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

Early in the COVID-19 pandemic, as it became clear that people with suppressed immune systems were particularly vulnerable to the worst of the virus, public health officials prioritized their protection. Leaders presented stay-at-home orders and masking requirements as measures to prevent the virus from spreading to high-risk individuals. And when vaccines became available, many governments placed immunocompromised 听people near the front of the line. 听

All the while, public health officials believed only about 3% of the American population was immunocompromised.听听

New research from the 天美影视传媒 suggests that number may have been a drastic undercount. The study, p, places the prevalence of immunosuppression at around 6.6% of American adults 鈥� more than twice as high as previously understood. That rise could have broad implications for how we navigate the late stages of COVID-19 and prepare for future pandemics. 听

UW News spoke with co-author , a UW associate professor of social work, about the reasons behind the rise and how public health officials can better serve this growing population.听

Immunosuppression and the experiences of immunocompromised people have become more visible in recent years, with the COVID-19 pandemic and our collective attempts to slow its spread. How has that added visibility affected people鈥檚 experiences?听听

Melissa Martinson: The COVID-19 pandemic really brought the experiences of immunosuppressed (more commonly called immunocompromised) people to the public attention, and the voices of this population and other medically vulnerable people were important to how people interacted in their communities in the early days of the pandemic. Early in the pandemic, public health guidance was focused on protecting medically vulnerable people. Four years on, that guidance has changed, and most folks are engaging in activities similarly to before the pandemic.听听

However, for some immunocompromised people, the lack of community protections today despite their continued risk of contracting COVID-19, can be an isolating experience. 听

You set out to find a better estimate of the prevalence of immunosuppression nationwide. Why is a more accurate number important? 听

MM: We were surprised by reports in the popular media that said about 3% of American adults were immunocompromised. Much of my research focuses on framing U.S. health in an international context, and we had seen estimates of immunocompromise prevalence in countries like the United Kingdom and Canada that were much higher than the widely reported American estimate. 听

Getting an updated and accurate estimate is important because immunosuppressed people are more likely to experience viral and bacterial infections, and these infections are more likely to be severe. We also now know that this population is still advised to take precautions against COVID-19 due to the higher risk of serious outcomes like hospitalization, death, and long COVID. This is a group who also has access to public health tools like additional vaccine doses and antiviral treatment (such as Paxlovid) regardless of age, so it is important that these tools are readily available to this population.Having an accurate estimate of the prevalence of immunosuppression can ensure that we have adequate supply of these tools.听

You estimate that about 6.6% of American adults have immunosuppression, which is more than twice as high as the figure in 2013 (2.7%). That鈥檚 quite the jump. What鈥檚 behind it? 听

MM: Unfortunately, we can鈥檛 answer this question definitively with the available data. However, we know that since prevalence was last estimated, immunosuppressive therapies for autoimmune diseases have been prescribed much more frequently and more of these medications are available. It might also be that more people have a better understanding of their immunocompromised health status due to conversations with their healthcare providers during the COVID-19 pandemic, along with awareness from public health guidance.

We also found that the proportional increase in prevalence was almost 2.5 times between 2013 and 2021, and this increase was even higher for some subpopulations including males, people with Hispanic ethnicity, adults under 50, and older adults ages 70 to 79. 听

You write that the COVID-19 pandemic may have contributed to the increase of immunosuppression prevalence. One obvious possibility is that the virus itself weakened people鈥檚 immune systems, but do you see any other ways in which the pandemic might have contributed to that rise?听

MM: New evidence does suggest that COVID-19 leads to an increased risk of autoimmune conditions that may result in immunosuppression either through the condition itself or medication to treat the condition. We also looked at the data available for the second half of 2020, and the rates were similar to 2021. To us, this suggests that more people may have been informed about their immunosuppressed status in light of the COVID-19 pandemic and conversations they may have had with their healthcare providers due to their increased risk of serious outcomes from infection.听听

From a public health perspective, what changes might we need to consider making in the face of these findings? How do we help to protect a population that might be twice as large as previously thought?听听

MM: It is important to note that almost 1 in 15 adults is immunosuppressed and that this population may need additional precautions in workplaces, schools and universities, and especially medical settings. Making sure that our gatherings and built environment are accessible to people who are at greater risk is something that we can all do. Measures such as ventilation, air filtration, and mask use can protect immunocompromised people in public settings.听听

The pandemic has been a difficult time for everyone, but this is a medically vulnerable group who is still advised to follow precautions that many people have given up at the end of the public health emergency in 2023. Given the recent changes in COVID-19 isolation guidelines from the CDC, it is important for the public 鈥� and policymakers 鈥� to consider that between older adults and this immunosuppressed population at high risk, it is worthwhile to use and promote tools like testing, vaccines, sick leave and staying home when ill, and use of masks or respirators to reduce virus spread to vulnerable people.听

For more information, contact Martinson at melmart@uw.edu. 听

When schools closed during the first year of the pandemic, an immediate and potentially devastating problem surfaced: How would millions of children in struggling families get the school meals many of them depended on?

