observed in both urban and rural communities in Florida. The findings of this work demonstrate how commodity carrier movements, assessed through FHWA vehicle category counts, were less impacted by the governmental restrictions during the pandemic than passenger transportation. While overall traffic volume dropped by more than half in most places at the height of the pandemic, larger commodity-carrying vehicles remained nearly unchanged from the prior year by June of 2020. This was likely because of the critical need to maintain trucking movements to sustain populations. Understanding how truck traffic and freight movements more broadly were impacted during the COVID-19 pandemic is critical in preserving the continuity of service and preventing supply shortages in the event of future outbreaks. [ABSTRACT FROM AUTHOR]

Background and Objectives Adopting preventive behaviors is crucial to avoiding coronavirus disease 2019 (COVID-19) infection, and perceived anxiousness may influence such behaviors among older adults and their caregivers. This study investigated the relationships between perceived anxiousness about COVID-19 and preventive behaviors in older adult–caregiver dyads. Research Design and Methods A cross-sectional study was conducted using 1,565 older adult–caregiver dyads from the 2020 National Health and Aging Trend Study (NHATS)/National Study of Caregiving (NSOC) COVID-19 Supplements data. Actor–partner interdependence models were estimated to examine the associations between older adults' and family caregivers' perceived anxiousness about COVID-19 and their engagement in personal (e.g. wearing masks, washing hands) and social (e.g. avoiding contact with friends, limiting grocery shopping) preventive behaviors. Separate models were estimated based on older adults' dementia status. Results We found significant actor effects of anxiousness about COVID-19 on preventive behaviors of both older adults and caregivers in nondementia dyads. The anxiousness about COVID-19 of older adults had significant partner effects on both personal and social preventive behaviors of caregivers, whereas caregivers' anxiousness about COVID-19 only had a significant partner effect on social preventive behaviors of older adults. No significant partner effect was found in dementia dyads. Discussion and Implications Our findings highlight the critical role of caregivers in promoting older adults' health behaviors during the COVID-19 pandemic and maintaining mental well-being of older adults. The study also implies future efforts to explore the dyadic relationship of dementia care dyads in promoting health behaviors and mental health. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. Methods: As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. Results: Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. Conclusions: Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms. [ABSTRACT FROM AUTHOR]

The novel coronavirus (COVID-19) pandemic has been a major global event. Countless restrictions and recommendations have revealed novel insights into the everyday lives of people, which are far from uniform across cultures. In this explorative study, the mood perception of people from "individualistic" (Finland) and "collectivistic" (Japan and South Korea) cultures were studied via self-administered questionnaires at the time of major social restrictions (spring–summer of 2020) when the sociocultural effect of the pandemic was at its strongest. A simple measure of "recent mood perception" forms the core of the analysis, against which various factors were analyzed. Such coarse measures fit well with cross-cultural research, for more specific experiences typically do not translate very well between cultures. Somewhat surprisingly, almost no "constant" measures (e.g., occupation, household structure) proved to be significantly correlated with recent mood, whereas the degree of "changes" in personal situation (time spent home, number of people met, and so on, before and after the outbreak) proved to be significant factors, highlighting contextuality and mindset. Further, difference between "individualistic" and "collectivistic" cultures was also observed. These results highlight the vital importance of not only observing consistent phenomena but also recognizing changes and understanding the unique perspectives and experiences individuals have of them. Depending on the context, an objectively same thing can evoke vastly different perceptions. [ABSTRACT FROM AUTHOR]

In the face of the unprecedented challenges posed by the COVID-19 pandemic, this article thoroughly explores the intricate landscape of COVID-related trauma and psychological distress experienced during lockdown enforcement, analyzing its origins and repercussions. By delving into individuals' experiences throughout the lockdown period, the study investigates how lockdown measures contributed to heightened trauma and psychological distress, particularly focusing on triggers such as illness fear, disrupted routines, and social isolation. The profound impact of isolation and restrictions on mental health and well-being is scrutinized, revealing disparities among various demographic groups in enduring COVID-related trauma. The article underscores adaptive coping mechanisms, like virtual connections and creative outlets, while emphasizing the crucial role of mental health support in mitigating trauma effects. It also elucidates the amplified trauma resulting from pandemic uncertainty and lockdowns, highlighting technology's role in alleviating distress. Cultural factors are examined, and the article concludes by offering recommendations for policymakers to integrate mental health services into crisis response plans, foster community resilience, and enhance public education on coping strategies to promote overall well-being during crises. [ABSTRACT FROM AUTHOR]

