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This case study will critically examine lessons learned during COVID-19 to inform how we advance change towards socially sustainable public spaces. Through the lens of equity, access to public space for vulnerable populations during COVID-19 in Victoria, British Columbia, is explored. A stakeholder analysis is presented to illuminate the nature of stakeholder engagement within the City of Victoria, followed by a review of the intersectoral response that led to the activation of ERCs and the mobilization of hotel rooms to accommodate people experiencing homelessness during the pandemic. Furthermore, this case study will discuss how participatory processes, such as equity-centred design, placemaking, and equity mapping, can facilitate community and citizen engagement. This case highlights the emergence of leisure-related innovations as catalysts for social change—an increasingly important area of leisure research. In addition, this case study outlines the urgent need for research related to the intersection of COVID-19, equity, public space, and leisure. For broader audiences, such as local governments, not-for profit organizations, and leisure service providers, the value of this case study is underscored by the relevance of co-creation in the context of inclusive land-use planning, policy, and design. https://viurrspace.ca/bitstream/handle/10613/25231/Broderick.pdf?sequence=3

Gateway communities throughout the intermountain west are an important part of the tourism experience. They are often the doorstep to the national parks and public lands that draw millions of international and domestic visitors each year. Along with many benefits, tourism brings unique challenges to these communities, and they face them with limited staff, resources, and time. This chapter explains the recent development of the Gateway and Natural Amenity Region (GNAR) Initiative and its current efforts to assist gateway communities in the intermountain west region of the United States. The GNAR Initiative is a Cooperative Extension program of the Institute of Outdoor Recreation and Tourism at Utah State University. The Initiative is a hub for gateway community stakeholders to identify shared needs, and cooperatively develop, share, and access resources. The initiative utilizes the infrastructure and mission of the university land grant extension system to operationalize its own, similarly aligned three-part mission: multidisciplinary, trans-boundary research, community and student education, and community capacity building. An overview of the GNAR Initiative’s development is provided as a possible model for similar efforts in other regions. The GNAR Initiative’s internal structure and development path focused on using a collaborative, grass-roots effort to build peer-to-peer networks that link GNAR communities to GNAR communities, and GNAR communities to research and resources in an arena that continues to rapidly evolve. The Initiative’s efforts to include a diverse stakeholder group to guide its efforts resulted in the initiative being equipped to quickly respond to the evolving issues in gateway communities during the COVID-19 pandemic of 2020. https://viurrspace.ca/bitstream/handle/10613/25258/PowellRumoreSmith.pdf?sequence=3

This research has aimed to identify the ways in which social service delivery in the mid-Island region of Vancouver Island has shifted because of COVID-19 conditions. Prompted by initial informal comments regarding the effect of the pandemic, we initiated an 18-month research process that checked in with representatives of social service agencies at six-month intervals. The study offers a local perspective that may have insights and lessons relevant to social service organizations elsewhere. https://viurrspace.ca/bitstream/handle/10613/25255/SchmidBradley2021.pdf?sequence=3

BackgroundThe COVID-19 pandemic has had an impact on the mental health of healthcare and social care workers, and its potential effect on suicidal thoughts and behaviour is of particular concern.MethodsThis systematic review identified and appraised the published literature that has reported on the impact of COVID-19 on suicidal thoughts and behaviour and self-harm amongst healthcare and social care workers worldwide up to May 31, 2021.ResultsOut of 37 potentially relevant papers identified, ten met our eligibility criteria. Our review has highlighted that the impact of COVID-19 has varied as a function of setting, working relationships, occupational roles, and psychiatric comorbidities.LimitationsThere have been no completed cohort studies comparing pre- and post-pandemic suicidal thoughts and behaviours. It is possible some papers may have been missed in the search.ConclusionsThe current quality of evidence pertaining to suicidal behaviour in healthcare workers is poor, and evidence is entirely absent for those working in social care. The clinical relevance of this work is to bring attention to what evidence exists, and to encourage, in practice, proactive approaches to interventions for improving healthcare and social care worker mental health.

Purpose To prospectively validate two risk scores to predict mortality (4C Mortality) and in-hospital deterioration (4C Deterioration) among adults hospitalised with COVID-19. Methods Prospective observational cohort study of adults (age ≥18 years) with confirmed or highly suspected COVID-19 recruited into the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study in 306 hospitals across England, Scotland and Wales. Patients were recruited between 27 August 2020 and 17 February 2021, with at least 4 weeks follow-up before final data extraction. The main outcome measures were discrimination and calibration of models for in-hospital deterioration (defined as any requirement of ventilatory support or critical care, or death) and mortality, incorporating predefined subgroups. Results 76 588 participants were included, of whom 27 352 (37.4%) deteriorated and 12 581 (17.4%) died. Both the 4C Mortality (0.78 (0.77 to 0.78)) and 4C Deterioration scores (pooled C-statistic 0.76 (95% CI 0.75 to 0.77)) demonstrated consistent discrimination across all nine National Health Service regions, with similar performance metrics to the original validation cohorts. Calibration remained stable (4C Mortality: pooled slope 1.09, pooled calibration-in-the-large 0.12; 4C Deterioration: 1.00, –0.04), with no need for temporal recalibration during the second UK pandemic wave of hospital admissions. Conclusion Both 4C risk stratification models demonstrate consistent performance to predict clinical deterioration and mortality in a large prospective second wave validation cohort of UK patients. Despite recent advances in the treatment and management of adults hospitalised with COVID-19, both scores can continue to inform clinical decision making. Trial registration number NCT66726260.