The U.S. Congress responded by authorizing the Department of Agriculture to roll out two major programs. It launched the 鈥済rab and go school meals,鈥� which helped schools provide prepared meals for off-site consumption and distributed funding for the state-operated Pandemic EBT (P-EBT) program, which gave parents debit cards so they could purchase groceries from food retailers.

A new study led by the Harvard and 天美影视传媒 schools of public health found that the programs reached more than 30 million children and either directly provided meals or, through the P-EBT program, cash for nearly 1.5 billion meals a month in 2020.

In the new study , the researchers found:

• The P-EBT program reached 26.9 million of the 30 million children whose families qualified because of low income at a cost of $6.46 per meal, providing access to 1.1 billion meals a month.
• The grab-and-go program reached 8 million children not eligible for P-EBT at a cost of $8.07 per meal, providing 429 million meals a month.

鈥淲hen schools had to close across the country during the spring of 2020 due to COVID-19, kids all of a sudden lost access to school lunches and breakfasts. From a public health and nutrition security听perspective, this was an urgent concern, given that these meals are critical for students at risk of food insecurity and are also an essential source of nutrition for millions of children,鈥� said , study lead author and assistant professor of public health nutrition at Harvard.

Kenney said when these programs began, no one really knew how effectively they would reach kids who needed them and at what cost per meal. So the researchers set out to try to answer how these two major policy responses to the loss of regular school meal access worked.

鈥淭his study suggests that, in many states, P-EBT can reach the most eligible children at relatively low cost to the government, while a meal distribution model such as grab-and-go school meals can also ensure families directly receive meals and reach children beyond those who are P-EBT-eligible,鈥� said , senior author and clinical professor of health systems and population health in the UW School of Public Health.

Now, Krieger said, extensions of these two key projects are being debated in Congress. On July 27, the House Education and Labor Committee sent its 2022 Child Nutrition Reauthorization bill (H.R. 8450), the 鈥�“鈥痶o the House floor.

In the following Q&A, Krieger and Kenney discuss what their findings mean for this or similar policy.

What would the new 鈥渒ids act鈥� do?

Krieger: The act proposes a comprehensive, science-driven reauthorization of federal child nutrition programs that meets the needs of children and families. It includes many familiar and essential programs, such as school meals and the WIC program. It would address food insecurity among children during the summer, when schools are closed, by significantly expanding access to summer meals and creating a nationwide Summer-EBT program. The Summer-EBT program would operate similarly to P-EBT in many ways and provide $75 per month per household on an electronic debit card. It supports school efforts to increase access to summer meals using methods that worked in the grab-and-go school meals program during COVID school closures.

Based on your findings, what should Congress do for kids?

Krieger: Our study offers evidence that these components of the proposed act 鈥� an EBT program to distribute the value of school meals, similar to the proposed summer-EBT program, combined with expanded distribution of meals in the community, similar to the expanded summer meals program鈥� were effective in feeding millions of children when schools were closed due to COVID and suggests that they will also likely be effective in delivering food to children during school summer recess. Including both programs in the act would help to assure food access when schools are closed during summer breaks.

Kenney: An important takeaway from our study that may be relevant for the conversation about the Healthy Meals, Healthy Kids Act is that these should be considered together, as a two-pronged strategy. The two approaches complement one another: P-EBT can help make sure that at least the cash value of those missed meals can get out to low-income families efficiently, and grab-and-go meals can ensure that families who may be struggling but may not have a low-enough income to qualify for P-EBT can still get meals. They can also ensure that families who may have more difficulty preparing food 鈥� like families experiencing homelessness or with limited kitchen facilities, or even just with limited time 鈥� can access nutritionally adequate meals.

What else should Congress consider?