bstract Crisis narratives have long been a prominent feature of the climate movement to spur system change. The COVID‐19 pandemic brought to the fore the complexities of navigating climate action through the overlapping crises of the Anthropocene. While crisis is seen to offer possibilities for transformational change, it also threatens to prioritise urgency over justice. It is therefore important to understand how climate activists, in practice, are mobilising different narratives of crisis. To this end, we empirically examine climate activists' reflections on crisis in Aotearoa New Zealand through their experiences of the COVID‐19 pandemic. We identify a narrative of ‘panic‐activism’ that uses crisis to demonstrate the severity of the climate threat to enable drastic action. Such narratives are often underpinned by a ‘hierarchy of crisis’ that positions climate change as the most imminent existential crisis. We caution that this crisis narrative is troubling for climate justice, particularly as it positions one crisis as more urgent than others. However, in contrast to panic‐activism, our study suggests climate activists in Aotearoa tended to approach crisis cautiously and with reluctant necessity, rather than as something to be actively catalysed or capitalised on. Instead, activists cultivated a narrative of ‘crisis solidarity’ that highlights the networks of reciprocity and vulnerability across and within communities for more intersectional social movement organising. [ABSTRACT FROM AUTHOR]

AbstractObjectiveParticipantsMethodsResultsConclusionsThis study at a US Native American-serving Nontribal Institution (NASNTI) deeply analyzed collegiate leadership’s responses and experiences during the first year of the COVID-19 pandemic.Elite interviews were conducted between April and June 2021 with the college president, provost, dean of student engagement, human resources director, and chief of police. Interviewees were purposively selected due to their positions of authority.Each one-hour interview used a semi-structured guide for standardization and was conducted either virtually or in-person while following COVID-19 protocols. The general inductive method was used to identify nodes and categories within the transcripts.Six nodes (conceptual domains) and 18 categories were identified. Though there was variability in interviewee emphasis, the respondents described the motivations, drivers, and sentiment behind their decision-making in a transparent way.NASNTI leadership reported being able to navigate the pandemic by emphasizing transparency and engaging students, while working alongside the community. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic was uniquely challenging for public health workers charged with enforcing recommendations. In the United States, media reports highlight frequent outbursts and threats from community members and elected officials regarding masking protocols, vaccine mandates, and other public health measures such as isolation/quarantining recommendations. Given this backdrop, the purpose of this study was to better understand the lived experiences of this critical workforce in the context of COVID-19. We conducted in-depth phone interviews with public health workers in Ohio (N = 11). Questions were designed to illicit workers' experiences and sense-making of the pandemic experience. We analyzed results using the techniques of interpretive phenomenological analysis. Five major themes focused on how workers experienced public perceptions of COVID-19 and the public health response. Three themes highlight the role of media and social media in polarizing public perceptions. These we note as: Dealing with Deadlock, Feeling Misunderstood and Misrepresented, and The Rollercoaster of Public Opinion. Getting on With the Work reveals strategies used to navigate public perceptions and misperceptions. This ranged from aggressive education and information sharing, to setting boundaries around the controversial or disputed aspects of the pandemic. Finally, After the Dust Settles comments on hopes for postpandemic transformations of public health and public perceptions thereof. These results can inform new pathways for public health. Paramount among these are effective strategies that address public knowledge, values, and worldviews. Such messaging must promote nuanced understanding and customized approaches for local realities, rather than relying on rigid dichotomies that further polarization and distrust. [ABSTRACT FROM AUTHOR]

To reduce transmission risk during the COVID-19 pandemic, 'telehealth' (health care delivered via telephone/video-conferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives' perspectives regarding telehealth use. A qualitative study was conducted in Australia during 2020–2021 using two data sources from the Birth in the Time of COVID-19 (BITTOC) study: i) interviews and ii) surveys (open-text responses). Content analysis was utilised to analyse the data and explore telehealth from the perspective of midwives and women accessing maternity care services. In-depth interviews were conducted with 20 women and 16 midwives. Survey responses were provided from 687 midwives and 2525 women who were pregnant or gave birth in 2021, generating 212 and 812 comments respectively. Telehealth delivery was variable nationally and undertaken primarily by telephone/videoconferencing. Perceived benefits included: reduced COVID-19 transmission risk, increased flexibility, convenience and cost efficiency. However, women described inadequate assessment, and negative impacts on communication and rapport development. Midwives had similar concerns and also reported technological challenges. During the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services, but is not a suitable replacement to traditional face-to-face maternity care. [ABSTRACT FROM AUTHOR]

Purpose: The COVID‐19 pandemic highlighted the importance of having emergency and acute care services close to home and emerged as an opportunity for hospital‐community engagement. This study examined whether rural residents' satisfaction with their local hospital's pandemic response was associated with improved community perception of the hospital and an intention to use it in the future. Methods: Data for the study were obtained from a survey of rural residents of 6 Georgia rural communities and analyzed using multivariable logistic regression and mediation analyses. Results: Rural residents' satisfaction with their local hospital's pandemic response was associated with an improved perception of the hospital. Improvement in the perception of rural hospitals following the pandemic was found to partially mediate a positive association between community residents' satisfaction with hospital pandemic response and the intention to use the hospital when needed. Conclusion: The COVID‐response efforts may have given rural hospitals an opportunity to influence public perception. [ABSTRACT FROM AUTHOR]

