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COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions
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COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Infectious Disease Epidemiology".

Deadline for manuscript submissions: closed (3 May 2021) | Viewed by 81022

Special Issue Editors

Prof. Dr. Keith C. Norris

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Guest Editor
Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
Interests: health services; chronic kidney disease; health disparities
Prof. Dr. Arleen F. Brown

E-Mail Website
Guest Editor
Department of Medicine, Division of General Internal Medicine and Health Services Research (GIM and HSR), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
Interests: diabetes; chronic diseases; health care; HIV; cardiovascular disease; health outcomes
Prof. Dr. Roland J. Thorpe, Jr.

E-Mail Website
Guest Editor
Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD 21205, USA
Interests: minority aging; stress and biopsychosocial pathways influencing age-related outcomes among black men over the life course; black–white disparities in age-related outcomes among men in middle to late life; social determinants of age-related outcomes among black and white men
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Coronavirus disease 2019 (COVID-19) pandemic has revealed societal vulnerabilities on a global level. COVID-19 hospitalizations and deaths have disproportionately affected low-income and marginalized communities, in part through chronic medical conditions such as hypertension, diabetes, obesity, and kidney, cardiovascular, and chronic lung diseases and in part through a global structure of inequity. The World Health Organization has outlined three principles of global action to address these inequities and their contribution to health, commonly called the social determinants of health, with the aim of achieving health equity within a generation. These include: i) improving the conditions of daily life—the circumstances in which people are born, grow, live, work, and age; ii) tackling the inequitable distribution of power, money, and resources—the structural drivers of those conditions of daily life—globally, nationally, and locally; and iii) measuring the problem, evaluating action, expanding the knowledge base, developing a workforce that is trained in the social determinants of health, and raising public awareness about the social determinants of health.

In this spirit, we have created a Special Issue of the International Journal of Environmental Research and Public Health entitled “COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions” to capture many of the exciting investigations spanning clinical, community-engaged, and policy research around COVID-19 and health inequities.

We invite investigators to contribute original research (empirical and theoretical) and systematic reviews that will further broaden the understanding of the cultural, economic, political, and social factors that contribute to, or may decrease COVID-19-related health disparities. Papers that include qualitative, quantitative, or mixed methods are welcomed; papers that discuss the design, implementation, and evaluation of behavioral and policy interventions are encouraged. An important aspect of every manuscript selected for inclusion in the special issue will be the focus on social determinants of health disparities and/or applications of research findings reducing health disparities. Potential topics focusing on unique aspects of COVID-19 include but are not limited to:

  • Papers that discuss, refine or test theoretical models specifying the relationship between social determinants, COVID-19 and health disparities;
  • Papers that emphasize how an intersectional approach (e.g., race, gender, and social class) to COVID-19 in particular may help in advancing our general understanding of social determinants and health disparities;
  • Papers that highlight how social determinants have implications for individual- (e.g., discrimination), place- (e.g., urbanicity) and community-oriented (e.g., segregation) factors contribute to COVID-19 related health disparities;
  • Descriptions of epidemiological studies explicitly examining the interface between social determinants and COVID-19 and how this association may impact health disparities;
  • Intervention studies that consider how social determinants of health affect COVID-19 health disparities;
  • Modeling of COVID-19 that may help predict infection surges and/or future similar viral epidemics with an emphasis on how to use this to ensure equity in risk to exposure;
  • Public health approaches that help to identify and reduce COVID-19-related disparities (e.g., race, gender, and social class);
  • Health system approaches that might address potential disparate exposure among staff/employees and lessons learned in during this pandemic;
  • Community engaged approaches to reduce the impact of COVID-19 on under resourced communities.

Prof. Dr. Keith Norris
Prof. Dr. Arleen F Brown
Dr. Roland J. Thorpe
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Published Papers (15 papers)