Krieger: The federal government should be investigating strategies for optimizing the cost-effectiveness of grab-and-go school meals. It should also expand the P-EBT program or its equivalent to cover 60 meals per month instead of 40 to match the grab-and-go school meals benefit level. And, it should work to optimize the nutritional quality of the foods provided.

Co-authors include Lina Pinero Walkinshaw and Jessica Jones-Smith, UW Department of Health Systems and Population Health; Ye Shen and Sara Bleich, Harvard T.H. Chan School of Public Health; and Sheila E. Fleischhacker of the Georgetown University Law Center. This research was funded by the Robert Wood Johnson Foundation.

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For more information, contact Kenney at ekenney@hsph.harvard.edu or Krieger at jkrieger@hfamerica.org.

Your immune system鈥檚 ability to combat COVID-19, like any infection, largely depends on its ability to replicate the immune cells effective at destroying the SARS-CoV-2 virus that causes the disease. These cloned immune cells cannot be infinitely created, and a key hypothesis of a new 天美影视传媒 study is that the body鈥檚 ability to create these cloned cells falls off significantly in old age.

According to a model created by UW research professor , this genetically predetermined limit on your immune system may be the key to why COVID-19 has such a devastating effect on the elderly. Anderson is the lead author of a paper detailing this modeled link between aging, COVID-19 and mortality.

鈥淲hen DNA split in cell division, the end cap 鈥� called a telomere 鈥� gets a little shorter with each division,鈥� explains Anderson, who is a modeler of biological systems in the School of Aquatic and Fishery Sciences. 鈥淎fter a series of replications of a cell, it gets too short and stops further division. Not all cells or all animals have this limit, but immune cells in humans have this cell life.鈥�

The average person鈥檚 immune system coasts along pretty good despite this limit until about 50 years old. That鈥檚 when enough core immune cells, called T cells, have shortened telomeres and cannot quickly clone themselves through cellular division in big enough numbers to attack and clear the COVID-19 virus, which has the trait of sharply reducing immune cell numbers, Anderson said. Importantly, he added, telomere lengths are inherited from your parents. Consequently, there are some differences in these lengths between people at every age as well as how old a person becomes before these lengths are mostly used up.

Anderson said the key difference between this understanding of aging, which has a threshold for when your immune system has run out of collective telomere length, and the idea that we all age consistently over time is the 鈥渕ost exciting鈥� discovery of his research.

鈥淒epending on your parents and very little on how you live, your longevity or, as our paper claims, your response to COVID-19 is a function of who you were when you were born,鈥� he said, 鈥渨hich is kind of a big deal.鈥�

To build this model the researchers used publicly available data on COVID-19 mortality from the Center for Disease Control and US Census Bureau and studies on telomeres, many of which were published by the co-authors over the past two decades.

Assembling telomere length information about a person or specific demographic, he said, could help doctors know who was less susceptible. And then they could allocate resources, such as booster shots, according to which populations and individuals may be more susceptible to COVID-19.

鈥淚鈥檓 a modeler and see things through mathematical equations that I am interpreting by working with biologists, but the biologists need to look at the information through the model to guide their research questions,鈥� Anderson said, admitting that 鈥渢he dream of a modeler is to be able to actually influence the great biologists into thinking like modelers. That鈥檚 more difficult.鈥�

One caution Anderson has about this model is that it might explain too much.

鈥淭here鈥檚 a lot of data supporting every parameter of the model and there is a nice logical train of thought for how you get from the data to the model,鈥� he said of the model鈥檚 power. 鈥淏ut it is so simple and so intuitively appealing that we should be suspicious of it too. As a scientist, my hope is that we begin to understand further the immune system and population responses as a part of natural selection.鈥�

Co-authors include Ezra Susser, Mailman School of Public Health, Columbia University; Konstantin Arbeev and Anatoliy Yashin, Social Science Research Institute, Duke University; Daniel Levy, National Heart, Lung, and Blood Institute, National Institutes of Health; Simon Verhulst, University of Groningen, Netherlands; Abraham Aviv, New Jersey Medical School, Rutgers University.

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For more information, contact Anderson at jjand@uw.edu.

Researchers at the 天美影视传媒 have developed a new test for COVID-19 that combines the speed of over-the-counter antigen tests with the accuracy of PCR tests that are processed in medical labs and hospitals.

