As unprecedented as the outbreak of COVID-19 felt, it was far from the first time a deadly disease has swept the globe. dating as far back as 430 B.C. Records tell us how these diseases spread and how many people died, but not people鈥檚 personal experiences of the crises.听听

COVID-19 presented a rare opportunity to document in real-time how people processed the tumult of a pandemic, and how necessary public health measures affected their lives. Starting in the earliest days of the 2020 outbreak, a team of researchers at the 天美影视传媒 conducted real-time surveys of King County residents, asking what measures people had taken to protect themselves, how their daily lives had been affected and what worried them most. 听

The results, , provide a glimpse into the subtle effects that public health measures like social distancing and stay-at-home orders had on the community.听听

UW News spoke with , research scientist at the UW Collaborative on Extreme Event Resilience, and a UW assistant professor of environmental and occupational health sciences and director of the new , to discuss the study, how people experienced those early months and what public health practitioners can learn for future pandemics.听听

It鈥檚 been four years since COVID-19 changed all our lives, and more than two years since we started to emerge into this new normal. Why is it important to share this research now, to understand people鈥檚 experiences of the pandemic and collective efforts to limit COVID鈥檚 spread?听听

Kathleen Moloney: Unfortunately, COVID-19 is unlikely to be the last pandemic we face. To fully understand this pandemic鈥檚 impacts and better prepare for the next, we need research studies like ours 鈥� where data was collected in real time, from March to May of 2020 鈥� that document the lived experiences of communities during the pandemic. For example, by documenting how people in King County experienced the social distancing measures in real-time, our study provides valuable insights into which negative impacts were most acute during the early stages of the pandemic. Our results, combined with evidence from other research studies, can provide direction for researchers and policymakers to explore effective interventions for future pandemics.听

Nicole Errett: It is really important to start collecting data in the immediate aftermath of a disaster to understand effects on health and well-being, but researchers face a variety of administrative, logistical and ethical challenges when designing rapid-response research studies. By sharing our approach in this paper, we can provide ideas and guidance for other investigators while designing studies for future disasters, whether those are caused by an infectious disease or natural hazard.听听

The COVID-19 pandemic has been unprecedented in a lot of ways, and was for most Americans the most significant disruption to our daily lives ever. How unusual are events like this in human history? What do we know about how past pandemics and epidemics have affected the people who lived through them?听听

KM: During the height of the COVID-19 pandemic, we often heard comparisons to the 1918 influenza pandemic, as closures of schools, businesses and other community gathering spaces were implemented in response to both. However, it isn鈥檛 really possible to compare the experiences of those who lived through COVID-19 with those who lived through the 1918 Flu and other pandemics throughout history, because there weren鈥檛 any research studies conducted at the time to document those experiences. That鈥檚 why rapid-response disaster research, like our study, is so important.听听

In the paper you evaluate the unintended impacts of efforts to slow the pandemic, like people losing their jobs and students falling behind in school. How do you think about that delicate balance between public health and individual well-being?听听

KM: I don鈥檛 think of protecting public health and individual well-being as opposing priorities that need to be balanced. Public health, as a field, is dedicated to protecting and improving the health and well-being of the individuals that make up communities. Disruptions to employment and schooling can negatively impact long-term health outcomes, and ideally, these potential consequences should be considered when thinking through the type and duration of social distancing measures. Unfortunately, all the empirical research needed to inform those decisions was limited prior to this pandemic.听听

You asked participants about steps they took to protect themselves at the height of the pandemic. Some steps had pretty low rates of participation 鈥� for example, only 63% of people said they stopped going to the gym, and 82% of people avoided large gatherings. What does that say about the effectiveness of our collective response to the pandemic?听听

KM: I want to give the caveat that our survey only captured participants鈥� self-reported behavior at a single point in time. For example, someone who responded to the survey on March 19th, 2020, that they had not stopped going to the gym might have stopped the next week, when the statewide Stay Home, Stay Safe order was issued. Our survey was also a convenience sample, and therefore shouldn鈥檛 be considered representative of the compliance of King County residents as a whole with various social distancing recommendations.听听

With that said, those numbers were still slightly surprising. The narrative we often hear of public acceptance of COVID-19 social distancing measures is that compliance was initially high, and then decreased over time due to factors such as message fatigue 鈥� there鈥檚 research documenting this phenomenon. We need additional research to confirm this, but our results might indicate that there was also an initial lag in compliance with the social distancing recommendations implemented in response to COVID-19.听听

Overall, these measures still appear to have been effective, despite imperfect or slightly delayed compliance among certain residents.听

NE: At the time of our survey, our understanding of disease transmission was still evolving. It鈥檚 possible that people took measures they thought were protective (like hand washing) while attending these gatherings, based on their understanding of transmission at the time. It would have been interesting to re-survey folks at various time points throughout the pandemic to see how their behavior evolved as the pandemic, and our understanding of the disease, progressed.听