Munster Technological University (MTU) responded to the COVID-19 pandemic's educational challenges with the creation of the Reach Initiative. This initiative, a comprehensive academic mentoring and coaching programme, was developed at MTU in response to the unique challenges of the COVID-19 pandemic. Primarily targeting first and second year students, this initiative was designed to support their academic and non-academic needs during the transition to online Emergency Remote Teaching (ERT). The programme involved the recruitment and training of Academic Mentors (members of academic staff) from various disciplines who provided tailored individual support to the students. A key component of this study is a survey conducted to evaluate the initiative's impact. The survey aimed to understand students' challenges during the pandemic and assess the effectiveness of the Reach Initiative as a support mechanism. The findings revealed significant engagement with the programme, indicating its importance in providing both academic guidance and emotional support. Students reported benefiting from the initiative in various ways, including improved understanding of academic content, better access to university resources, and enhanced emotional well-being. The conclusion highlights the critical role of academic mentoring in supporting students during unprecedented times. It underscores the need for such initiatives in higher education, particularly during crises that disrupt traditional learning environments. The Reach Initiative not only facilitated academic success but also contributed positively to the students' overall university experience during the pandemic. [ABSTRACT FROM AUTHOR]

This study explores the impact of government subsidies on the production dynamics within the medical product supply chain, particularly focusing on the remanufacturing of medical goods. Amidst the backdrop of the COVID-19 pandemic, which has underscored the critical shortages in medical supplies, our research delves into the adoption of remanufacturing practices by medical product manufacturers as a strategic response to these shortages and environmental concerns. We investigate how government subsidies influence the production volumes of original manufacturers and remanufacturers and examine the competitive interplay between newly manufactured and remanufactured medical products. Through the development of three production game models—Scenario B (manufacturers produce both new and refurbished products), Scenario N (separate production of new and refurbished products by manufacturers and remanufacturers, respectively), and Scenario C (similar to Scenario N but includes a certification fee paid by remanufacturers to original manufacturers)—we analyze the strategies that could mitigate supply deficiencies during medical crises. Our findings indicate that the certification strategy (Scenario C) not only yields the highest total production of medical products but also offers a viable solution to enhance the sustainability of the entire medical production system by alleviating supply chain disruptions. Furthermore, we discuss the managerial implications of our results, emphasizing the potential of a joint remanufacturing strategy to stabilize the supply chain and foster environmental conservation. Lastly, we highlight our study's limitations and suggest future research directions, particularly concerning the variability in product quality and the reliance on government subsidies. This research contributes to a nuanced understanding of green remanufacturing within the pharmaceutical supply chain, offering insights for manufacturers, remanufacturers, and policymakers aiming for sustainable industry practices.

The onset of the COVID-19 pandemic drove a widespread, often uncoordinated effort by research groups to develop mathematical models of SARS-CoV-2 to study its spread and inform control efforts. The urgent demand for insight at the outset of the pandemic meant early models were typically either simple or repurposed from existing research agendas. Our group predominantly uses agent-based models (ABMs) to study fine-scale intervention scenarios. These high-resolution models are large, complex, require extensive empirical data, and are often more detailed than strictly necessary for answering qualitative questions like “Should we lockdown?” During the early stages of an extraordinary infectious disease crisis, particularly before clear empirical evidence is available, simpler models are more appropriate. As more detailed empirical evidence becomes available, however, and policy decisions become more nuanced and complex, fine-scale approaches like ours become more useful. In this manuscript, we discuss how our group navigated this transition as we modeled the pandemic. The role of modelers often included nearly real-time analysis, and the massive undertaking of adapting our tools quickly. We were often playing catch up with a firehose of evidence, while simultaneously struggling to do both academic research and real-time decision support, under conditions conducive to neither. By reflecting on our experiences of responding to the pandemic and what we learned from these challenges, we can better prepare for future demands.

This study focuses on how academic libraries face ongoing challenges in adapting to emerging technologies and external events like the COVID-19 pandemic. It explores the literature on the decline in reference transactions and the growing reliance on technology-mediated reference services. It presents [Institution] Library’s approach to remediate and reverse this decline. The library aimed to enhance student access to reference services and increase librarian visibility by piloting in 2022-23 a mobile ASK desk. Data analysis from the pilot program indicates an increase in reference queries compared to previous years, reversing the multiyear downward trend and suggesting the effectiveness of the ASK desk in meeting student needs. The article introduces the Holistic 360 Reference Services Model (H360 Ref), which provides a framework for delivering comprehensive reference services. Overall, it asserts that enhancing reference services can contribute to increased student engagement, solidifying the essential role of libraries in supporting learning and research endeavors.