The Harmony COVID-19 test is a diagnostic test that, like PCR tests for COVID-19, detects genetic material from the SARS-CoV-2 virus. But whereas conventional PCR tests can take several hours, the Harmony kit can provide results in less than 20 minutes for some samples and with similar accuracy.

鈥淲e designed the test to be low-cost and simple enough that it could be used anywhere,鈥� said , a UW associate professor of bioengineering and investigator with the Brotman Baty Institute for Precision Medicine. 鈥淲e hope that the low cost will make high-performance testing more accessible locally and around the world.鈥�

Lutz is senior author on a published Dec. 15 in Science Advances that describes the Harmony COVID-19 test kit. The researchers developed Harmony to be simple and easy-to-use, employing ready-to-use reagents. The test uses a 鈥淧CR-like鈥� method to detect the presence of the SARS-CoV-2 RNA genome in a nasal swab sample with the aid of a small, low-cost detector, which was also designed by Lutz鈥檚 group. A smartphone is used to operate the detector and read the results. The detector can handle up to four samples at a time and would fit into a standard car鈥檚 glove compartment.

The accuracy of COVID-19 tests has been a pressing matter throughout the pandemic. Many at-home antigen kits for COVID-19, which detect pieces of the proteins the virus creates instead of its genetic material, are 80-85% accurate, though accuracy may drop with the omicron variant, which harbors a relatively high number of mutations not found in other strains. PCR tests are generally 95% accurate or better 鈥� a key FDA benchmark 鈥� but require expensive equipment and a long wait for results.

Initial results reported in the paper show that the Harmony kit is 97% accurate for nasal swabs. The Harmony kit detects three different regions of the virus鈥� genome. If a new variant has many mutations in one region, the new test can still detect the other two. It can, for example, detect the omicron variant, which has dozens of mutations in the region of the genome that encodes the so-called spike protein.

Though tests based on PCR 鈥� or polymerase chain reaction 鈥� are highly accurate, a key limitation is that PCR tests require dozens of cycles of heating and cooling to detect genetic material in a sample. The test developed by the UW team sidesteps this issue by relying on a PCR-like method known as RT-LAMP, which doesn鈥檛 have the same stringent temperature-cycling requirements.

鈥淭his test operates at a constant temperature, so it eliminates the time to heat and cool and gives results in about 30 minutes,鈥� said Lutz.

Lutz and two colleagues spun out a new company from the UW, Anavasi Diagnostics, which last year was supported by $300,000 from WE-REACH and received $14.9 million in grants from the National Institutes of Health to develop the Harmony prototype kit into a product and scale up manufacturing to help address the ongoing shortage of COVID-19 diagnostic tests.

Initially, Lutz and his team hope the kits could be made available first for use in clinics, as well as other settings with medical oversight, such as workplaces and schools. Later, they would like to adapt the test for home use.

鈥淔or a long time, the options have been either a PCR test that is expensive and typically takes a day or more to get a result, or a rapid antigen test that gives fast results and is low cost, but typically has lower accuracy than a lab PCR test,鈥� said Lutz. 鈥淔rom the first day, we designed our test to be manufacturable at low cost and high volume, while delivering fast results with PCR-like performance.鈥�

The NIH funding will support high-volume manufacturing at a new Anavasi facility near Seattle.

鈥淲e plan to make our test accessible and affordable throughout the world,鈥� said Lutz.

Lead author on the paper is Nuttada Panpradist, a recent UW doctoral alum in bioengineering. Second author is Enos Kline, a UW research scientist in bioengineering, who initiated the project in early 2020. Co-authors in the Department of Bioengineering are doctoral students Robert Atkinson, Ian Hull, Qin Wang, and Shane Gilligan-Steinberg; research scientists Michael Roller, Jack Henry Kotnik, Crissa Bennett and Daniel Leon; and doctoral alum Amy Oreskovic. Other co-authors, all at the UW, are Victoria Lyon in the Department of Family Medicine; Matthew Thompson, a professor of global health and the Helen D. Cohen Endowed Professor in Family Medicine; Peter Han in the Department of Genome Sciences; Lea Starita, an assistant professor of genome sciences; and Paul Drain, an associate professor of global health, of medicine and of epidemiology. The research was funded by the Seattle Flu Study and the National Institutes of Health.

For more information, contact Lutz at blutz@uw.edu.

When you get into the car of the app-based driver you just tapped up on your phone, you expect and hope the driver and the car are safe and capable of getting you where you need to go. Apps rate drivers, which you can see. But what if the driver is sick? What if the car has a mechanical problem? What if the driver has simply had a bad day?

