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While previous chapters have focused on the deaths of Christians under roughly ordinary circumstances, this chapter turns to deaths precipitated by pandemics and natural disaster. The necrosima accordingly features a number of poems that address instances of mass death due to pandemic and pestilence. In both form and context of preservation, these hymns were manifestly part of their communities’ ritual repertoire. At the same time, however, they witness to periods in which ordinary ritual pathways had broken down. In the midst of sickness and bereavement, the hymns suggest, churches stood empty, clergy mourned the loss of their brothers, even burials had ceased in light of death’s relentless onslaught. This chapter examines the madrāshê in question as spaces for reconfiguring communities’ ritual practices. The necrosima’s pandemic hymns and other, roughly contemporaneous liturgical sources thus point to communities’ embrace of lament, petition, and penance as models for engaging the divine.
What is the association between partisanship, individual views and behaviours towards the pandemic? This research note explores this question empirically using two datasets collected before and during the Covid‐19 pandemic: a daily survey covering nearly 100,000 individuals and county level mobility matched to UK 2019 general election results. At the individual level, our findings show that partisanship is strongly correlated with differences in both views and behaviours. Conservative voters were less likely to perceive Covid‐19 as dangerous and less likely to stay home during the national lockdown. At the county level, the effect of the national lockdown on mobility was negative and statistically significant only in less Conservative counties. Thus, partisanship is associated with different individual views and behaviours towards the pandemic even when there is broad consensus among the main political parties and the government about the nature of a public health problem and the appropriate policy response.
As countries around the world went into lockdown, we turned to 32 leading scholars working on different aspects of democracy and asked them what they think about how the COVID-19 pandemic has impacted democracy. In this article, we synthesize the reflections of these scholars and present five key insights about the prospects and challenges of enacting democracy both during and after the pandemic: (1) COVID-19 has had corrosive effects on already endangered democratic institutions, (2) COVID-19 has revealed alternative possibilities for democratic politics in the state of emergency, (3) COVID-19 has amplified the inequalities and injustices within democracies, (4) COVID-19 has demonstrated the need for institutional infrastructure for prolonged solidarity, and (5) COVID-19 has highlighted the predominance of the nation-state and its limitations. Collectively, these insights open up important normative and practical questions about what democracy should look like in the face of an emergency and what we might expect it to achieve under such circumstances.
That the present moment ties multiple crises together—not least because each is a future of pasts that wound(ed) through each other—must be factored into our intercessions and visions. If every crisis is also a call to order, then what order, old or new, does the pandemic call us to? Its literality provokes us to keep both the pan and the demos in sight, just as they are being extinguished through borders, disease, poverty, insecurity, hatred, and disposability in the global postcolony. We are asked to remember that capital and colony are inseparable, that the nation-state is too suspicious a source of comfort, that the eroding claims of citizenship across the postcolonial and post-democratic fascist failed states are instructive and prophetic, and that the assumptions of place and movement in our frames of the democratic political need revisiting.
This article provides a new perspective on EU exit as an exemplary form of disruptive dissensus or extreme Euroscepticism by examining how it is shaped by people’s attitudes towards the Union’s actions during the COVID-19 pandemic. We test how the dissatisfaction about how the EU handled the pandemic limited the trust in how it would manage it in the future, and influences a preference to exit the EU. We use a multi-level statistical model which combines individual-level data from a Eurobarometer survey and country-level characteristics from all 27 EU member states. The results indicate that disruptive dissensus is linked to both the retrospective and prospective attitudes towards the EU policy initiatives, even when controlling for the severity of the pandemic as well as the populists in government at the country level. We also find that the link between specific and diffuse support at the EU level holds during crises.
That effective leadership is crucial during global emergencies is uncontested. However what that leadership looks like, and how it plays out in different contexts is less straightforward. In representative democracy, diversity is considered to be a key element for true representation of the society. In addition, previous research has unequivocally demonstrated the positive impacts of gender equality in leadership. The COVID-19 pandemic has laid bare some of the real world implications of gender inequalities in the leadership context. In this article, we examine the differential impacts of COVID-19 on women, and reflect on potential pathways for women's active participation.
The COVID-19 pandemic has had devastating effects across the world, yet different countries have had varying degrees of success in their attempts to manage it. One of the reasons behind the different outcomes observed so far lies in the strengths and weaknesses of different governance arrangements leveraged to tackle the crisis. In this article we examine what we can learn about the operational capacity of different democracies through their early responses to the crisis. We provide a framework of four positive qualities of multilevel governance that might lead to greater chances of positive practical outcomes and present an illustrative case study of the experiences of Switzerland and the United Kingdom (UK). We conclude with some areas for further research and investigation.
The response to the COVID-19 pandemic has revealed how public health decisions in mass liberal democracies always reflect a political trade-off between protecting privileged groups and leaving more marginalized groups precariously exposed. Examining the “political epidemiology” of COVID-19, I focus on the ways that the lives and well-being of children are sacrificed to secure adult interests. I argue that in our efforts to protect older adults we have endangered children and abandoned the future of today's youth. This, I conclude, is indicative of a liberal preoccupation with adults and adult forms of agency, a defect that can only be adequately challenged by working toward more robust forms of democratic inclusion that include children and youth.
