The Delta variant, the fourth wave of the COVID-19 pandemic, caused a sharp surge in hospitalizations and deaths in July 2021, Thailand. Because to population density and insufficient immunization, Bangkok and the Metropolitan Region(BMR) were the epicenters. The Thai government switched from inpatient care to home isolation due to the massive outbreak.

Methods

A retrospective cohort study was conducted. A-MED Telehealth identified all BMR COVID-19 patients in the home isolation program (HI) between July and December 2021. On September 20, 2022, the National Civil Registration database evaluated patients. The Cox proportional hazard model determined 28-day mortality and its determinants. During the study, BMR had standard health systems and COVID-19 crisis response task force services. The Royal College of Family Physicians of Thailand and the Thai Red Cross Society supported Fammed CoCare (Tangerine Clinic), which was part of the HI crisis response task force.

Results

The overall number of participants was 90,861. In July, the first month of HI protocol implementation, Fammed CoCare treated up to 50% of patients. Average age was 37.28±18.96 years. Half of the participants were men. Asymptomatic, mild, urgent, death, resolution, and other administration are the initial symptoms(42.80%,29.50%,1.20%,0.01%,0.70%,and 9.30%). Andrographis paniculate, favipiravir, and corticosteroids were administered(8.70%,23.00%,0.53%).

The 28-day mortality rate was 55.80%. The independent factors were increasing age(HR,1.12;95%CI:1.11-1.14), male(HR,1.75;95%CI:1.28-2.39),increasing BMI(HR,1.05;95%CI:1.01–1.08),Mild symptoms(HR,1.55;95%CI:1.04–2.30),Urgent symptoms(HR,2.66;95%CI:1.52–4.65),Delayed assessment(HR,0.86;95%CI:0.78–0.95),increased O2 saturation(HR,0.89;95%CI:0.85–0.92),increased temperature(HR,2.26;95% CI:1.43–3.58) after adjusted for all factors and corticosteroid prescription.

Conclusions

Managing patients during the COVID-19 pandemic requires timely adaptation. Early on, conventional health systems should collaborate with the HI crisis response task force for COVID-19 patients to form multidisciplinary teams. In this situation, the various COVID-19 lessons learned guided outbreak management systems.

Public health implications

Standard health systems and a crisis response task team will be used to prototype pandemic prevention and control. Early crisis response necessitates a well-supported team, which is how future disasters will be handled. Furthermore, due to COVID-19, telemedicine should reinforce the chronic care model. Finally, the Thai government's healthcare staffing will be influenced by population density.

The impact of the COVID-19 pandemic response on the public health workforce has not been adequately examined. Working in public health during the pandemic was meaningful, though also challenging, demoralizing, and harsh. This project aims to uplift the experiences and stories of the public health workforce in Iowa.

Objectives: The objective of this qualitative project was to deconstruct the COVID-19 response in Iowa. We used an innovative mixed methods data collection tool, SenseMaker®, that allows respondents to share their experiences, and control the narrative and analysis of their own story.

Methods

This project was conducted in collaboration with the Iowa Public Health Association and informed by a project planning committee. Respondents were invited to share story about their experiences during the COVID-19 pandemic. They then answered both open and closed ended questions related to this story. We collected 179 stories in the Spring/Summer 2022. We thematically analyzed the stories, and visualized the quantitative data in addition to imbedding them in the stories.

Results

Thematic analysis revealed 8 themes. When summarized, they highlighted the facilitators and barriers to an effective response. Facilitators included: strong partnerships/collaboration, flexibility and thinking outside the box, effective and timely communication, and a focus on equity in resource and service allocation. Barriers to effective response were seen around politicization and controversial government response, lack of communication and changing guidelines, conflicting information, mental health burden, burnout, workload, and the public perception of the pandemic. Specific themes were more or less salient within subgroups. For example, stories written by men differed thematically from those submitted by women.

Conclusion

These stories powerfully illustrate the context of the pandemic in Iowa, a state that implemented few mitigation measures. Stories highlight the severe strain on the mental health of public health professionals during the pandemic and currently, including feelings of frustration and lack of appreciation. However, the stories also uplift the solidarity and camaraderie developed with others in the public health field, along with innovative solutions developed to respond to this crisis. Participants found telling their stories in this format therapeutic and welcomed the opportunity to share with the goal of enhancing future response.