What you may not have realized is that the driver is wondering the same thing about you: Is the passenger ill? Are they properly masked? Will they pull it down once seated? Will they cough, blowing air around? Are they in a bad mood? Did they just get out of a rough meeting or an alcohol-fueled altercation at a bar?

鈥淚t鈥檚 a job that is vital to so many people, for moving people to and from medical appointments, to and from the airport, etc. Obviously, app-based drivers are essential for moving people,鈥� said , an assistant professor of environmental and occupational health sciences at the 天美影视传媒. 鈥淚t鈥檚 vital work, but it鈥檚 largely something the general public seems to forget about.鈥�

Baker is senior author on new published Sept. 14 in the American Journal of Industrial Medicine that is focused on understanding the pressures, risks and dilemmas facing app-based drivers and how they were affected by the pandemic.

Every ride carries potential risks. Each trip includes at least two people 鈥� possible disease vectors, unpredictable humans 鈥� now in a closed and confined space. The passenger may face this risk a few times a week. For the driver, this is a workplace risk possibly undertaken dozens of times a day.

Throw a viral pandemic into the mix, and you have workers in a largely unprotected job facing a range of very difficult choices: keep driving no matter what or lose income; ignore an improperly masked passenger or tell them to mask up and risk a bad review or altercation; drive a coughing passenger to a COVID-19 testing site or face deactivation for turning them away; pay out-of-pocket for cleaning supplies and PPE or run an even greater risk of infection.

To illuminate these pressures, Baker and other UW researchers trained four app-based drivers, all affiliated with the Teamsters Local 117 in Seattle, to conduct survey interviews of their fellow drivers. The newly trained interviewers surveyed 100 app-based drivers in Seattle between Aug. 11 and Sept. 7, 2020. The drivers were predominantly male (97%), identified as Black or African (84%) and were under the age of 55 (87%).

The majority of drivers reported high levels of stress and concern about being exposed to the novel coronavirus. Roughly 30% thought they had already had COVID-19. Most, 73 drivers, lost income, while spending their own money on PPE. Those who left the business because of the pandemic (42 drivers) reported having a hard time getting unemployment benefits. Only 31% said they received an appropriate mask and hand sanitizer from the company they drove for, and even then the supplies were not enough.

鈥淔or workers who are in this kind of employment during the pandemic, they receive very little support from the companies that they drive for, and this is a population that had a lot of awareness of the potential exposures they could be facing,鈥� Baker said. 鈥淭hey had a lot of concerns and worries, not only about how those exposures would be affecting their health and their family’s health, but also the viability and their job.鈥�

The drivers spoke of feeling isolated and lonely, since they rarely have a chance to talk with their peers.

In the study, one driver explained, 鈥淸I]n this line of work, you’re very insular. I mean, I’m in my own little universe… so finding a way to bridge that gap has been the biggest challenge.鈥�

Simple issues, like finding restrooms, became bigger problems with libraries, community centers and businesses closed during shutdowns.

鈥淵ou have other people who are doing the same job as you, but you may never interact with them. So you miss out on some of that strength, not only brainstorming of like, 鈥楬ey what masks are you using?鈥� or 鈥榃here are you stopping?鈥� but it also keeps workers from organizing,鈥� Baker said. 鈥淚f you get these workers talking to each other and recognizing that they are all facing the same struggles, that can lead to changes.鈥�

In Seattle, drivers and their union leaders have been able to win a as well as establish a 鈥溾�� where drivers contest being taken off the apps through which they are hired. There have been other improvements as well in Seattle and .

Baker explains that while Seattle has taken steps to try to improve drivers鈥� working conditions, drivers nationwide do not enjoy the same benefits because they are not classified as employees. So, they don’t have access to state or federal health and safety protections, a living wage or sick leave.

鈥淭his is a full-time job for many people, this is not just driving on the weekends to supplement another job. These drivers are raising families, using what they make to pay for their kids to go to college. This is important, vital work, and we should be recognizing that through the benefits that we demand that these drivers receive,鈥� Baker said. 鈥淣ot only for their well-being, but also for the customers they interact with.鈥�

Co-authors include Kerry Beckman, Lily Monsey and Megan Archer, all graduate students and staff in the UW School of Public Health; Nicole Errett, an assistant professor in the UW Department of Environmental & Occupational Health Sciences; and Ann Bostrom, 听a UW professor of public policy and governance. This research was funded by a UW Population Health Initiative Economic Recovery Grant.

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For more information, contact Baker at bakermg@uw.edu

Now, two 天美影视传媒 scientists have developed a statistical framework that incorporates key COVID-19 data 鈥� such as case counts and deaths due to COVID-19 鈥� to model the true prevalence of this disease in the United States and individual states. Their approach, July 26 in the Proceedings of the National Academy of Sciences, projects that in the U.S. as many as 60% of COVID-19 cases went undetected as of March 7, 2021, the last date for which the dataset they employed is available.

This framework could help officials determine the true burden of disease in their region 鈥� both diagnosed and undiagnosed 鈥� and direct resources accordingly, said the researchers.

鈥淭here are all sorts of different data sources we can draw on to understand the COVID-19 pandemic 鈥� the number of hospitalizations in a state, or the number of tests that come back positive. But each source of data has its own flaws that would give a biased picture of what鈥檚 really going on,鈥� said senior author , a UW professor of sociology and of statistics. 鈥淲hat we wanted to do is to develop a framework that corrects the flaws in multiple data sources and draws on their strengths to give us an idea of COVID-19鈥檚 prevalence in a region, a state or the country as a whole.鈥�

Data sources can be biased in different ways. For example, one widely cited COVID-19 statistic is the proportion of test results in a region or state that come back positive. But since access to tests, and a willingness to be tested, vary by location, that figure alone cannot provide a clear picture of COVID-19鈥檚 prevalence, said Raftery.

Other statistical methods often try to correct the bias in one data source to model the true prevalence of disease in a region. For their approach, Raftery and lead author , a UW doctoral student in statistics, incorporated three factors: the number of confirmed COVID-19 cases, the number of deaths due to COVID-19 and the number of COVID-19 tests administered each day as reported by the . In addition, they incorporated results from random COVID-19 testing of Indiana and Ohio residents as an 鈥渁nchor鈥� for their method.

The researchers used their framework to model COVID-19 prevalence in the U.S. and each of the states up through March 7, 2021. On that date, according to their framework, an estimated 19.7% of U.S. residents, or about 65 million people, had been infected. This indicates that the U.S. is unlikely to reach herd immunity without its ongoing vaccination campaign, Raftery and Irons said. In addition, the U.S. had an undercount factor of 2.3, the researchers found, which means that only about 1 in 2.3 COVID-19 cases were being confirmed through testing. Put another way, some 60% of cases were not counted at all.

This COVID-19 undercount rate also varied widely by state, and could have multiple causes, according to Irons.

鈥淚t can depend on the severity of the pandemic and the amount of testing in that state,鈥� said Irons. 鈥淚f you have a state with severe pandemic but limited testing, the undercount can be very high, and you鈥檙e missing the vast majority of infections that are occurring. Or, you could have a situation where testing is widespread and the pandemic is not as severe. There, the undercount rate would be lower.鈥�

In addition, the undercount factor fluctuated by state or region as the pandemic progressed due to differences in access to medical care among regions, changes in the availability of tests and other factors, Raftery said.

With the true prevalence of COVID-19, Raftery and Irons calculated other useful figures for states, such as the infection fatality rate, which is the percentage of infected people who had succumbed to COVID-19, as well as the cumulative incidence, which is the percentage of a state鈥檚 population who have had COVID-19.

Ideally, regular random testing of individuals would show the level of infection in a state, region or even nationally, said Raftery. But in the COVID-19 pandemic, only Indiana and Ohio conducted random viral testing of residents, datasets that were critical in helping the researchers develop their framework. In the absence of widespread random testing, this new method could help officials assess the true burden of disease in this pandemic and the next one.

鈥淲e think this tool can make a difference by giving the people in charge a more accurate picture of how many people are infected, and what fraction of them are being missed by current testing and treatment efforts,鈥� said Raftery.

The research was funded by the National Institutes of Health.

For more information, contact Raftery at raftery@uw.edu.

Public health researchers have learned a lot about how the pandemic affected workers and exacerbated existing health disparities that exist in many communities. However, there鈥檚 still a lot we don鈥檛 know about the experience of workers deemed essential in the food industry and who were at higher risk of contracting COVID-19, such those working in grocery stores, restaurants, delivery and factories.

