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Arturo González was a thirty-eight-year-old man who presented to our hospital during the Delta variant surge with COVID-related pneumonia that badly damaged his lungs. He was cannulated for extracorporeal membrane oxygenation (ECMO) upon admission; he had been on ECMO for seventy days and was awake and alert when Ethics was consulted. Due to multiple marginalized identities—he was an undocumented immigrant, uninsured, and had limited social support—Arturo did not have access to a lung transplant and was dependent on ECMO for survival. In the face of mounting critical care resource scarcity, Arturo’s intensivists disagreed about whether to continue ECMO indefinitely or to explore discussions about withdrawing support. In this book chapter, we discuss our role as ethics consultants balancing the organizational duty to justly steward scarce resources with the professional duty to this vulnerable patient: setting treatment boundaries while collaborating with Arturo on a treatment plan within these boundaries. We also discuss our role in addressing the care team’s moral distress at the most haunting aspect of this case: that Arturo’s social position limited his access to a lifesaving transplant.
What explains when states derogate from international human rights law during the COVID-19 pandemic? Conventional understanding of treaty derogations suggests that domestic democratic structures, not the crisis at hand, explain derogation submissions. I argue that during COVID-19, global crisis measures mattered. WHO legitimacy and issue framing of the crisis made states more likely to perceive the pandemic as a severe one and derogate from the International Covenant on Civil and Political Rights. Using country-day level from January 2020 to February 2021 analysis of over 70,000 observations, I test the determinants of ICCPR derogations during the COVID-19 pandemic. I find that global crisis measures of WHO responses and global COVID-19 deaths were significant, positive indicators of ICCPR derogations while domestic crisis measures were not. This piece contributes to our understanding of how states use international law during crises, derogations, international organization legitimacy and of human rights law during the COVID-19 pandemic.
The COVID-19 pandemic presented significant challenges to infectious disease management and mental health services (MHS). Service demand and delivery changed due to fear of infection, economic hardships, and the psychological effects of protective measures. This systematic review with meta-analysis aims to quantify these impacts on different mental health service settings.
Methods
Comprehensive searches were conducted in PubMed, Embase, and PsycINFO, focusing on studies published from the initial outbreak of COVID-19, starting in November 2019. Studies were included comparing the utilization of mental health inpatient, emergency department (ED), and outpatient services (including telemedicine and medication prescriptions) before and during the COVID-19 pandemic. A random-effects model was employed to estimate pooled effects, with study quality assessed using a modified Newcastle-Ottawa Scale.
Results
Among 128 studies, significant decreases in utilization were observed during the initial phase of the pandemic for inpatient services (RR: 0.75, 95% CI: 0.67 to 0.85) and ED visits (RR: 0.87, 95% CI: 0.69 to 1.10). Outpatient services showed a similar decline (RR: 0.78, 95% CI: 0.66 to 0.92), while no significant change was found in psychotropic medication prescriptions (RR: 0.90, CI: 0.77 to 1.05). In contrast, telemedicine utilization increased significantly (RR: 7.57, 95% CI: 3.63 to 15.77).
Conclusions
The findings reveal substantial shifts in mental health service utilization during the pandemic, with the largest reductions in inpatient services and significant increases in telemedicine use. These results emphasize the need for flexible healthcare models. Further research is essential to evaluate the consequences of reduced MHS utilization.
The effect of the narrator is understudied in the Narrative Policy Framework. We offer a systematic approach that details narrator definition, features (proximity to audience), and functions (audience trust). Informed by Construal Level Theory, we conducted an exploratory study (n = 2268) that assigned proximal to distal narrator features (“your friend,” “your doctor,” “the CDC,” and a control “someone”) and affixed narrators to visual messages about getting the COVID-19 vaccine. We investigated the extent to which proximity, trust, and congruence between narrator and narrative form predicts motivation to vaccinate. Narrator alone had no significant effect, but the proximal narrator paired with proximal characters in the policy message did have significant effects on motivation to vaccinate. Individual trust of distal narrators elicits affective responses, whereas individual trust of the proximal narrator is associated with motivation. These results suggest effects of narrator feature, characteristic, and function are dynamic and contextual.
