Introduction:The impact of the COVID-19 pandemic on the incidence of pediatric type 1 (T1D) and type 2 diabetes (T2D) and severity of presentation at diagnosis is unclear. Methods: A retrospective comparison of 737 youth diagnosed with T1D and T2D during the initial 12 months of the CO-VID-19 pandemic and in the preceding 2 years was conducted at a pediatric tertiary care center. Results: Incident cases of T1D rose from 152 to 158 in the 2 years before the pandemic (3.9% increase) to 182 cases during the pandemic (15.2% increase). The prevalence of diabetic ketoacidosis (DKA) at T1D diagnosis increased over 3 years (41.4%, 51.9%, and 57.7%, p = 0.003); severe DKA increased during the pandemic as compared to the 2 years before (16.8% vs. 28%, p = 0.004). Although there was no difference in the mean hemoglobin A1c (HbA1c) between racial and ethnic groups at T1D diagnosis in the 2-years pre-pandemic (p = 0.31), during the pandemic HbA1c at T1D diagnosis was higher in non-Hispanic Black (NHB) youth (11.3 ± 1.4%, non-Hispanic White 10.5 ± 1.6%, Latinx 10.8 ± 1.5%, p = 0.01). Incident cases of T2D decreased from 54 to 50 cases (7.4% decrease) over the 2-years pre-pandemic and increased 182% during the pandemic (n = 141, 1.45 cases/month, p < 0.001). As compared to the 2-years pre-pandemic, cases increased most among NHB youth (56.7% vs. 76.6%, p = 0.001) and males (40.4% vs. 58.9%, p = 0.005). Cases of DKA (5.8% vs. 23.4%, p < 0.001) and hyperosmolar DKA (0 vs. 9.2%, p = 0.001) increased among youth with T2D during the pandemic. Conclusions: During the pandemic, the incidence and severity of presentation of T1D increased modestly, while incident cases of T2D increased 182%, with a nearly 6-fold increase in DKA and nearly a 10% incidence of hyperosmolar DKA. NHB youth were disproportionately impacted, raising concern about worsening of pre-existing health disparities during and after the pandemic.

In this article, we argue that new kinds of risk are emerging with the COVID-19 virus, and that these risks are unequally distributed. As we expose to view, digital inequalities and social inequalities are rendering certain subgroups significantly more vulnerable to exposure to COVID-19. Vulnerable populations bearing disproportionate risks include the social isolated, older adults, penal system subjects, digitally disadvantaged students, gig workers, and last-mile workers. Therefore, we map out the intersection between COVID-19 risk factors and digital inequalities on each of these populations in order to examine how the digitally resourced have additional tools to mitigate some of the risks associated with the pandemic. We shed light on how the ongoing pandemic is deepening key axes of social differentiation, which were previously occluded from view. These newly manifested forms of social differentiation can be conceived along several related dimensions. At their most general and abstract, these risks have to do with the capacity individuals have to control the risk of pathogen exposure. In order to fully manage exposure risk, individuals must control their physical environment to the greatest extent possible in order to prevent contact with potentially compromised physical spaces. In addition, they must control their social interactional environment to the greatest extent possible in order to minimize their contacts with potentially infected individuals. All else equal, those individuals who exercise more control over their exposure risk — on the basis of their control over their physical and social interactional environments — stand a better chance of staying healthy than those individuals who cannot manage exposure risk. Individuals therefore vary in terms of what we call their COVID-19 exposure risk profile (CERPs). CERPs hinge on preexisting forms of social differentiation such as socioeconomic status, as individuals with more economic resources at their disposal can better insulate themselves from exposure risk. Alongside socioeconomic status, one of the key forms of social differentiation connected with CERPs is digital (dis)advantage. Ceteris paribus, individuals who can more effectively digitize key parts of their lives enjoy better CERPs than individuals who cannot digitize these life realms. Therefore we believe that digital inequalities are directly and increasingly related to both life-or-death exposure to COVID-19, as well as excess deaths attributable to the larger conditions generated by the pandemic.

2020 marks the 25th anniversary of the “digital divide.” Although a quarter century has passed, legacy digital inequalities continue, and emergent digital inequalities are proliferating. Many of the initial schisms identified in 1995 are still relevant today. Twenty-five years later, foundational access inequalities continue to separate the digital haves and the digital have-nots within and across countries. In addition, even ubiquitous-access populations are riven with skill inequalities and differentiated usage. Indeed, legacy digital inequalities persist vis-à-vis economic class, gender, sexuality, race and ethnicity, aging, disability, healthcare, education, rural residency, networks, and global geographies. At the same time, emergent forms of inequality now appear alongside legacy inequalities such that notions of digital inequalities must be continually expanded to become more nuanced. We capture the increasingly complex and interrelated nature of digital inequalities by introducing the concept of the “digital inequality stack.” The concept of the digital inequality stack encompasses access to connectivity networks, devices, and software, as well as collective access to network infrastructure. Other layers of the digital inequality stack include differentiated use and consumption, literacies and skills, production and programming, etc. When inequality exists at foundational layers of the digital inequality stack, this often translates into inequalities at higher levels. As we show across these many thematic foci, layers in the digital inequality stack may move in tandem with one another such that all layers of the digital inequality stack reinforce disadvantage.