Abstract The COVID-19 pandemic has revealed the contested politics of global health governance, though we still don’t know enough about the dynamics of domestic pandemic responses, or about the relationship between the politics of those responses and the politics of global health governance, both of which have changed significantly in recent decades. Focusing on three cases (HIV/AIDS, SARS, and COVID-19) of cross-border infectious diseases, this article explores the trajectory of China’s pandemic responses in the context of globalization. Attending to changing politics at domestic, international, and global levels, I argue that those responses have been a complex combination of China’s domestic politics (e.g., priorities, institutions, leadership, and timing), its international relations (especially with the US), and its engagements with global health governance. It is concluded that the increasing divergence of pandemic responses in a time of ubiquitous global health crisis demands urgent attention to the connections (including contestations) between domestic pandemic responses and the evolvement of global health governance from a broader perspective that considers changes in geopolitics.

This short commentary draws on academic and grey literature to critically evaluate the UK response to the COVID-19 pandemic, highlighting aspects in which the response fell short and their ramifications on public trust and compliance with preventive measures. Such aspects include the initial delay in response to the outbreak, the controversial “herd immunity approach,” the mismanagement of care home patients, the inadequacy of the contact tracing system, the scandals around the procurement of personal protective equipment, and the breach of lockdown/social distancing regulations by government officials. Based on the lessons learned from these shortcomings, this commentary seeks to provide suggestions for effective public governance in the face of future health emergencies.

Leiqing Gao,1,2,&ast; Shi Tang,1,&ast; Weiyan Zheng1 1Department of Nursing, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Nursing, Pu Jiang Hospital, Minhang District, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Weiyan Zheng, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, Shanghai, 200127, People’s Republic of China, Fax +86-21-63730455, Email renji_zhengweiyan@163.comObjective: In the first half of 2022, Shanghai faced the challenge of an emerging wave of epidemics caused by the Omicron variant. In response, 48 hospitals, spanning municipal and district levels, were rapidly converted into designated hospitals. This case study focuses on the South Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, as one such designated hospital.Methods: Facing unprecedented challenges without prior experience, we devised a strategic approach to deploy ICU nurses effectively. This approach involved crisis event gradation, establishing a human resources pool, and classifying nursing staff based on qualifications and proficiencies.Results: By May 11, 2022, all 48 designated hospitals were operational. The South Branch of Renji Hospital treated 3310 Omicron-infected patients between April 7 and June 21, 2022, including 115 critically ill patients in a 38-bed ICU. We meticulously assigned 136 nurses, distributed as follows: Grade A 12.5%, Grade B 12.5%, Grade C 40%, and Grade D 35%, with three specialized nursing managers. Nurses worked tirelessly in 4-hour shifts, wearing full protective gear. Remarkably, the hospital maintained a flawless record, with no nursing-related adverse events and zero patient mortality in the ICU.Conclusion: Effective management of ICU nursing personnel is associated with patient safety. Strategic rostering and placement of ICU nurses in designated hospitals optimize resource utilization, enhancing service effectiveness and working conditions. This technique is a crucial resource for hospitals facing unforeseen public health crises requiring rapid ICU nurse resource allocation and management.Keywords: Omicron variant, pandemic response, designated hospital, ICU, nurse, human resource management, resource allocation

In response to the SARS-CoV-2 pandemic, the United States declared a state of emergency and implemented large-scale shutdowns and public health initiatives to prevent overwhelming public resources. The success of these prevention methods remains unresolved as restrictions and implementation varied from national, state, and local levels. Despite national and local regulations, individual adherence to preventative guidelines presented an additional layer of variability. Cases of COVID-19 continued to rise and fall over a two-year period on a national level, despite masking recommendations, ease of testing, and availability of vaccines. The Ysleta del Sur Pueblo is a Native American tribal community and sovereign nation located in El Paso, Texas. Speaking Rock Entertainment Center is a major business operated by the tribe, employing many tribal and non-tribal members from the El Paso area. Following nationwide re-openings of non-essential businesses, Speaking Rock implemented an infection control program with strict adherence to recommendations provided by the Center for Disease Control and Prevention (CDC) and additional disease control. This response would result in a fully vaccinated workforce within the wider community of El Paso, where the vaccination rate was less than 80%. Herein, we examine the efficacy of these measures and report on the success of the program resulting in zero hospitalizations or deaths compared with rates of 1 in 250 and 1 in 40, respectively, in the surrounding community.

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy.