COVID-19 Commons^™

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Living In Liberal Areas Reduced Covid-19 Vaccine Hesitancy Among Conservatives, Brittany L. Kmush, Rachel E. Dinero

Population Health Research Brief Series

Political divisions shaped public health responses throughout the COVID-19 pandemic, with conservatives expressing higher vaccine hesitancy than liberals. But does where conservatives live matter? This brief summarizes findings from a study using survey data from 683 U.S. adults (ages 18-94) collected March-April 2023, combined with 2020 presidential election results by zip code. The authors found that liberals consistently had low vaccine hesitancy and high uptake regardless of where they lived, but conservatives living in lower Trump vote share communities reported lower vaccine hesitancy and higher vaccination and booster uptake than conservatives in high Trump vote share communities. This pattern was …

Hold Harmless For Whom? The Impact Of Covid Era Policies On School Funding, Teachers, And Students, Michah W. Rothbart, Samantha Cervantes, Amy Ellen Schwartz

Center for Policy Research

This study evaluates the fiscal and academic consequences of New York City’s hold harmless policy during COVID-19, which aimed to stabilize school expenditures amid unexpected enrollment declines by restoring schools’ funding up to initial levels. We examine how school racial composition predicts whether or when schools receive hold harmless “treatment” and assess the impact of hold harmless on financial resources, staffing, and student outcomes, exploring heterogeneity by timing of policy announcement. Although schools with higher White student shares were no more likely than those with higher Hispanic or Black shares to receive hold harmless funds, schools with higher Black shares …

Pandemic Mask Mandates And Closures Were Linked To Increased Gun Violence, Douglas A. Wolf, Emily W. Wiemers, Iliya Gutin, Jennifer Karas Montez, Shannon M. Monnat

Population Health Research Brief Series

Gun violence worsened substantially during the COVID-19 pandemic. This brief summarizes findings from a study using weekly gun violence casualty data from 2016-2021 for 304 U.S. counties from the Gun Violence Archive and COVID-19 policy data from county-level measures of activity restrictions and masking requirements. The authors find that policies requiring masking and activity restrictions were associated with significant increases in gun violence. Indoor masking requirements were linked to a 28% increase in gun violence, while activity restrictions were associated with a 4.2% increase.

Asian College Students' Well-Being During A Period Of Rising Anti-Asian Sentiment, Kyuhan Choi, Ying Shi, Maria Zhu

Center for Policy Research

We use a large survey of students in U.S. colleges to study the distinct ways in which the COVID-19 pandemic and accompanying anti-Asian rhetoric shaped the experiences of Asian and Pacific Islanders (APIs). Using a difference-in-differences approach, we find that the pandemic led to Asian students experiencing more discrimination, feeling less safe during the day, and using fewer mental health services compared to White peers. The increase in discrimination and the perceived lower safety are concentrated among East and Southeast Asians, while South Asians were not affected. Despite these effects, we detect no relative deterioration in severe psychological distress or …

Inequality And Covid Risk At School: Racial Disparities In Indoor Density, Vaccination Rates, And Consequences For Absenteeism, Michael C. Quinn, Michah W. Rothbart, Amy Ellen Schwartz, Brian Elbel

Center for Policy Research

During the COVID pandemic, schools were widely believed to be a venue that facilitated disease transmission. While some worried Black and Hispanic students would disproportionately face greater risk of COVID exposure at school (school COVID risk) – given well-documented racially disparate school environments and resources – little empirical evidence exists documenting or refuting potential disparities in school COVID risk. This paper begins to fill this gap by examining racial disparities in the school environments that contribute to COVID risk at school—specifically, vaccination rates and classroom space per pupil (indoor density) - in New York City elementary schools. We then document …

The Effect Of Ex-Ante Government Responsibility For Health On Public Health Financing In Post Pandemic Budgets, Denis Granados, Rylee Roman, Hallie Sidman

Working Papers Series

This paper investigates how pre-pandemic levels of government responsibility for public health financing influenced post-pandemic health spending across selected OECD countries. Using a combination of descriptive analysis and regression modeling, the study examines changes in public health expenditure per capita between 2019 and 2022, focusing on key variables such as the government’s share of health financing, the Total Pandemic Policy Intensity (PPI) index, and GDP per capita. Findings suggest that while all countries increased health spending post-COVID-19, the scale of change varied significantly based on economic capacity, institutional readiness, and political will. Notably, countries with higher pre-pandemic public health investment …