To find out how food workers were or were not protected and how they can be better protected going forward, researchers at the 天美影视传媒 and Indiana University are听听food industry workers who are 50 or older and live in either state. Through this听study听of older food industry workers, researchers are aiming to find ways to create more protections for this workforce.

鈥淓mployers play a big role in worker safety and health, and can be a valuable partner. In conjunction with policymakers, we can all work to keep employees and the people they come in contact with safe,鈥� said , a lead investigator in the study and associate professor in the UW Department of Epidemiology.

“What are we doing to protect our essential workers? Moving forward we need to consider essential workers, especially those whose voices aren’t often heard. This issue isn鈥檛 just about workers 鈥� businesses also have a lot at stake. If they鈥檙e losing longtime employees, that has a negative impact on the business. So in addition to being the right thing to do, there are other reasons for employers to want to better protect their workforce,鈥� said Hajat.

To complete a brief online survey, which will determine eligibility for the 90-minute phone interview, see . Participants will receive a $40 gift card for their time.

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For more information, contact Jake Ellison at jbe3@uw.edu.

In early March 2020, the 天美影视传媒 became the first four-year U.S. university to transition to online-only classes due to the COVID-19 pandemic.

severe consequences of these physical distancing measures. To understand how this change affected college students’ mental health, UW researchers surveyed 147 UW students over the 2020 spring quarter, which began shortly after the university transitioned to online-only classes. The team compared the students’ responses to a previous survey of 253 students in spring quarter 2019.

The researchers didn’t see much change in average levels of students’ depressive symptoms, anxiety, stress or loneliness between 2019 and 2020 or between the beginning and the end of spring quarter 2020. But these average values were masking large differences in students’ individual pandemic experiences. In general, students who used more problem-focused forms of coping 鈥� creating plans, focusing on positive aspects, etc. 鈥� experienced fewer mental health symptoms than those who disengaged or ignored a situation that was bothering them.

The researchers June 28 in PLOS ONE.

“During the pandemic, the challenges of online learning were entwined with social isolation, family demands and socioeconomic pressures,” said lead author , an affiliate associate professor in the UW Information School. “There鈥檚 not a simple answer to the question of how students were affected: Some experienced intense distress while others were unscathed.”

For the past four years, this team has spent spring quarter studying what factors contribute to undergraduates’ overall mental health and well-being. Students are invited to continue participating in each spring quarter study, and the researchers also recruit new students each time. In a previous paper, the researchers found that experiencing discrimination events altered student behavior, such as the amount of sleep or exercise a student got following the event.

For the 2020 cohort, the team used three different survey methods to monitor student health. First, they sent large surveys at the beginning and end of spring quarter. Then participants received two shorter surveys each week that asked them to reflect on how they felt 鈥� in terms of stress, loneliness, depressive symptoms 鈥� in the moment.

In general, students who reported more mental health symptoms at the beginning of the pandemic continued to experience elevated symptoms during the pandemic.

鈥淧roblem-focused coping protected students from the harmful effects of stress (anxiety and depression, for example), even though students who used more problem-focused strategies reported more stress,” said co-author , a UW doctoral student in clinical psychology.

“What these findings suggest is that students who coped by actively confronting their challenges, rather than avoiding them, still experienced highly stressful events over the course of the pandemic. However, they were protected from the mental health consequences,” Kuehn said. “It may not always feel pleasant or easy to confront the challenges of daily life, particularly during a pandemic, but doing so is likely to be highly beneficial in terms of reducing anxiety and depressive symptoms.”

Finally, at the end of spring quarter, the team conducted 90-minute in-depth interviews over Zoom with a subset of participants to gain deeper insight into their experiences.

The students described a range of challenges that interfered with learning:

• Decreased interaction with faculty and peers 鈥� students mentioned that having fewer opportunities to interact with faculty and peers left them feeling less engaged. Some students said they felt like part-time students, even when they had full course loads
• No shared learning environments 鈥� students spoke longingly of a table in a dorm or a spot in the library where they used to gather with classmates for impromptu study sessions
• Family needs 鈥� family members’ requests or noise often interrupted studying and even test-taking. Family needs, such as caregiving, were a particular challenge to learning for first-generation college students
• Interrupted autonomy 鈥� some students felt “trapped” back at home and described difficult “power dynamics” with their parents
• Well-being and mental health 鈥� many students described disrupted sleep, decreased motivation, and said that they felt depressed or anxious for periods of time. Students’ feelings of detachment from school sometimes contributed to depression. Similarly, worry about grades sometimes cascaded into anxiety and insomnia that, in turn, made it harder to focus