The global COVID-19 pandemic has changed how elected officials govern, campaign, and present themselves. One key change is that politicians across the world often wear face masks when in public. To what extent does this practice influence how the public perceives politicians? We investigate this question in Japan, a country where people – though not politicians – often wore face masks even before the novel coronavirus outbreak. Conducting a survey experiment with a nationally representative sample of about $1500$ Japanese residents, we find that masks do influence public perceptions and that women politicians lose more public support when wearing masks than men. Given the nature of political campaigns in the COVID-19 world, we think that our results have broad implications for women politicians competitiveness, specifically, and for politics and gender, more generally. We outline these in the conclusion along with several new research directions.
This study examined whether coronavirus disease 2019 (COVID-19) infection experience enhances preventive behaviour (i.e., hand disinfection and mask-wearing), with risk perception acting as a mediating factor. The study included participants aged ≥18 years residing in Japan, enrolled in a 30-wave cohort study conducted from January 2020 to March 2024. Using propensity score matching, 135 pairs of participants with and without infection were extracted, adjusting for dread and unknown risk perception, preventive behaviours, sociopsychological variables, and individual attributes. Comparisons of risk perception and preventive behaviour were made between groups post-infection experience, and mediation analysis was conducted to test whether risk perception mediated the effect of infection experience on preventive behaviour. Following the infection experience, participants in the infection group reported significantly higher scores for one item of unknown risk perception and a greater proportion of mask-wearing. The indirect effect of infection experience on mask-wearing, mediated by the unknown risk perception item, was significant. COVID-19 infection experience increased perceptions of unknowable exposure, which in turn promoted mask-wearing behaviour. Incorporating insights from personal infection experiences into public health messaging may enhance risk perception and promote preventive behaviour among non-infected individuals, offering a novel approach to infection control at the population level.
During a crisis, the public expects the government to handle the situation. In parliamentary democracies, these expectations are directed to the cabinet and its ministers. Cabinet ministers are expected to be highly involved in policy making under their jurisdiction and in general. During periods of politics as usual, ministers differ in their policy involvement. This paper asks whether that changes during a crisis. Based on an analysis of cabinet ministers in Israel during the first wave of the COVID19 crisis, this paper finds that ministers’ policy involvement during a crisis is relatively low. Most ministers are little involved in issues outside their jurisdiction. Ministers less central to the crisis management are also little involved in issues under their jurisdiction. Ministers central to the crisis management are highly involved in introducing decisions on issues under their jurisdiction, but not necessarily in other aspects of policy making. These findings have implications for issues of accountability and trust.
This article seeks to analyze the resilience of arts and cultural nonprofit organizations in France during the Covid-19 crisis. A broad survey and multiple logistic regressions highlight the resources availability, the crisis impact, the NPOs’ needs and the reforms they conducted during the first French lockdown. This study shows that the resilience of these NPOs must be differentiated between activity continuity and organizational persistence. Resilience in culture and the arts is specific, based on reforms, and requires special support from partners.
Systematic and openly accessible data are vital to the scientific understanding of the social, political, and economic consequences of the COVID-19 pandemic. This article introduces the Austrian Corona Panel Project (ACPP), which has generated a unique, publicly available data set from late March 2020 onwards. ACPP has been designed to capture the social, political, and economic impact of the COVID-19 crisis on the Austrian population on a weekly basis. The thematic scope of the study covers several core dimensions related to the individual and societal impact of the COVID-19 crisis. The panel survey has a sample size of approximately 1500 respondents per wave. It contains questions that are asked every week, complemented by domain-specific modules to explore specific topics in more detail. The article presents details on the data collection process, data quality, the potential for analysis, and the modalities of data access pertaining to the first ten waves of the study.