Functional Resilience Of Healthcare In The Critical Juncture Of The Covid-19 Pandemic, Avner Kronisch, Christian Bongiorno, Kerane Smith, John Baker

Working Papers Series

This paper offers a comparative analysis of eight national healthcare systems—spanning democracies, autocracies, and various institutional models—to evaluate resilience during the COVID-19 pandemic. Drawing on Shvetsova et al.’s framework of informational and authority redundancies, and Parker & Klein’s “choke point” theory of healthcare rationing, we examine how institutional structure shaped pandemic response, system adaptability, and continuity of non-COVID services. Using indicators like life expectancy, under-five mortality, hospital capacity, cancer survival, and excess mortality, we explore how systems absorbed shock and maintained essential care. We find that decentralized and polycentric governance structures, when paired with coordination and resource adequacy, enhanced resilience—exemplified …

Covid-19 & Healthcare (Re)Privatization? A Comparative Analysis Of High And Medium Per Capita Gdp Countries, Kristina Donders, Kaitlyn Matthews, Brittany Reyes, Frank. H. Rizzo

Working Papers Series

This paper examines whether the COVID-19 pandemic accelerated healthcare privatization in high- and medium-GDP countries. Drawing on political economy theories of path dependence and privatization, we analyze changes in public and private healthcare expenditures in eight countries: Canada, Chile, Denmark, Georgia, Luxembourg, Norway, the Philippines, and South Korea—comparing data from 2019 and 2022. Using World Bank indicators on healthcare financing, GDP, aging populations, and food insecurity, we find that although healthcare expenditures generally increased during the pandemic, this increase was primarily in public, not private, spending. Case studies of Georgia and South Korea reveal that local economic and demographic pressures, …

Shifting To A Culture Of Inclusion By Design: Applying A Mixed-Methods Approach To Advance Accessibility Of Public Health Emergency Information & Communication Technology, Jessica L. Franks, Erin Vinoski Thomas

Developmental Disabilities Network Journal

Adults with intellectual and developmental disabilities (IDD) experience inequities in access to timely, accurate, and understandable information and communication technology (ICT), which increases risk for public health emergency (PHE)-related health disparities and impedes opportunities to achieve optimal health. This study assessed federal COVID-19 webpage accessibility levels and explored existing knowledge of and experience with filing accessibility complaints for federal ICT among adults with IDD. Through a mixed-methods approach, we evaluated compliance with accessibility standards for 18 federal agencies’ COVID-19 webpages (study 1) and interviewed 16 adults with IDD about experiences accessing federal webpages and filing accessibility complaints (study 2). We …

Science Tikkun: A Bioscience Pandemic Framework In A Hebrew Tradition Of Global Repair, Peter Hotez

Center for Medical Ethics and Health Policy Staff Publications

Over the past decade we have seen a steady increase in dangerous pandemic threats. They include two major Ebola epidemics and cholera in Africa; dengue, Zika, yellow fever in the Americas; a COVID-19 pandemic; and H5N1 in Texas. This is happening because of a confluence of modern forces including urbanization, deforestation, and climate change. Yet as pandemics emerge on a crowded and warming planet, anti-science disinformation and antisemitism impede our response. Science tikkun is an overarching framework for repair and redress. It honors the legacy of Maimonides, Teilhard de Chardin, and others who have sought reconciliation between science and religion.

Educational Leadership In A Vuca World: The Crisis Management Experiences Of Rural School Superintendents, Lucas J. Grossnicklaus

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The job of both urban and rural superintendents is challenging, but it is the rural school superintendency that comes with unique challenges that aren’t always faced by their urban and suburban counterparts. The COVID-19 Pandemic brought about a number of crises for school superintendents such as school closures, mask mandates, and navigating positions taken by governors, teachers unions, and school boards. While concerns about school closures and mask mandates has dissipated, conflict within school districts has only seemed to grow since the pandemic.