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Research

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12 pages, 5808 KiB  
Article
Analysis of Hazard Rate of Municipalities in Slovakia in Terms of COVID-19
by František Petrovič, Katarína Vilinová and Radovan Hilbert
Int. J. Environ. Res. Public Health 2021, 18(17), 9082; https://doi.org/10.3390/ijerph18179082 - 28 Aug 2021
Cited by 10 | Viewed by 2525
Abstract
The coronavirus became a phenomenon in 2020, which is making an unwanted but wide space for the study of various scientific disciplines. The COVID-19 pandemic situation which has reached almost the whole civilized world by its consequences thus offers a unique possibility to [...] Read more.
The coronavirus became a phenomenon in 2020, which is making an unwanted but wide space for the study of various scientific disciplines. The COVID-19 pandemic situation which has reached almost the whole civilized world by its consequences thus offers a unique possibility to analyze the graphic space and the human activities inside it. The aim of this study is to predict and identify the potential rate of threat on the example of COVID-19 in Slovakia through an established model. This model consisted of an assessment of the partial phenomena of exposure, vulnerability, and overall risk. The statistical data used to evaluate these phenomena concerned individual cities in Slovakia. These represent the smallest administrative unit. Indirect methods based on the point method were applied in the paper. The spreading and transfer of the disease was influenced much more by the exposure presented by traffic availability, especially, but also the concentration of inhabitants in the selected locations (shops, cemeteries, and others). In the results, our modeling confirmed the regions with the highest intensity, especially in the districts (Bratislava, Košice, Prešov, and Nitra). The selection of the data and method used in this study together with the results reached and presented may serve as an appropriate tool for the support of decision-making of other measures for the future. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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17 pages, 940 KiB  
Article
Evaluation of COVID-19 Mitigation Policies in Australia Using Generalised Space-Time Autoregressive Intervention Models
by Ryan H. L. Ip, Dmitry Demskoi, Azizur Rahman and Lihong Zheng
Int. J. Environ. Res. Public Health 2021, 18(14), 7474; https://doi.org/10.3390/ijerph18147474 - 13 Jul 2021
Cited by 5 | Viewed by 2709
Abstract
In handling the COVID-19 pandemic, various mitigation policies aiming at slowing the spread and protecting all individuals, especially the vulnerable ones, were implemented. A careful evaluation of the effectiveness of these policies is necessary so that policy-makers can implement informed decisions if another [...] Read more.
In handling the COVID-19 pandemic, various mitigation policies aiming at slowing the spread and protecting all individuals, especially the vulnerable ones, were implemented. A careful evaluation of the effectiveness of these policies is necessary so that policy-makers can implement informed decisions if another wave of COVID-19 or another pandemic happens in the future. This paper reports an assessment of some policies introduced by the Australian governments using a generalised space-time autoregressive model which incorporates multiple exogenous variables and delay effects. Our results show that the number of daily new cases from the states and territories are influenced by both temporal and spatial aspects. Business and border restrictions are found helpful in reducing the number of new cases a few days after implementation while gathering restrictions may not be effective. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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18 pages, 1035 KiB  
Article
Local Government Approaches to Combating COVID-19 Inequities: A Durham County Department of Public Health Perspective
by Kristen Burwell-Naney, Marissa Mortiboy, John-Paul Zitta, Elizabeth Stevens, Kristen Patterson, James Christopher Salter, Michele Easterling, Lindsey Bickers Bock, Hattie Wood, Malkia Rayner and Rodney Jenkins
Int. J. Environ. Res. Public Health 2021, 18(12), 6544; https://doi.org/10.3390/ijerph18126544 - 18 Jun 2021
Cited by 4 | Viewed by 2961
Abstract
When a novel coronavirus disease (COVID-19) made major headlines in 2020, it further exposed an existing public health crisis related to inequities within our communities and health care delivery system. Throughout the COVID-19 pandemic, populations of color had higher infection and mortality rates, [...] Read more.
When a novel coronavirus disease (COVID-19) made major headlines in 2020, it further exposed an existing public health crisis related to inequities within our communities and health care delivery system. Throughout the COVID-19 pandemic, populations of color had higher infection and mortality rates, and even experienced greater disease severity compared to whites. Populations of color often bear the brunt of COVID-19 and other health inequities, due to the multifaceted relationship between systemic racism and the social determinants of health. As this relationship continues to perpetuate health inequities, the local health department is an agency that has the jurisdiction and responsibility to prevent disease and protect the health of the communities they serve. When equity is integrated into a health department’s operational infrastructure as a disease prevention strategy, it can elevate the agency’s response to public health emergencies. Collecting, reporting, and tracking demographic data that is necessary to identify inequities becomes a priority to facilitate a more robust public health response. The purpose of this paper is to present strategies of how a local health department operationalized equity in various stages of COVID-19 response and apply these methods to future public health emergencies to better serve vulnerable communities. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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14 pages, 1063 KiB  
Article
Immigration and Gender as Social Determinants of Mental Health during the COVID-19 Outbreak: The Case of US Latina/os
by Barbara Gomez-Aguinaga, Melanie Sayuri Dominguez and Sylvia Manzano
Int. J. Environ. Res. Public Health 2021, 18(11), 6065; https://doi.org/10.3390/ijerph18116065 - 4 Jun 2021
Cited by 24 | Viewed by 6094
Abstract
While men and women make up a similar number of COVID-19 cases, and are equally likely to know someone who has become ill due to the virus, the gendered and systemic implications of immigration during public health emergencies among minority groups in the [...] Read more.
While men and women make up a similar number of COVID-19 cases, and are equally likely to know someone who has become ill due to the virus, the gendered and systemic implications of immigration during public health emergencies among minority groups in the United States are empirically underexplored. Using the SOMOS COVID-19 Crisis National Latino Survey, we conduct a series of intersectional analyses to understand the extent to which personal experiences with COVID-19, gendered structural factors, and spillover effects of US immigration policies impact the mental health of US Latina/os during a public health emergency. The results show that among Latinas, knowing an undocumented immigrant and someone ill with COVID-19 increases the probability of reporting worse mental outcomes by 52 percent. Furthermore, being a woman increases the probability of reporting the highest level of mental health problems by 30 percent among Hispanic people who know someone with COVID-19 and an undocumented immigrant. These findings indicate that the effects of the COVID-19 outbreak among US Latinas and Latinos are entrenched in gendered and systemic inequalities. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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12 pages, 774 KiB  