The COVID-19 pandemic raises questions about the future of democracy and civil society. Some recent predictions seem to use the suffering to score points in ongoing political arguments. As a better example of how to describe the future during a crisis, I cite the prophetic voice of Martin Luther King, Jr. King does not merely predict: he calls for action, joins the action, and makes himself responsible for its success or failure. With these cautions about prediction in mind, I venture two that may guide immediate responses. First, communities may erect or strengthen unjustifiable barriers to outsiders, because boundaries enhance collective action. Second, although the pandemic may not directly change civic behavior, an economic recession will bankrupt some organizations through which people engage.
In this paper, we leverage newly available rich administrative data to study the heterogeneous evolution of fertility and newborn health during the pandemic. We focus on Tuscany, a representative region of Italy, which was one of the first countries to experience the severe impact of the COVID-19 outbreak in early 2020. Our findings indicate a decline in the number of births relative to the pre-pandemic trend in late 2020 and early 2021, roughly nine to twelve months after the pandemic onset. However, starting in March 2021, birth numbers consistently exceeded the pre-pandemic trend, resulting in a cumulative “baby bump” compared to the counterfactual scenario. This aggregate increase conceals significant heterogeneity across sociodemographic groups, with positive deviations entirely driven by native, educated, and employed parents. During the same period, newborn health indicators showed no signs of deterioration and, if anything, slightly improved.
People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.
Aims
To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.
Method
This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive–behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.
Results
Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8–30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.
Conclusions
For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.
This chapter examines the likelihood of voluntary compliance in public health contexts, with emphasis on lessons learned during COVID-19 regarding trust in mask wearing, social distancing, and vaccine uptake.
The COVID-19 pandemic exacerbated psychological distress, but limited information is available on the shifts in mental health symptoms and their associated factors across different stages. This study was conducted to more reliably estimate shifts in mental health impacts and to identify factors associated with symptoms at different pandemic stages.
Methods
We performed a national repeated cross-sectional study at stable (2021), recurrence (2022), and end-of-emergency (2023) stages based on representative general national population with extensive geographic coverage. Anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia symptoms were evaluated by GAD-7, PHQ-9, IES-R and ISI scales, respectively, and their associated factors were identified via multivariable linear regression.
Results
Generally, 42,000 individuals were recruited, and 36,218, 36,097 and 36,306 eligible participants were included at each stage. The prevalence of anxiety, depression and insomnia symptoms increased from 13.7–16.4% at stable to 17.3–22.2% at recurrence and decreased to 14.5–18.6% at end of emergency, while PTSD symptom continuously increased from 5.1% to 7.6% and 9.2%, respectively (all significant, P < 0.001). Common factors associated with mental health symptoms across all stages included centralized quarantine, frontline work and residence in initially widely infected areas. Centralized quarantine was linked to anxiety, depression, PTSD and insomnia during the stable, recurrence and end-of-emergency stages. Frontline workers exhibited higher risks of anxiety, depression and insomnia throughout these stages. Individuals in initially widely infected areas were more likely to experience depression and PTSD, particularly during the stable and recurrence stages. Stage-specific risk factors were also identified. Lack of outdoor activity was associated with anxiety, depression and insomnia during the stable and recurrence stages. Residents in high-risk areas during the recurrence stage correlated with increased anxiety and insomnia. Suspected infection was tied to anxiety and insomnia in the recurrence and end-of-emergency stages, while the death of family or friends was linked to PTSD during recurrence and to depression, PTSD and insomnia at the end-of-emergency stage.
Conclusions
Mental health symptoms increased when pandemic recurred, and could remain after end-of-emergency, requiring prolonged interventions. Several key factors associated with mental symptoms and their variations were identified at different pandemic stages, suggesting different at-risk populations.
Acute poisoning is a major cause of pediatric emergency department (PED) visits, with the COVID-19 pandemic potentially altering exposure risks and care-seeking behaviors. This study compares pediatric poisoning characteristics before and during the pandemic.
Methods
A retrospective analysis was conducted at the Gazi University PED between January 2018 and June 2022. Patients aged 1 month-18 years diagnosed with poisoning were identified via ICD codes grouped into before pandemic and during pandemic cases. A systematic random sampling yielded 178 BP (before the pandemic) and 94 DP (during the pandemic) cases with complete data. Demographic and clinical properties of cases were analyzed.
Results
The mean age was significantly higher during the pandemic (BP:7.63±0.49; DP:9.27±0.69). A higher prevalence of chronic diseases was noted in DP cases (BP:0.29±0.049; DP:0.57±0.100). Hotline consultations were higher in DP period (54.5% vs.72.5%) while hospitalization rates were lower (55% vs. 35.2%). While suicide attempts were significantly higher in women compared to men before the pandemic, this difference disappeared during the pandemic period (BP:8.6% of males vs. 37.2% of females; DP: 25% of males vs. 39% of females).