The dramatic rise of charitable crowdfunding has changed the landscape of fundraising and giving. Little empirical work, however, has been done to explore critical factors that are associated with successful charitable crowdfunding campaigns run both by formal charities and non-charities. To advance the literature on donation-based charitable crowdfunding, we draw on a unique dataset of 427 COVID-19 crowdfunding campaigns in China, examining whether and how external and internal quality signals are related to crowdfunding success measured by total donation amount. Our results show that crowdfunding success is positively associated with internal signals (updates and predefined duration), whereas the role of external signals (platform and award) is less certain. While we find a positive relationship between award information and funding success, informal campaigns using an alternative medium seem to generate more donations than formal campaigns using authorized platforms. The implications of this study for theory, practice and policy are also discussed.
During crises such as the present coronavirus disease-19 (COVID-19) pandemic, nonprofits play a key role in ensuring support to improve the most vulnerable individuals’ health, social, and economic conditions. One year into the COVID-19 pandemic, an extensive automated literature analysis was conducted of 154 academic articles on nonprofit management during the pandemic—all of which were published in 2020. This study sought to identify and systematize academics’ contributions to knowledge about the crisis’s impact on the nonprofit sector and to ascertain the most urgent directions for future research. The results provide policymakers, nonprofit practitioners, and scholars an overview of the themes addressed and highlight the important assistance academic researchers provide to nonprofits dealing with the COVID-19 pandemic.
During the COVID-19 pandemic, opposition parties found themselves in a dilemma: either to cooperate with the government for the nation’s sake or to take advantage of the situation for political purposes. However, the extant research has not yet fully uncovered the patterns of opposition behaviour during this recent and rather intense crisis. In this article, we examine the case of Portugal, exploring possible differences between opposition parties on this regard and taking into consideration the role of time and focus of COVID-19-related legislation. We do so by investigating the behaviour of opposition parties in parliament, through an analysis of their voting behaviour, enriched by party leader statements, between March 2020 and January 2022. Our results show a different pattern to the right of the incumbent, with the main opposition party being more collaborative (framing its behaviour as responsible and patriotic) than the newer right-wing opposition parties, both populist and not populist. Pandemic gravity and focus of the legislation under vote are also relevant factors of opposition behaviour.
Italy was the first Western country to be severely affected by the COVID-19 pandemic. Within it, immigrants have played an important role as essential workers and throughout solidarity initiatives. The present article is based on 64 in-depth interviews with immigrants who engaged in solidarity actions directed toward the immigrant population and the host society during the COVID-19 pandemic. Analytically, it emerged that through solidaristic initiatives, immigrants articulated what we called ‘claims of recognition.’ Recognition here is considered in both its individual form, as interpersonal acceptance and esteem for single immigrants, and its collective form, as the social regard of immigrant groups as constituents of Italian society. Despite being perhaps 'elementary,' these claims aim to fight forms of both non-recognition and mis-recognition that are pervasive in Italy and aim to transform the symbolic 'fabric' of this country.
This article argues that the COVID-19 crisis has brought to light the importance of state democratic capacities linked with humanist governance. This requires securing individuals’ silent freedoms as embedded in the way “developmental” institutions that constitute social relations and well-being are governed. I argue health and well-being inequalities brought out by the crisis are but a manifestation of the way, in the context of the competition paradigm in global governance, states have become relatedly more punitive and dis-embedded from society. The answer lies in providing a more explicit defence of the features of a human development democratic state. An implication is to move democratic theory beyond the concern with redistributive and participatory features of democracy to consider foundational institutional properties of democratic deepening and freedom in society.
The COVID-19 pandemic has challenged the viability and effectiveness of nonprofit organizations compelling them to make tough choices. Evidence suggests that different wordings or message settings may affect people’s decisions when presenting equivalent outcome information with positive or negative framing. Nevertheless, there have been few attempts to assess how procedural fairness and framing effects shape nonprofit managers’ reactions to job layoffs due to the COVID-19 pandemic. Using a survey experiment, we explore whether framing effects—by affecting perceived outcome favorability—and procedural fairness interact to influence nonprofit managers’ trust and support for their organizations. The findings of this 2 × 2 between-participants experimental design indicated that only when procedural fairness was relatively low did nonprofit managers react more favorably in the positive frame (keep) than in the negative frame (layoff) condition. This study adds to our understanding of how the pandemic impacts nonprofit managers, including their commitment to continue working in the sector, and has practical implications for nonprofit organizations that manage resilience in a crisis.