This multi-case study explored the lived experience of rural superintendents in the Midwest who have experienced a …

Rewriting The Rules: Impact Of Covid-19 On Norms In Science, The International Order, And China, Jacob Kissling '25

Honor Scholar Theses

The Covid-19 pandemic exposed both strengths and vulnerabilities in global responses, many of which were shaped by underlying norms and behavioral expectations within key institutions. Understanding how these norms influenced decision-making, collaboration, and communication—and how they were themselves challenged or reshaped by the crisis—can provide valuable insights for improving future responses. While some norms adapted in response to the evolving crisis, others remained stagnant or were inconsistently enforced, contributing to fragmented and, at times, ineffective responses. This paper investigates the role of norms in three critical sectors: the scientific community, the international order, and China. Within the scientific community, norms …

The Self-Sustainability Of Federally Qualified Health Centers, Javier Vallejo

MUSC Theses and Dissertations

This exploratory data analysis examines the self-sustainability of Federally Qualified Health Centers (FQHCs) using the 2023 Uniform Data Systems (UDS) dataset, focusing on health centers' reliance on government grants as a revenue source. FQHCs provide high-quality healthcare services to medically underserved populations; today, nearly 1 out of every 11 Americans receives some form of care at an FQHC. There is widespread variability in the delivery of care amongst FQHCs. Additionally, funding and reimbursement methodologies vary across states and geographic regions. FQHCs face challenges maintaining operational efficiency amid federal funding shortfalls, shifting reimbursement methodologies, and the lingering impact of the COVID-19 …

A Narrative Review Of The Covid-19 Infodemic And Censorship In Healthcare, Mitchell Liester, Sohaib Ashraf, Patricia Callisperis, Hector Carvallo, Shankara Chetty, Robert Enzenauer, Carlos Franco-Paredes, Raul Pineda, Panagis Polykretis, Rachel Wilkenson, Peter Mccullough

Secrecy and Society

Ideological and financial motivations have undermined science for decades. In this narrative review, we explore how organizations and governments used misinformation, disinformation, censorship, and secrecy to manage the COVID-19 pandemic. Various rationales for employing censorship and secrecy during the COVID-19 pandemic are examined including how organizations and governments create confusion about the risks associated with their products and blame avoidance to shift responsibility and to avoid accountability for their actions. Methods of censorship employed during the COVID-19 pandemic are reviewed, examples are provided, and the consequences of these actions are reviewed. Information included in this review was obtained from scientific …

Association Of Messenger Rna Coronavirus Disease 2019 (Covid-19) Vaccination And Reductions In Post Covid Conditions Following Severe Acute Respiratory Syndrome Coronavirus 2 Infection In A Us Prospective Cohort Of Essential Workers, Josephine Mak, Sana Khan, Amadea Britton, Spencer Rose, Lisa Gwynn, Katherine D Ellingson, Jennifer Meece, Leora R Feldstein, Harmony Tyner, Laura J Edwards, Matthew S Thiese, Allison Naleway, Manjusha Gaglani, Natasha Solle, Jefferey L Burgess, Julie Mayo Lamberte, Meghan Shea, Taryn Hunt-Smith, Alberto Caban-Martinez, Cynthia Porter, Ryan Wiegand, Ramona Rai, Kurt T Hegmann, James Hollister, Ashley Fowlkes, Meredith Wesley, Andrew L Philips, Patrick Rivers, Robin Bloodworth, Gabriella Newes-Adeyi, Lauren E W Olsho, Sarang K Yoon, Sharon Saydah, Karen Lutrick

Center for Medical Ethics and Health Policy Staff Publications

Background: Data are limited on whether vaccination reduces post COVID conditions (PCCs) risk after less severe nonhospitalized coronavirus disease 2019 (COVID-19). This study assessed whether COVID-19 vaccination protected against PCCs in persons with mild initial infections during Delta and Omicron variant predominance.

Methods: This study utilized a case-control design, nested within the HEROES-RECOVER cohort. Participants aged ≥18 years with test-confirmed severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) between 28 June 2021 and 14 September 2022 were surveyed for PCCs, defined by symptoms lasting >4 weeks after initial infection. Cases self-reported PCCs and controls self-reported no PCCs. The exposure was …

Politics In Public Health: Growing Partisan Divides In Covid-19 Vaccine Attitudes And Uptake Post-2021 Presidential Inauguration, Hongbin Fan, Zhongliang Zhou, Guanping Liu, Chi Shen, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives: To investigate whether the 2021 U.S. presidential inauguration contributed to a widening of partisan divides in COVID-19 vaccine attitudes and uptake. Methods: We leverage the presidential inauguration as a natural experiment and analyze data from the Household Pulse Survey and CDC vaccination records. Using a difference-in-differences framework with continuous treatment, we examine how the transition differentially affected state-level vaccine refusal rates and county-level vaccination rates, based on varying levels of partisanship as measured by the Trump-Biden vote gap. Results: Following Biden's inauguration, vaccine refusal declined more in pro-Biden states. Distrust in government and vaccines accounted for approximately 80% of …