You evaluated participants鈥� well-being as described in their written stories about their experience. What trends appeared there, and were they what you expected to find?听听

KM: Two findings surprised me in particular. First, less than half of our participants described impacts to their social life 鈥� I expected the percentage to be much higher. It would be interesting to know how that result might change if we surveyed the same participants at a later point in the pandemic, when social distancing measures had been in place for longer. I was also surprised to see the poorest average well-being reported by those over the age 65, and the highest average well-being reported by 18-to-34 year olds. This is in contrast to several other national-scale studies in the US and Europe, which found worse mental health impacts in young adults.听听

Given that older adults are more likely to reside alone in the U.S. than in most other countries and report high rates of social isolation and loneliness even during non-pandemic times, interventions to mitigate the mental health impacts of future pandemics on older adults probably deserve special attention.听听

In their written responses, participants most frequently described a negative financial or employment-related impact, even more than social impacts. How might that change how we prepare to help people through future crises?听听

KM: Knowing which negative impacts are most prevalent at various points in the pandemic, and how these impacts differ between groups, can help us develop more specific, more effective interventions to prevent these unintended consequences in the future. We saw that employment and financial impacts were the top concern for every age group except those 65 and older 鈥� this group expressed higher concern about physical health and social impacts. So while an early intervention to mitigate the financial impacts of a future crisis on younger adults could be effective, we would likely want to prioritize different resources for older adults.听听

What鈥檚 also interesting is that many of the concerns our participants reported, both in written narratives and the close-ended survey questions, were about impacts to others, rather than themselves. Concern and empathy for fellow community members鈥� well-being is something that we should want to cultivate for many reasons, but specifically in a pandemic context, there鈥檚 evidence that decreased concern for others鈥� well-being is correlated with decreased compliance with non-pharmaceutical interventions. Something we should also think about while preparing for future crises is how we can foster the concern for others and the sense of community that were clearly present during the early stages of the pandemic to make sure they endure.听听

NE: The pandemic influenced the development 鈥� or at least accelerated the uptake 鈥� of systems that allowed many folks to work safely from the comfort of their own home without financial or employment impacts. However, folks with jobs in 鈥渆ssential鈥� services and sectors often had to physically report to work, and often interface with the public. My colleague, Marissa Baker, found that . Accordingly, I鈥檇 suspect that employment and financial concerns would be disproportionately borne among lower wage workers, who would have to choose between their health and safety and their income. In advance of the next pandemic, we need to figure out ways to keep these folks safe and at work.听听

For more information, contact Errett at nerrett@uw.edu or Moloney at kmoloney@uw.edu.听

doesn鈥檛 want her work to scare people. It鈥檚 already unsettling when wildfire smoke descends upon a community, when eyes burn and throats scratch and people trickle into emergency rooms. She鈥檇 rather people see her research, which ties wildfire smoke to an increased risk of emergency department visits, as a step toward protecting themselves. 听

鈥淚 think it鈥檚 useful to see it as more information, and use that to help us figure out what we can do to protect ourselves,鈥� said Doubleday, who completed the research while working toward her doctorate in environmental health at the UW and now works on air quality for the Washington State Department of Health. 鈥淔or me the takeaway is we鈥檙e all at risk of health impacts. Obviously some more than others, such as those with pre-existing respiratory or cardiovascular conditions, but we all should be taking steps to reduce exposure and watching for any symptoms.鈥�听

That’s the crux of two papers recently published in Environmental Research: Health by researchers at the 天美影视传媒, which found an increased risk of hospital service encounters in the days following wildfire smoke events. Taken together, their findings suggest that wildfire smoke poses a risk to people of all ages, not just young children and older adults. 听

The researchers found that the risk of respiratory-related emergency department encounters increased most sharply for those between the ages of 19 and 64. The findings suggest that public health messaging should also target younger and middle-aged adults, who may not see themselves as vulnerable to wildfire smoke. 听

鈥淲e do have this younger age group in there who may think they鈥檙e invincible, or that the risk messaging doesn鈥檛 apply to them because they鈥檙e not very young or elderly,鈥� said , teaching professor of environmental and occupational health sciences at the UW and co-author of both papers. Isaksen is also co-director of the , which has produced a string of papers on the risks of wildfire smoke. 听

鈥淜nowing that essentially all age groups are at risk of negative health outcomes during wildfire smoke events is an important finding and a shift in how we think of who is vulnerable in our population during these events,鈥� Busch Isaksen said. 鈥淚 expect these results will be informative to public health risk communication strategies aimed at reducing wildfire smoke exposure in all age groups through behavior change such as limiting time outdoors, actively cleaning your indoor air, etc. 鈥�听