Article
Impact of the First Wave of the COVID-19 Pandemic on HIV/AIDS Programming in Kenya: Evidence from Kibera Informal Settlement and COVID-19 Hotspot Counties
by Samuel Muhula, Yvonne Opanga, Violet Oramisi, Catherine Ngugi, Caroline Ngunu, Jane Carter, Enock Marita, Joachim Osur and Peter Memiah
Int. J. Environ. Res. Public Health 2021, 18(11), 6009; https://doi.org/10.3390/ijerph18116009 - 3 Jun 2021
Cited by 28 | Viewed by 5595
Abstract
The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV [...] Read more.
The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018–2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%–62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%–77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%–49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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14 pages, 471 KiB  
Article
Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality
by Michelle S. Wong, Taona P. Haderlein, Anita H. Yuan, Ernest Moy, Kenneth T. Jones and Donna L. Washington
Int. J. Environ. Res. Public Health 2021, 18(9), 4848; https://doi.org/10.3390/ijerph18094848 - 1 May 2021
Cited by 19 | Viewed by 3137
Abstract
Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these [...] Read more.
Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these gaps, we examined time trends in racial/ethnic disparities in COVID-19 infection and mortality. We used the Veteran Health Administration’s (VHA) national database of veteran COVID-19 infections over three time periods: 3/1/2020–5/31/2020 (spring); 6/1/2020–8/31/2020 (summer); and 9/1/2020–11/25/2020 (fall). We calculated COVID-19 infection and mortality predicted probabilities from logistic regression models that included time period-by-race/ethnicity interaction terms, and controlled for age, gender, and prior diagnosis of CDC risk factors. Racial/ethnic groups at higher risk for COVID-19 infection and mortality changed over time. American Indian/Alaskan Natives (AI/AN), Blacks, Hispanics, and Native Hawaiians/Other Pacific Islanders experienced higher COVID-19 infections compared to Whites during the summertime. There were mortality disparities for Blacks in springtime, and AI/ANs, Asians, and Hispanics in summertime. Policy makers should consider the dynamic nature of racial/ethnic disparities as the pandemic evolves, and potential effects of risk mitigation and other (e.g., economic) policies on these disparities. Researchers should consider how trends in disparities change over time in other samples. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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15 pages, 1415 KiB  
Article
Socioeconomic Conditioning of the Development of the COVID-19 Pandemic and Its Global Spatial Differentiation
by Jerzy Bański, Marcin Mazur and Wioletta Kamińska
Int. J. Environ. Res. Public Health 2021, 18(9), 4802; https://doi.org/10.3390/ijerph18094802 - 30 Apr 2021
Cited by 18 | Viewed by 2925
Abstract
The COVID pandemic very quickly became the world’s most serious social and economic problem. This paper’s focus is on the spatial aspect of its spread, with the aims being to point to spatial conditioning underpinning development of the pandemic, and to identify and [...] Read more.
The COVID pandemic very quickly became the world’s most serious social and economic problem. This paper’s focus is on the spatial aspect of its spread, with the aims being to point to spatial conditioning underpinning development of the pandemic, and to identify and assess possible socio-economic features exerting an impact on that. Particular attention has been paid to the percentage of positive tests for the presence of the coronavirus, as well as mortality due to the disease it causes. The statistics used relate to 102 countries, with the research for each extending from the time first cases of COVID-19 were reported through to 18 November 2020. The focus of investigation has been the stochastic co-occurrence of both a morbidity index and a mortality index, with intentionally selected socio-economic variables. Results have then been summarized through the classification of countries in relation to the two indices. Highest values relate to Latin America. A significant co-occurrence of morbidity and mortality with GDP per capita has been identified, as values for the indices are found to be lower in wealthier countries. The basic conclusion is that the dependency of the pandemic on environmental and socio-economic conditioning became more complex and ambiguous, while also being displaced gradually as concrete political decisions came to be taken. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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14 pages, 372 KiB  
Article
Vaccine Willingness and Impact of the COVID-19 Pandemic on Women’s Perinatal Experiences and Practices—A Multinational, Cross-Sectional Study Covering the First Wave of the Pandemic
by Michael Ceulemans, Veerle Foulon, Alice Panchaud, Ursula Winterfeld, Léo Pomar, Valentine Lambelet, Brian Cleary, Fergal O’Shaughnessy, Anneke Passier, Jonathan Luke Richardson, Karel Allegaert and Hedvig Nordeng
Int. J. Environ. Res. Public Health 2021, 18(7), 3367; https://doi.org/10.3390/ijerph18073367 - 24 Mar 2021
Cited by 84 | Viewed by 7495
Abstract
The COVID-19 pandemic may be of particular concern for pregnant and breastfeeding women. We aimed to explore their beliefs about the coronavirus and COVID-19 vaccine willingness and to assess the impact of the pandemic on perinatal experiences and practices. A multinational, cross-sectional, web-based [...] Read more.
The COVID-19 pandemic may be of particular concern for pregnant and breastfeeding women. We aimed to explore their beliefs about the coronavirus and COVID-19 vaccine willingness and to assess the impact of the pandemic on perinatal experiences and practices. A multinational, cross-sectional, web-based study was performed in six European countries between April and July 2020. The anonymous survey was promoted via social media. In total, 16,063 women participated (including 6661 pregnant and 9402 breastfeeding women). Most responses were collected from Belgium (44%), Norway (18%) and the Netherlands (16%), followed by Switzerland (11%), Ireland (10%) and the UK (3%). Despite differences between countries, COVID-19 vaccine hesitancy was identified among 40–50% of the respondents at the end of the first wave of the pandemic and was higher among pregnant women. Education level and employment status were associated with vaccine hesitancy. The first wave had an adverse impact on pregnancy experiences and disrupted access to health services and breastfeeding support for many women. In the future, access to health care and support should be maintained at all times. Evidence-based and tailored information on COVID-19 vaccines should also be provided to pregnant and breastfeeding women to avoid unfounded concerns about the vaccines and to support shared decision making in this population. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