Public Health Implications

The harnessing of experiences allowed us to capture a more personal, and yet collective and nuanced understanding of the COVID-19 pandemic in Iowa. Results will guide strategic planning and action in public health organizations, and have also been shared with policy makers.

The COVID-19 pandemic was an unprecedented challenge for public health systems to rapidly communicate prevention guidelines and distribute tests, particularly to people living in rural areas with limited healthcare capacity.

Objectives

This qualitative study assesses the social, behavioral, structural and policy factors that contributed to COVID-19 testing disparities in underserved and vulnerable rural Northern New England communities to inform future public health interventions and improve rural community engagement.

Methods

We conducted semi-structured interviews with state public health officials and local community-based health and service organizations in both states (N=38) and focus groups in a sample of large, small and isolated rural communities (ME) and older adults in congregate housing and parents of school-aged children (VT) (N=87 participants) to assess local testing efforts and availability, motivating factors for, and facilitators and barriers to, getting COVID-19 tests in rural communities.

Results

Rural residents’ reasons for seeking COVID-19 tests were fear of severe illness and a desire to keep themselves or high-risk older family members safe and avoid community spread. People also sought testing to return to work or school or travel/visit family post emergency shut-down.

COVID-19 testing barriers included limited availability of on-site test sites and medical personnel to administer prior to self-testing; long wait times for results; lack of or changing information over time about who should test, where/how to get tested and, if positive, isolation and quarantine requirements; test and transportation and lost work/school day costs for quarantine period if testing positive; difficulty using on-line scheduling systems particularly by those with limited internet literacy; and discomfort from posterior nasal swabs. COVID-19 fatigue, misinformation, and beliefs that early COVID-19 fears were overstated also contributed to less testing in some communities.

Facilitators included strong rural community response systems, offering testing and messaging through multiple community venues and both formal and informal trusted local sources/partners (e.g., pharmacies, local businesses, schools). Expanding testing access through pharmacies and free home-testing helped increase access.

Conclusions

Successful COVID-19 testing in rural and underserved communities involved a coordinated cross-sector effort involving multiple local trusted organizations, repeated messaging through local and social media, and the provision of free tests through community organizations.

Public Health Implications

Future rural COVID-19 testing efforts should engage, resource and leverage local trusted health and community-based agencies and services in both testing distribution and messaging to reduce rural testing disparities.

The National COVID-19 Resiliency Network (NCRN) is a collaborative network of over 400 multi-level partnerships working to mitigate the impact of COVID-19 among disproportionately impacted communities, including rural, racial, ethnic, and socially vulnerable populations. Based on the priority populations, NCRN identified the objectives of each microgrant and extended request for proposals to community-based organizations (CBOs) committed to addressing health disparities. The selected CBOs implemented their proposed projects and reported their efforts/outcomes to NCRN for a mixed-methods evaluation.

Purpose

Support community-driven intervention and build CBO capacity to address COVID-19 recovery needs and social determinants of health concerns, exacerbated during the pandemic, by disseminating health promotion messages, building community capacity, increasing vaccine uptake, increasing awareness/access to behavioral and mental health resources, and improving community resilience.

Results

From 2021-2023, NCRN leveraged $415,000 to award 7 rounds of microgrants to 44 CBOs located throughout the 10 HHS regions. Over 32% of CBOs hosted vaccine clinics to increase vaccine uptake among community members. Twenty percent of CBOs developed community mobilization plans to implement in their community. Sixteen percent of CBOs addressed mental health through efforts such as Mental Health First Aid training or linkage to care. Collectively, CBOs disseminated over 167,845 print materials and reached/engaged over 574,656 individuals through their efforts.

Conclusion/Implications

CBOs increased their capacity and leveraged their resources to implement programs that resulted in greater health education, expansion of resources/ health services to their communities, and improved community trust, outreach, and impact. Our microgrant framework is an effective tool for improving population health at the community level.