The first study, led by Doubleday and , analyzed emergency department (ED) data from hospitals across Washington state. It found an increased risk of respiratory-related ED visits, including visits for asthma, in the five days following a smoke event. Researchers also observed a delayed increase in the odds of cardiovascular-related ED visits. 听

The analysis also found a correlation between the amount of smoke in the air and the risk of ED encounters. For every 10 碌g尘鈭�3 increase in the concentration of fine particle pollution 鈥� PM 2.5 or particulate matter 2.5 micrometers or smaller 鈥� the odds of ED visits rose accordingly. 听

The second study, led by recent UW graduate , is among the first to document the health effects of wildfire smoke on children in Washington state. , it analyzed 15 years of data from Seattle Children鈥檚 Hospital鈥檚 emergency department and in-patient hospital admissions, comparing rates of visits on days with and without smoke. 听

Researchers linked wildfire smoke events to a 7% increase in the odds of all-cause hospital admissions. Notably, the odds of hospitalization remained elevated in the week after smoke events, highlighting the need to monitor children鈥檚 symptoms well after exposure.听

鈥淲e definitely want to be more cognizant of exposure when it comes to children during wildfire smoke season,鈥� said Iyaz, who earned a master鈥檚 in environmental health from the UW and now works in extreme heat mitigation for King County. 鈥淎fter children are exposed to wildfire smoke, keep monitoring symptoms for a couple of days, because they can lag, especially if there are underlying health conditions that might contribute.鈥�听

The study did not find any change in visits to the emergency department, which researchers attributed to the unique population served by Seattle Children鈥檚. As a Level I trauma center, the hospital draws medically complicated cases from across the region, so its patients may be at greater risk of hospitalization than the general population. Parents may also be more likely to bring a sick child to the nearest emergency room, where their visit wouldn鈥檛 be captured by this specific dataset.听

Even before these papers were published, the findings began to show real-world impacts on public health.听Iyaz designed an easy-to-read summary of how smoke can affect children鈥檚 health, so patients鈥� families can better prepare for future events. 听

鈥淲ildfire smoke days are relatively new, and not all people may understand them,鈥� Iyaz said. 鈥淚f people aren鈥檛 aware of what wildfire smoke is and the impacts it can have, that makes it more important to meet communities where they are and talk about what the health effects can be.鈥�听

For more information, contact Busch Isaksen at tania@uw.edu, or visit the

Because of the quick and deadly outbreak in late December of a novel coronavirus in Wuhan, China, now known as COVID-19 鈥� infecting tens of thousands and killing hundreds within weeks, while spreading to at least 24 other countries 鈥� many governments, including the United States, have banned or significantly restricted travel to and from China.

And while travel bans are frequently used to stop the spread of an emerging infectious disease, a new 天美影视传媒 and Johns Hopkins University of published research found that the effectiveness of travel bans is mostly unknown.

However, said lead author , a lecturer in the UW Department of Environmental & Occupational Health Sciences in the School of Public Health, that鈥檚 largely due to the fact that very little research into the effectiveness of travel bans exists.

鈥淪ome of the evidence suggests that a travel ban may delay the arrival of an infectious disease in a country by days or weeks. However, there is very little evidence to suggest that a travel ban eliminates the risk of the disease crossing borders in the long term,鈥� said Errett, co-director of the , a research lab focused on addressing real-world issues relevant to community resilience.

The researchers combed through thousands of published articles in an effort to identify those that directly addressed travel bans used to reduce the geographic impact of the Ebola virus, SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome) and the Zika virus. They did not include studies of influenza viruses, for which travel bans have already been shown to be .

In the end, the researchers were able to identify just six studies that fit their criteria. Those six were based on models or simulations, not data from actual bans after they were implemented, to assess the effectiveness of travel bans in controlling outbreaks. Consequently, to improve research in this area, the study authors recommend that research questions, partnerships and study protocols be established ahead of the next outbreak so empirical data can be collected and assessed quickly.

鈥淭ravel bans are one of several legal options that governments have drawn on to mitigate a pandemic,鈥� said co-author , a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. 鈥淎s coronavirus spreads, our study raises the importance of understanding the effectiveness of legal and policy responses intended to protect and promote the public鈥檚 health.鈥�

鈥淲hen assessing the need for, and validity of, a travel ban, given the limited evidence, it鈥檚 important to ask if it is the least restrictive measure that still protects the public鈥檚 health, and even if it is, we should be asking that question repeatedly, and often,鈥� said co-author , an assistant professor of emergency medicine at Johns Hopkins University’s School of Medicine and director of operations with the university’s Office of Critical Event Preparedness and Response.

Consequently, the authors write, additional research is 鈥渦rgently needed鈥� to inform policy decisions, especially in light of the tremendous social, economic and political impacts of their implementation.

Learn more about the 鲍奥鈥檚 Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.