15 pages, 587 KiB  
Article
Who Got Infected with COVID-19? A Study of College Students in Wuhan (China)
by Changyu Fan, Min Li, Xueyan Li, Miao Zhu and Ping Fu
Int. J. Environ. Res. Public Health 2021, 18(5), 2420; https://doi.org/10.3390/ijerph18052420 - 2 Mar 2021
Cited by 9 | Viewed by 3206
Abstract
College students represent a large group of people who frequently travel across regions, which increased their risk of infection and exacerbated the risk of COVID-19 spread throughout China. This study uses survey data from the end of April 2020 to analyze the status [...] Read more.
College students represent a large group of people who frequently travel across regions, which increased their risk of infection and exacerbated the risk of COVID-19 spread throughout China. This study uses survey data from the end of April 2020 to analyze the status of COVID-19-infected cases, the group differences, and influencing factors in college students in Wuhan. The sample size was made up 4355 participants, including 70 COVID-19-infected students. We found that during the COVID-19 outbreak in early 2020, college students in Wuhan were primarily infected during off-campus events after winter break or infected in their hometowns after leaving Wuhan; the percentage of college students with severe cases was relatively low, and most had mild cases; however, a large proportion of asymptomatic cases may exist; there were significant group differences in gender, age and place of residence; and the risk of infection was closely related to the campus environment, in which the population density and number of faculty and students on campus had a significant impact. The results indicated that the infection of students did not occur at random, thus strengthening student health education and campus management can help curb the spread of COVID-19 among students. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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11 pages, 887 KiB  
Article
Prevalence and Determinants of Fatigue after COVID-19 in Non-Hospitalized Subjects: A Population-Based Study
by Knut Stavem, Waleed Ghanima, Magnus K. Olsen, Hanne M. Gilboe and Gunnar Einvik
Int. J. Environ. Res. Public Health 2021, 18(4), 2030; https://doi.org/10.3390/ijerph18042030 - 19 Feb 2021
Cited by 104 | Viewed by 7851
Abstract
This study assessed the prevalence and determinants of fatigue in a population-based cohort of non-hospitalized subjects 1.5–6 months after COVID-19. It was a mixed postal/web survey of all non-hospitalized patients ≥18 years with a positive PCR for SARS-CoV-2 until 1 June 2020 in [...] Read more.
This study assessed the prevalence and determinants of fatigue in a population-based cohort of non-hospitalized subjects 1.5–6 months after COVID-19. It was a mixed postal/web survey of all non-hospitalized patients ≥18 years with a positive PCR for SARS-CoV-2 until 1 June 2020 in a geographically defined area. In total, 938 subjects received a questionnaire including the Chalder fatigue scale (CFQ-11) and the energy/fatigue scale of the RAND-36 questionnaire. We estimated z scores for comparison with general population norms. Determinants were analyzed using multivariable logistic and linear regression analysis. In total, 458 subjects (49%) responded to the survey at median 117.5 days after COVID-19 onset, and 46% reported fatigue. The mean z scores of the CFQ-11 total was 0.70 (95% CI 0.58 to 0.82), CFQ-11 physical 0.66 (0.55 to 0.78), CFQ-11 mental 0.47 (0.35 to 0.59) and RAND-36 energy/fatigue −0.20 (−0.31 to −0.1); all CFQ-11 scores differed from those of the norm population (p < 0.001). Female sex, single/divorced/widowed, short time since symptom debut, high symptom load, and confusion during acute COVID-19 were associated with higher multivariable odds of fatigue. In conclusion, the burden of post-viral fatigue following COVID-19 was high, and higher than in a general norm population. Symptoms of fatigue were most prevalent among women, those having a high symptom load, or confusion during the acute phase. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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13 pages, 797 KiB  
Article
Perceptions of Health Care Use in Germany during the COVID-19 Pandemic
by André Hajek, Freia De Bock, Lothar H. Wieler, Philipp Sprengholz, Benedikt Kretzler and Hans-Helmut König
Int. J. Environ. Res. Public Health 2020, 17(24), 9351; https://doi.org/10.3390/ijerph17249351 - 14 Dec 2020
Cited by 24 | Viewed by 5659
Abstract
This paper examined the determinants of perceived access to health care use during the COVID-19 pandemic in Germany using data from two waves (8 and 16) of the COVID-19 Snapshot Monitoring (COSMO). Descriptive and regression analysis were used. In wave 8, we found [...] Read more.
This paper examined the determinants of perceived access to health care use during the COVID-19 pandemic in Germany using data from two waves (8 and 16) of the COVID-19 Snapshot Monitoring (COSMO). Descriptive and regression analysis were used. In wave 8, we found that about 60% of the individuals rather disagreed about having had problems accessing medical care. Furthermore, 73% of the individuals rather disagreed to having experienced health deteriorations due to restrictions on the availability of medical care. Moreover, 85% of the individuals were rather optimistic about future access to healthcare services. Overall, slightly better past and future access to healthcare services has been reported in wave 16. Several determinants were identified in regression analysis. In conclusion, data suggest that perceived past and future access to healthcare services during the COVID-19 pandemic is reasonably good. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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17 pages, 3060 KiB  
Article
Challenges of Testing COVID-19 Cases in Bangladesh
by Khan Rubayet Rahaman, Md. Sultan Mahmud and Bishawjit Mallick
Int. J. Environ. Res. Public Health 2020, 17(18), 6439; https://doi.org/10.3390/ijerph17186439 - 4 Sep 2020
Cited by 30 | Viewed by 6339
Abstract
Keeping the dynamic nature of Coronaviruses (COVID-19) pandemic in mind, we have opted to explore the importance of the decentralization of COVID-19 testing centers across the country of Bangladesh in order to combat the pandemic. In doing so, we considered quantitative, qualitative, and [...] Read more.
Keeping the dynamic nature of Coronaviruses (COVID-19) pandemic in mind, we have opted to explore the importance of the decentralization of COVID-19 testing centers across the country of Bangladesh in order to combat the pandemic. In doing so, we considered quantitative, qualitative, and geographic information systems (GIS) datasets to identify the location of existing COVID-19 testing centers. Moreover, we attempted to collect data from the existing centers in order to demonstrate testing times at the divisional level of the country. Results show that the number of testing centers is not enough to cater to the vast population of the country. Additionally, we found that the number of days it takes to receive the results from the COVID-19 testing centers is not optimal at divisional cities, let alone the remote rural areas. Finally, we propose a set of recommendations in order to enhance the existing system to assist more people under a testing range of COVID-19 viruses at the local level. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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Review