Conclusion
The COVID-19 pandemic significantly impacted pediatric poisoning profiles, underscoring the need for targeted prevention strategies and adaptive emergency protocols.
This paper draws upon the theoretical literature on migration policy and health, and empirical data on three European states with differing welfare models – Sweden (social democrat), France (conservative), and the United Kingdom (liberal) – during Covid-19, to highlight the often hidden and contradictory politics through which refugees, asylum seekers, and undocumented migrants were forced to navigate during the most uncertain period of the pandemic. Although migrants’ treatment during Covid-19 was generally better in Sweden with a social democrat welfare tradition, we see migration management priorities greatly undermining the extent to which welfare systems function overall for the benefit of population health. Furthermore, Sweden’s recent political shift to the right exacerbates those negative tendencies. As the paper shows, there was considerable effort by civil society and local government to fill the gap where national governments failed to protect this group, stepping in to provide health information, and support.
The COVID-19 pandemic threatened to worsen pre-existing economic inequality in China. This chapter discusses how the Chinese party-state used distinctive “ultra-heterodox” measures to alter or nullify contractual terms in contractual disputes during the pandemic that raised serious concerns about inequality, social unrest, or systemic financial risk. Specifically, courts would refer such disputes to either mediation, insolvency, or a “macro-prudential” proceeding that involved courts collaborating with government agencies, party officials, and stakeholders of firms experiencing financial distress to negotiate and implement resolutions of disputes. These procedures allow the party-state to achieve its objectives of preventing market disruption, social unrest, and financial crisis triggered by unfair and unequal contracts. The “negotiated legality” reflected in these measures works in China because of the dominance of the party-state, widespread acceptance among contracting parties of a communitarian understanding of liability and responsibility, and the efficiency of postponing risk allocation to the enforcement stage from the contract formation stage in an emerging market.
Brazil and the United States adopted contrasting approaches to protection of tenants against eviction during the COVID-19 pandemic. In the United States, the legislature adopted protective measures for tenants early in the pandemic that were later overturned by the Supreme Court. In Brazil, the legislature failed to adopt significant protective measures during the early phases of the pandemic; the first important protective measure was an interim decision of Brazil’s Supreme Court handed down over one year after the beginning of the pandemic. In this sense, Brazil’s overall approach was heterodox while the approach in the United States was orthodox. At the same time, the actions of the Brazilian legislature and executive branch were highly orthodox, based on the argument that measures that served to protect tenants might harm vulnerable landlords. In fact, economically vulnerable tenants are likely to be much more common in Brazil than economically vulnerable landlords. This episode shows that a heterodox system may contain orthodox institutions that deny the distributional potential of private law. It also shows that a heterodox system may be less effective than an orthodox system at enforcing social rights.
The COVID-19 pandemic and associated restrictive measures affected the mental health and well-being of individuals globally. We assessed non-modifiable and modifiable factors associated with the change in well-being and mental health from before to during the COVID-19 pandemic in South Africa.
Methods:
A cross-sectional online survey was conducted from 26 April, 2020, to 22 April, 2021. Paired samples t-tests were conducted to assess change in well-being (measured on The World Health Organization-Five Well-Being Index (WHO-5)) and mental health (a validated composite psychopathology p-score). Sociodemographic, environmental, clinical, and behavioural factors associated with change in outcomes were examined.
Results:
The sample comprised of 1866 adults (M age = 44.26 ± 17.36 years, female = 78.9%). Results indicated a significant decrease in well-being (p < 0.001) and increase in p-score (p < 0.001) from before to during the pandemic. Having a prior mental health condition was associated with a worsening well-being score, while being female was associated with a worsening p-score. Being of Black African descent was associated with improved p-score and higher socio-economic status (SES) was associated with improved well-being. Factors associated with worsening of both well-being and the p-score included adulthood adversity, financial loss since COVID-19, and placing greater importance on direct contact/interactions and substance use as coping strategies. Higher education level and endorsing studying/learning something new as a very important coping strategy were associated with improved well-being and p-score.
Conclusion:
Findings inform the need for targeted interventions to reduce and prevent adverse well-being and mental health outcomes during a pandemic, especially among vulnerable groups.
This essay explores central aspects of the relationship between money and national health policy from the passage of Medicare in 1965 to the present, including the two most sweeping attempts at system reinvention during that period: the Patient Protection and Affordable Care Act of 2010 (ACA), and the failed Health Security Act of the early 1990s. Its point is not that ethical professionalism has prevailed, though it survives on the skill and dedication of nurses, physicians, and other health care workers. Rather, its point is that one should not criticize the morality of change without interrogating the morality of the status quo. In the 1990s, Jerome Kassirer wrote that “a system in which there is no equity is, in fact, already unethical.” The same can be said for a system that overfunds medical care and underfunds other essential social investments, including education. A system that, moreover, cannot be justified by the limited morality of competition in the marketplace because it does not — and could not absent radical change — perform as a functioning market would. In terms of robust market competition with its winners and losers, U.S. health care has been, at worst, a sheep in wolf’s clothing.