The Impact Of Covid-19 Pandemic On Economic Convergence Between Developed And Developing Nations, Lucile Sabas, Williams Kwasi Peprah [email protected], Carmelita Troy, Quentin Sahly

Faculty Publications

This study investigates convergence between developed and developing countries’ GDP during the pre-COVID-19 era (1960-2019) and post-COVID-19 era (2020-2023) using World Bank data and the Augmented Dickey-Fuller (ADF) test. For the pre-COVID period, results show no significant convergence, with an ADF statistic of −1.78 and a P = 0.39, likely due to disparities in industrialization and governance. Similarly, post-COVID results (ADF statistic −1.2, P = 0.67) also suggest no convergence, possibly exacerbated by pandemic-related challenges. The study highlights that structural barriers and the pandemic have hindered economic convergence.

The Meatpacking Industry Needs Stronger Worker Protections And Enhanced Oversight, India Luxton, Laura-Anne Minkoff-Zern

Center for Policy Research

Meatpacking plants are hazardous workplaces with high injury rates and poor working conditions, negatively impacting the health of the industry’s predominately immigrant and refugee workforce. The COVID-19 pandemic illuminated ongoing concerns in the industry, including the problems associated with consolidation and concentration, worker safety, and poor public health outcomes. This brief summarizes findings from a study that used data from 39 interviews with local, state, and federal officials and bureaucrats, worker advocates, and workers to analyze meatpacking policymaking and oversight during COVID-19. The authors find that a lack of industry oversight and decreased regulation contribute to unsafe environments, and injustices …

Political Polarization Harms Public Health, Shana Kushner Gadarian, Jay Van Bavel, Kai Ruggeri, Eric Knowles

Population Health Research Brief Series

Political polarization poses considerable risks to well-being. Both ideological polarization (“extremification” of policy positions and ideological orientations) and affective polarization (out-party hate) have increased over the past several decades with detrimental effects on public health. This brief summarizes the impacts of political polarization on public health in the U.S., highlighting the COVID-19 pandemic as a case study on the health risks of polarization. The authors show that, in the United States, one of the strongest predictors of COVID-19 prevention behaviors, such as social distancing and vaccination, was political partisanship. Gaps in these behaviors between Republicans and Democrats increased over the …

What Is The Economic Benefit Of Annual Covid-19 Vaccination From The Adult Individual Perspective?, Sarah M Bartsch, Kelly J O'Shea, Colleen Weatherwax, Ulrich Strych, Kavya Velmurugan, Danielle C John, Maria Elena Bottazzi, Mustafa Hussein, Marie F Martinez, Kevin L Chin, Allan Ciciriello, Jessie Heneghan, Alexis Dibbs, Sheryl A Scannell, Peter J Hotez, Bruce Y Lee

Center for Medical Ethics and Health Policy Staff Publications

Background: With coronavirus disease 2019 (COVID-19) vaccination no longer mandated by many businesses/organizations, it is now up to individuals to decide whether to get any new boosters/updated vaccines going forward.

Methods: We developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine.

Results: For an 18-49 year old, getting vaccinated at its current price ($60) can save the individual on average $30-$603 if the individual is uninsured and $4-$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe …

Expanding A Behavioral View On Digital Health Access: Drivers And Strategies To Promote Equity, Maura M Kepper, Lauren A Fowler, Isabelle S Kusters, Jean W Davis, Manal Baqer, Sara Sagui-Henson, Yunyu Xiao, Adati Tarfa, Jean C Yi, Bryan Gibson, Kristin E Heron, Nicole M Alberts, Marissa Burgermaster, Veronica Ps Njie-Carr, Lisa M Klesges

Center for Medical Ethics and Health Policy Staff Publications

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for …

Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus

Dissertations and Theses

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at …

Supporting South Korea’S Aging Population: How Ai And Iot Acceptance Connects The Young And Old, Bobby Im

Master's Projects and Capstones

In 2024, South Korea surpassed every other nation by becoming the country with the lowest fertility rate (below 0.7%). Population decline will hinder future ability to care for their aging population and although the government and private corporations are investing millions of dollars on developing Artificial Intelligence-Internet of Things (AI-IoT) devices to support the aging, the acceptance levels and the amount of family support required is undervalued. By examining AI-IoT’s current use and role in South Korea’s public health system this paper shows how intergenerational support helps optimize existing procedures and equipment, increases the level of acceptance and use, and …