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29 pages, 533 KiB  
Review
COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy
by Susanna Esposito, Federico Marchetti, Marcello Lanari, Fabio Caramelli, Alessandro De Fanti, Gianluca Vergine, Lorenzo Iughetti, Martina Fornaro, Agnese Suppiej, Stefano Zona, Andrea Pession, Giacomo Biasucci and on behalf of the Working Group on COVID-19 in Pediatrics of the Emilia-Romagna Region (RE-CO-Ped)
Int. J. Environ. Res. Public Health 2021, 18(8), 3919; https://doi.org/10.3390/ijerph18083919 - 8 Apr 2021
Cited by 25 | Viewed by 5337
Abstract
Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide). Many aspects of SARS-CoV-2 infection in children and adolescents remain [...] Read more.
Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide). Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear, and optimal treatment has not yet been defined. Therefore, our goal was to develop a consensus document, practically synthesizing the accumulated data and clinical experience of our expert group. Literature research was carried out using the keywords “COVID-19” or “SARS-CoV-2” and “children” or “pediatrics” and “prevention” or “diagnosis” or “MIS-C” or “treatment” in electronic databases (MEDLINE, PUBMED), existing guidelines and gray literature. The fact that the majority of the problems posed by SARS-CoV-2 infection in pediatric age do not need hospital care and that, therefore, infected children and adolescents can be managed at home highlights the need for a strengthening of territorial pediatric structures. The sharing of hospitalization and therapeutic management criteria for severe cases between professionals is essential to ensure a fair approach based on the best available knowledge. Moreover, the activity of social and health professionals must also include the description, management and limitation of psychophysical-relational damage resulting from the SARS-CoV-2 pandemic on the health of children and adolescents, whether or not affected by COVID-19. Due to the characteristics of COVID-19 pathology in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics, school, educational, social and family personnel both for strictly clinical management and for the reduction in discomfort, with priority in children of more frail families, represents a priority. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)