In this article we challenge the conventional wisdom that COVID-19 and related legal restrictions invariably reinforce a global trend of shrinking civic space. We argue that the legal guarantee (or restriction) of civil society rights is not the sole factor configuring civic space. Instead, we reconceptualize civic space by broadening its determinants to also include needs-induced space and civil society activism. Investigating five countries with flawed democracic or competitive autocracic regimes in Southeast Asia, we propose a three-pronged mechanism of how these determinants interact in the context of COVID-19. First, legal restrictions on civil society rights intertwine with the space created by health and economic needs to create new opportunities for civil society activism. Second, these new opportunity structures lead to the cross-fertilization between service delivery and advocacy activism by civil society. Third, this new trajectory of civil society activism works to sustain civic space.
Why did some individuals react to the Covid-19 crisis in a prosocial manner, whereas others withdrew from society? To shed light onto this question, we investigate changing patterns of charitable giving during the pandemic. The study analyzes survey data of 2000 individuals, representative of the populations of Germany and Austria. Logistic regressions reveal that personal affectedness by Covid-19 seems to play a crucial role: those who were personally affected either mentally, financially, or health-wise during the first 12 months of Covid-19 were most likely to have changed their giving behavior. The observed patterns fit psychological explanations of how human beings process existential threats. Our findings indicate that a profound societal crisis in itself mainly leads to changes in charitable giving if individuals are severely affected on a personal level. Thereby, we contribute to a better understanding of the mechanisms underlying individuals’ charitable giving behavior in times of crisis.
The threat of emergency measures introduced in face of COVID-19 has largely been framed in terms of individual rights. We argue that it is not the protection of the sovereign individual that is most at stake, but the relations between political subjects and the institutions that enable their robust political participation. Drawing on Hannah Arendt's analysis of the ways in which isolation and the incapacity to discern truth or reality condition totalitarianism and are exacerbated by it, we argue that the dangers for the evacuation of democratic politics are stark in our era. We consider contemporary political action in concert in Germany to illustrate this critique of COVID-19 emergency measures. Drawing on the legal concept of “appropriateness,” we explicate how the German critical response to the shutdown is founded on a concern for democratic principles and institutions, and aims to achieve two crucial goals: governmental transparency and social-political solidarity.
Latin America was hit by COVID-19 in a moment of (socio-)economic distress and political unrest. This essay reflects on the immediate repercussions of the COVID-19 crisis for democracy in the region. It expounds how responding to the pandemic put to the test the still consolidating democracies with their long-standing defects in the areas of political and civil rights and horizontal accountability. In the course of coping with the crisis, it is precisely in these problem areas that additional risks for democracy have arisen due to infringements of political rights and the performance of presidents. Regarding the latter, the ambiguities of presidential leadership become particularly evident when comparing pragmatic and populist responses to the crisis.
How did Civil Society Organizations (CSOs) globally address the needs caused by the COVID-19 pandemic? In this study, we examine the roles CSOs played during the first 18 months of the pandemic, their main challenges, and how the pandemic changed CSOs’ roles in society across 39 countries and economies. Using inductive thematic analysis analyzing responses from global philanthropy experts in two consecutive studies (2020 and 2021), we find that CSOs played fourteen roles, of which we discuss the six most mentioned: providing social assistance; responding to health care needs; coordinating and collaborating with government and business; mobilizing funds to address societal needs; raising awareness and combating misinformation; and advocating. Challenges for CSOs included reduced revenue and difficulty reaching beneficiaries. We found these challenges led to innovative ways of operating and new arrangements between civil societies and governments, which may have opened opportunities for a more active role of CSOs.