Purpose Telemedicine has been advancing for decades and is more indispensable than ever in this unprecedented time of the COVID-19 pandemic. As shown, eHealth appears to be effective for routine management of chronic conditions that require extensive and repeated interactions with healthcare professionals, as well as the monitoring of symptoms and diagnostics. Yet much needs to be done to alleviate digital inequalities that stand in the way of making the benefits of eHealth accessible to all. The purpose of this paper is to explore the recent shift in healthcare delivery in response to the COVID-19 pandemic towards telemedicine in healthcare delivery and show how this rapid shift is leaving behind those without digital resources and exacerbating inequalities along many axes. Design/methodology/approach Because the digitally disadvantaged are less likely to use eHealth services, they bear greater risks during the pandemic to meet ongoing medical care needs. This holds true for both medical conditions necessitating lifelong care and conditions of particular urgency such as pregnancy. For this reason, the authors examine two case studies that exemplify the implications of differential access to eHealth: the case of chronic care diseases such as diabetes requiring ongoing care and the case of time-sensitive health conditions such as pregnancy that may be compromised by gaps in continuous care. Findings Not only are the digitally disadvantaged more likely to belong to populations experiencing greater risk – including age and economic class – but they are less likely to use eHealth services and thereby bear greater risks during the pandemic to meet ongoing medical care needs during the pandemic. Social implications At the time of writing, almost 20% of Americans have been unable to obtain medical prescriptions or needed medical care unrelated to the virus. In light of the potential of telemedicine, this does not need to be the case. These social inequalities take on particular significance in light of the COVID-19 pandemic. Originality/value In light of the COVID-19 virus, ongoing medical care requires exposure to risks that can be successfully managed by digital communications and eHealth advances. However, the benefits of eHealth are far less likely to accrue to the digitally disadvantaged.

Objective The relative risk of SARS–CoV‐2 infection and COVID‐19 disease severity among people with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs is unclear. This study was undertaken to quantify the risk of SARS–CoV‐2 infection in those with RMDs and describe clinical outcomes of COVID‐19 in these patients. Methods We conducted a systematic literature review using 14 databases from January 1, 2019 to February 13, 2021. We included observational studies and experimental trials in RMD patients that described comparative rates of SARS–CoV‐2 infection, hospitalization, oxygen supplementation/intensive care unit (ICU) admission/mechanical ventilation, or death attributed to COVID‐19. Methodologic quality was evaluated using the Joanna Briggs Institute critical appraisal tools or the Newcastle‐Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated, as applicable for each outcome, using the Mantel‐Haenszel formula with random effects models. Results Of the 5,799 abstracts screened, 100 studies met the criteria for inclusion in the systematic review, and 54 of 100 had a low risk of bias. Among the studies included in the meta‐analyses, we identified an increased prevalence of SARS–CoV‐2 infection in patients with an RMD (RR 1.53 [95% CI 1.16–2.01]) compared to the general population. The odds of hospitalization, ICU admission, and mechanical ventilation were similar in patients with and those without an RMD, whereas the mortality rate was increased in patients with RMDs (OR 1.74 [95% CI 1.08–2.80]). In a smaller number of studies, the adjusted risk of outcomes related to COVID‐19 was assessed, and the results varied; some studies demonstrated an increased risk while other studies showed no difference in risk in patients with an RMD compared to those without an RMD. Conclusion Patients with RMDs have higher rates of SARS–CoV‐2 infection and an increased mortality rate.

Highlights This scoping review provides an up-to-date overview of published evidence regarding the frequency and severity of acute viral respiratory AEs related to antirheumatic disease therapies. Glucocorticoid use was associated with a higher frequency of acute upper and lower respiratory viral events. Mild viral respiratory infections occurred more frequently in several studies in which patients were treated with JAKi, most notably at higher doses. TNFi and IL-17 inhibitors seemed to be associated with higher frequency of mild viral respiratory infections such as URTI and nasopharyngitis. Our review identifies a knowledge gap for most antirheumatic medications and their acute respiratory viral complications; in the context of the COVID-19 pandemic, increased widespread respiratory viral PCR testing offers immediate research opportunities to clarify the safety of antirheumatic therapies in terms of viral respiratory complications.

Marking the 25th anniversary of the “digital divide,” we continue our metaphor of the digital inequality stack by mapping out the rapidly evolving nature of digital inequality using a broad lens. We tackle complex, and often unseen, inequalities spawned by the platform economy, automation, big data, algorithms, cybercrime, cybersafety, gaming, emotional well-being, assistive technologies, civic engagement, and mobility. These inequalities are woven throughout the digital inequality stack in many ways including differentiated access, use, consumption, literacies, skills, and production. While many users are competent prosumers who nimbly work within different layers of the stack, very few individuals are “full stack engineers” able to create or recreate digital devices, networks, and software platforms as pure producers. This new frontier of digital inequalities further differentiates digitally skilled creators from mere users. Therefore, we document emergent forms of inequality that radically diminish individuals’ agency and augment the power of technology creators, big tech, and other already powerful social actors whose dominance is increasing.

This research brings together digital inequality scholars from across the Americas and Caribbean to examine efforts to tackle digital inequality in Uruguay, Chile, Peru, Brazil, Mexico, Cuba, Jamaica, the United States, and Canada. As the case studies show, governmental policy has an important role to play in reducing digital disparities, particularly for potential users in rural or remote areas, as well as populations with great economic disparities. We find that public policy can effectively reduce access gaps when it combines the trifecta of network, device, and skill provision, especially through educational institutions. We also note, that urban populations have benefitted from digital inclusion strategies to a greater degree. This underscores that, no matter the national context, rural-urban digital inequality (and often associated economic inequality) is resistant to change. Even when access is provided, potential users may not find it affordable, lack skills, and/or see no benefit in adoption. We see the greatest potential for future digital inclusion in two related approaches: 1) initiatives that connect with hard-to-reach, remote, and rural communities outside urban cores and 2) initiatives that learn from communities about how best to provide digital resources while respecting their diversely situated contexts, while meeting social, economic and political needs.