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14 pages, 387 KiB  
Perspective
Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination
by Anuli Njoku, Marcelin Joseph and Rochelle Felix
Int. J. Environ. Res. Public Health 2021, 18(18), 9904; https://doi.org/10.3390/ijerph18189904 - 20 Sep 2021
Cited by 115 | Viewed by 10214
Abstract
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of [...] Read more.
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
12 pages, 380 KiB  
Perspective
Social Inequality and Solidarity in Times of COVID-19
by F. Marijn Stok, Michèlle Bal, Mara A. Yerkes and John B. F. de Wit
Int. J. Environ. Res. Public Health 2021, 18(12), 6339; https://doi.org/10.3390/ijerph18126339 - 11 Jun 2021
Cited by 33 | Viewed by 7053
Abstract
The enormous public health burdens of the COVID-19 pandemic are not distributed equally. Inequalities are noticeable along socio-economic and socio-cultural fault lines. These social determinants of health affect both the prevalence and severity of COVID-19 infections as well as the magnitude of negative [...] Read more.
The enormous public health burdens of the COVID-19 pandemic are not distributed equally. Inequalities are noticeable along socio-economic and socio-cultural fault lines. These social determinants of health affect both the prevalence and severity of COVID-19 infections as well as the magnitude of negative impacts of the measures taken to slow the spread of the virus. This perspective paper summarizes key inequalities in who is affected by SARS-CoV-2 infection and in who is affected by COVID-19 prevention measures, based on evidence presented in state-of-the-art literature, and discusses the scope of challenges that these inequalities pose to solidarity and social justice. Key challenges for solidarity are highlighted across three areas: challenges to intergenerational solidarity, to global solidarity, and to intergroup solidarity. Full article
(This article belongs to the Special Issue COVID-19 and Health Inequities: Opportunities, Challenges, and Future Directions)
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