La Crisis Contemporánea Y Los Cuidados: Respuesta Gubernamental Al Trabajo De Cuidado Feminizado Y La Pandemia / The Contemporary Crisis And Care: Government Response To Feminized Care Work And The Pandemic, Iris Diez

Independent Study Project (ISP) Collection

Este proyecto investiga cómo las respuestas gubernamentales al trabajo no remunerado de cuidado realizado por mujeres, durante la época de la crisis socioeconómica de la pandemia, impactan el uso del tiempo en trabajo no remunerado doméstico de cuidado por parte de mujeres en Argentina. Basándose en la teoría feminista y en las ideas de Verónica Gago, Lucí Cavallero y Tithi Bhattacharya, este proyecto busca crear una perspectiva critica de las interaciones entre genero, economia, deuda y el trabajo reproductivo. El método de análisis sigue descripciones de las respuestas gubernamentales con respecto del trabajo de cuidado y también presentaciones de datos …

Spanish-Language Communication Of Covid-19 Information Across Us Local Health Department Websites, Isabelle S Kusters, Amanda M Gutierrez, Julianna M Dean, Mark Sommer, Anna Klyueva

Center for Medical Ethics and Health Policy Staff Publications

The COVID-19 pandemic has brought new urgency to a longstanding problem: the US health system is not well-equipped to accommodate the country's large limited English proficient (LEP) population in times of national emergency. We examined the landscape of Spanish-language COVID-19 website information compared to information in English provided by health departments of the top 10 cities by population in the USA. For each city, coders evaluated three score measures (amount of information, presentation quality, and ease of navigation) for six content types (general information, symptoms, testing, prevention, vaccines, and live statistics) across six delivery modes (print resources, website text, videos, …

How Have Researchers Defined Institutions, Politics, Organizations And Governance In Research Related To Epidemic And Pandemic Response? A Scoping Review To Map Current Concepts, Austin Wu, Shivangi Khanna, Shelly Keidar, Peter Berman, Laura Jane Brubacher

Faculty, Staff and Student Publications

In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health and biomedical sciences as well as …

Place Still Matters: Social Vulnerabilities, Place-Level Disadvantage, And Food Insecurity During Covid-19, Kevin M. Fitzpatrick, Casey Harris, Don Willis, Amber Obermaier, Grant Drawve

Sociology and Criminology Faculty Publications and Presentations

COVID-19 variants continue to create public health danger impacting mortality and morbidity across the United States. The spillover effects of COVID-19 on the economy and social institutions pose a significant threat to broader wellbeing, including the food security of millions across the country. We aim to explore whether the context of place matters above and beyond individual and social vulnerabilities for food insecurity. To do so, we employ a multi-level framework using data from a survey of over 10,000 U.S. adults from March 2020 with American Community Survey (ACS) and John Hopkins COVID Dashboard county-level data. We find nearly two …

Containment Measures During The Covid Pandemic: The Role Of Non-Pharmaceutical Health Policies, Michael Funke, Tai-Kuang Ho, Andrew Tsang

Faculty, Staff and Student Publications

Many countries have imposed a set of non-pharmaceutical health policy interventions in an effort to slow the spread of the COVID-19 pandemic. The objective of this paper is to examine the effects of the interventions, drawing on evidence from the OECD countries. A special feature here is the mechanism that underlies the impact of the containment policies. To this end, a causal mediation analysis decomposing the total effect into a direct and an indirect effect is conducted. The key finding is a dual cause-effect channel. On the one hand, there is a direct effect of the non-pharmaceutical interventions on the …

Public Mental Health During And After The Sars-Cov-2 Pandemic: Opportunities For Intervention, Melissa M Karnaze, Brent M Kious, Lindsay Z Feuerman, Sarah Classen, Jill O Robinson, Cinnamon S Bloss, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Importance: During the pandemic, the number of United States adults reporting clinically significant symptoms of anxiety and depression sky-rocketed, up from 11% in 2020 to more than 40% in 2021. Our current mental healthcare system cannot adequately accommodate the current crisis; it is therefore important to identify opportunities for public mental health interventions.

Objective: Assess whether modifiable emotional factors may offer a point of intervention for the mental health crisis.

Design setting and participants: From January 13 to 15, 2022, adults living in the United States were recruited via Amazon Mechanical Turk to complete an anonymous survey.

Main outcomes and …