Abstract. Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13–16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.

Vaccination now offers a way to resolve the COVID-19 pandemic. However, it is critical to recognise the full energy, environmental, economic and social equity (4E) impacts of the vaccination life cycle. The full 4E impacts include the design and trials, order management, material preparation, manufacturing, cold chain logistics, low-temperature storage, crowd management and end-of-life waste management. A life cycle perspective is necessary for sustainable vaccination management because a prolonged immunisation campaign for COVID-19 is likely. The impacts are geographically dispersed across sectors and regions, creating real and virtual 4E footprints that occur at different timescales. Decision-makers in industry and governments have to act, unify, resolve, and work together to implement more sustainable COVID-19 vaccination management globally and locally to minimise the 4E footprints. Potential practices include using renewable energy in production, storage, transportation and waste treatment, using better product design for packaging, using the Internet of Things (IoT) and big data analytics for better logistics, using real-time database management for better tracking of deliveries and public vaccination programmes, and using coordination platforms for more equitable vaccine access. These practices raise global challenges but suggest solutions with a 4E perspective, which could mitigate the impacts of global vaccination campaigns and prepare sustainably for future pandemics and global warming.

Abstract Teaching and learning anatomy by using human cadaveric specimens has been a foundation of medical and biomedical teaching for hundreds of years. Therefore, the majority of institutions that teach topographical anatomy rely on body donation programmes to provide specimens for both undergraduate and postgraduate teaching of gross anatomy. The COVID‐19 pandemic has posed an unprecedented challenge to anatomy teaching because of the suspension of donor acceptance at most institutions. This was largely due to concerns about the potential transmissibility of the SARS‐CoV‐2 virus and the absence of data about the ability of embalming solutions to neutralise the virus. Twenty embalming solutions commonly used in institutions in the United Kingdom and Ireland were tested for their ability to neutralise SARS‐CoV‐2, using an established cytotoxicity assay. All embalming solutions tested neutralised SARS‐CoV‐2, with the majority of solutions being effective at high‐working dilutions. These results suggest that successful embalming with the tested solutions can neutralise the SARS‐CoV‐2 virus, thereby facilitating the safe resumption of body donation programmes and cadaveric anatomy teaching. Twenty different, commonly used anatomical embalming solutions neutralise SARS‐CoV‐2, at a range of dilutions.

Background:\ud \ud Venous thromboembolism (VTE) is a common, life-threatening complication of COVID-19 infection. COVID-19 risk-prediction models include a history of venous thromboembolism. However, it is unclear whether remote history (>9 years previously) of VTE also confers increased risk of COVID-19.\ud \ud Objectives:\ud \ud To investigate possible association between VTE and COVID-19 severity, independent of other risk factors.\ud \ud Methods:\ud \ud Cohort study of UK Biobank participants recruited between 2006-2010. Baseline data, including history of VTE, were linked to COVID-19 test results, COVID-19 related hospital admissions and COVID-19 deaths. The risk of COVID-19 hospitalisation or death was compared for participants with a remote history VTE versus without. Poisson regression models were run univariately then adjusted stepwise for socio-demographic, lifestyle and comorbid covariates.\ud \ud Results:\ud \ud After adjustment for socio-demographic and lifestyle confounders and comorbid conditions, remote history of VTE was associated with non-fatal community (RR 1.61, 95% CI 1.02-2.54, p=0.039), non-fatal hospitalised (RR 1.52, 95% CI 1.06-2.17, p=0.024) and severe (hospitalised or fatal) (RR 1.40, 95% CI 1.04-1.89, p=0.025) COVID-19. Associations with remote history of VTE were stronger among men (severe COVID-19: RR 1.68, 95% CI 1.14-2.42, p=0.009) than for women (severe COVID-19: RR 1.07, 95% CI 0.66-1.74, p=0.786).\ud \ud Conclusion:\ud \ud Our findings support inclusion of remote history of VTE in COVID-19 risk-prediction scores, and consideration of sex-specific risk scores.

In the light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programmes will identify hundreds of novel viruses that might someday pose a threat to humans. To support the extensive task of laboratory characterization, scientists may increasingly rely on data-driven rubrics or machine learning models that learn from known zoonoses to identify which animal pathogens could someday pose a threat to global health. We synthesize the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions. What are the prerequisites, in terms of open data, equity and interdisciplinary collaboration, to the development and application of those tools? What effect could the technology have on global health? Who would control that technology, who would have access to it and who would benefit from it? Would it improve pandemic prevention? Could it create new challenges? This article is part of the theme issue ‘Infectious disease macroecology: parasite diversity and dynamics across the globe’.