Students also developed strategies to combat these challenges, including:

• Self-learning 鈥� students used independent online research to figure out answers to their questions and made up their own experiments to explore what they were learning in class
• Structuring routines and environments 鈥� many students created fixed schedules for studying or used physical calendars to mark timelines and assignments
• Learning with peers 鈥� students created remote study groups and held informal remote co-working sessions that combined homework with personal conversations, which helped keep them on task
• Participating more in online spaces 鈥� many students found it less daunting to ask questions in online classes than in large lecture halls, others found it easier to participate in online office hours and meetings with advisers
• Using communication platforms for emotional wellbeing 鈥� some students used telehealth or meditation apps, but almost all of them used video communication to check in with their friends. Students emphasized that these connections were critical for their mental health

“On an optimistic note, students are emerging with critical skills for learning and maintaining connectedness with peers over a distance,” Morris said. “These active coping skills, which include things such as initiating virtual co-working sessions, leveraging online functions to participate in class and checking in on friends in an emotionally sensitive way, will have continued value as we resume in-person and hybrid models of education.”

The team plans to follow students through all four years of their time at the UW. The first study cohort graduated this year, and the second cohort will graduate in spring 2022.

Additional co-authors are Jennifer Brown, an alumnus of the UW school of public health who is the research coordinator for this project; , a professor in the UW School of Social Work; and , UW doctoral students in the Paul G. Allen School of Computer Science & Engineering; , a doctoral student in the Information School; , a UW professor of electrical and computer engineering; , professor and dean of the UW Information School; , a researcher at Google; and , a professor in the Allen School. This research was funded by the National Science Foundation, the National Institute of Mental Health, Google, the Allen School, UW Department of Electrical & Computer Engineering, the UW College of Engineering and the UW Population Health Initiative.

For more information, contact Morris at margiemm@uw.edu.

Grant numbers: EDA-2009977, CHS-2016365, CHS-1941537, F31MH117827

Manuel S. Martinez, a lifelong campesino, trabajador and community organizer, recalls the beginning of the pandemic. Interviewed by UW student Adriana Martinez.听

Zoom, masks, family and politics听鈥� these are some of the lasting memories shared by participants in a 天美影视传媒 student oral history project.

Undergraduate seniors in the听Public Health Global Health major at the UW School of Public Health partnered with the to record the experiences of friends, family and associates living through the COVID-19 pandemic.

For the course’s winter quarter capstone project, students recorded an interview with a person in their community about what they’ve seen and thought about since the pandemic began. Interview subjects were encouraged to submit a significant “artifact” related to their pandemic experience, like a photo of their home office or vaccination card. The course was taught by 听associate teaching professor in the School of Public Health, with teaching assistant a graduate student in public health and urban planning, and aimed, in part, to document stories from marginalized communities who have been most impacted by COVID-19.

Anthony Trinh is a sophomore in high school and is currently participating in virtual learning.听 Interviewed by UW student Tina Trinh.

Margaret Wetherbee and Molly Wilmoth from the Washington State Historical Society joined the class regularly, instructing听students in how to conduct oral histories and prepare a historical record. All of the recordings, artifacts and notes will be archived at the

BIPOC (Black, Indigenous, and people of color) representation has been left out or minimized in historical narratives. This public health project offered the students and the Historical Society an opportunity: a collaboration bringing BIPOC voices at a significant moment in history directly into the Society鈥檚 collections, where they can be preserved and shared for generations in the future.

Gilbert Rivera is an executive manager at a major retail store in Seattle.听At the beginning of the COVID-19 pandemic, Gilbert proposed to his partner of four years. Interviewed by UW student Dan Nguyen.

Partnering with a museum is unusual for a public health project, said Ganti, and a particularly beneficial example for students. Through the process of collecting oral histories, they gain a better understanding of the people represented in public health data.

鈥淭his partnership trains students to innovate beyond current public health approaches by centering equity through collecting oral histories,鈥� said Ganti. 鈥淚t鈥檚 a means to lift up the stories of people who already hold the solutions for addressing their public health needs. All we have to do is listen and respond.鈥�

Araceli Lucatero is a licensed home daycare owner whose income was impacted by the pandemic. She talks about how the spread of COVID-19 was perceived in her Hispanic community. Interviewed by UW student Ariana Deniz.