ObjectivesEssential healthcare workers (HCW) uniquely serve as both COVID-19 healers and, potentially, as carriers of SARS-CoV-2. We assessed COVID-19-related stigma and bullying against HCW controlling for social, psychological, medical and community variables.DesignWe nested an analytical cross-sectional study of COVID-19-related stigma and bullying among HCW within a larger mixed-methods effort assessing COVID-19-related lived experience and impact. Adjusted OR (aOR) and 95% CIs evaluated the association between working in healthcare settings and experience of COVID-19-related bullying and stigma, controlling for confounders. Thematic qualitative analysis provided insight into lived experience of COVID-19-related bullying.SettingWe recruited potential participants in four languages (English, Spanish, French, Italian) through Amazon Mechanical Turk’s online workforce and Facebook.ParticipantsOur sample included 7411 people from 173 countries who were aged 18 years or over.FindingsHCW significantly experienced more COVID-19-related bullying after controlling for the confounding effects of job-related, personal, geographic and sociocultural variables (aOR: 1.5; 95% CI 1.2 to 2.0). HCW more frequently believed that people gossip about others with COVID-19 (OR: 2.2; 95% CI 1.9 to 2.6) and that people with COVID-19 lose respect in the community (OR: 2.3; 95% CI 2.0 to 2.7), both which elevate bullying risk (OR: 2.7; 95% CI 2.3 to 3.2, and OR: 3.5; 95% CI 2.9 to 4.2, respectively). The lived experience of COVID-19-related bullying relates frequently to public identities as HCW traverse through the community, intersecting with other domains (eg, police, racism, violence).InterpretationAfter controlling for a range of confounding factors, HCW are significantly more likely to experience COVID-19-related stigma and bullying, often in the intersectional context of racism, violence and police involvement in community settings.

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Background Practitioners and researchers in the midst of overwhelming coronavirus disease 2019 (COVID-19) outbreaks are calling for new ways of looking at such pandemics, with an emphasis on human behavior and holistic considerations. Viral outbreaks are characterized by socio-behaviorally-oriented public health efforts aimed at reducing exposure and prevention of morbidity/mortality once infected. These efforts involve different points-of-view, generally, than do those aimed to understand the virus’ natural history. Rampant spread of SARS-CoV-2 infection in cities clearly signals that urban areas contain conditions favorable for rapid transmission of the virus. Main text The Critical Medical Ecology model is a multidimensional, multilevel way of viewing pandemics comprehensively, rooted simultaneously in microbiology and in anthropology, with shared priority for evolution, context, stressors, homeostasis, adaptation, and power relationships. Viewing COVID-19 with a Critical Medical Ecological lens suggests three important interpretations: 1) COVID-19 is equally — if not more — a socially-driven disease as much as a biomedical disease, 2) the present interventions available for primary prevention of transmission are social and behavioral interventions, and 3) wide variation in COVID-19 hospitalization/death rates is not expected to significantly be attributable to a more virulent and rapidly-evolving virus, but rather to differences in social and behavioral factors — and power dynamics — rather than (solely) biological and clinical factors. Cities especially are challenged due to logistics and volume of patients, and lack of access to sustaining products and services for many residents living in isolation. Conclusions In the end, SARS-CoV-2 is acting upon dynamic social human beings, entangled within structures and relationships that include but extend far beyond their cells, and in fact beyond their own individual behavior. As a comprehensive way of thinking, the Critical Medical Ecology model helps identify these elements and dynamics in the context of ecological processes that create, shape, and sustain people in their multidimensional, intersecting environments.

BackgroundDeterminants of COVID-19 vaccine acceptance are complex; how perceptions of the effectiveness of science, healthcare and government impact personal COVID-19 vaccine acceptance is unclear, despite all three domains providing critical roles in development, funding and provision, and distribution of COVID-19 vaccine.ObjectiveTo estimate impact of perception of science, healthcare systems, and government along with sociodemographic, psychosocial, and cultural characteristics on vaccine acceptance.DesignWe conducted a global nested analytical cross-sectional study of how the perceptions of healthcare, government and science systems have impacted COVID-19 on vaccine acceptance.SettingGlobal Facebook, Instagram and Amazon Mechanical Turk (mTurk) users from 173 countries.Participants7411 people aged 18 years or over, and able to read English, Spanish, Italian, or French.MeasurementsWe used Χ2 analysis and logistic regression-derived adjusted Odds Ratios (aORs) and 95% CIs to evaluate the relationship between effectiveness perceptions and vaccine acceptance controlling for other factors. We used natural language processing and thematic analysis to analyse the role of vaccine-related narratives in open-ended explanations of effectiveness.ResultsAfter controlling for confounding, attitude toward science was a strong predictor of vaccine acceptance, more so than other attitudes, demographic, psychosocial or COVID-19-related variables (aOR: 2.1; 95% CI: 1.8 to 2.5). The rationale for science effectiveness was dominated by vaccine narratives, which were uncommon in other domains.LimitationsThis study did not include participants from countries where Facebook and Amazon mTurk are not available, and vaccine acceptance reflected intention rather than actual behaviour.ConclusionsAs our findings show, vaccine-related issues dominate public perception of science’s impact around COVID-19, and this perception of science relates strongly to the decision to obtain vaccination once available.

BackgroundThe COVID-19 pandemic has led to widespread public health measures to reduce transmission, morbidity, and mortality attributed to the SARS-CoV-2 virus. While much research and focus surrounds COVID-19 vaccine development, testing, and supportive management, little is known about the determinants of non-medical, personal impact of COVID-19 prevention policies. We aimed to understand determinants of non-medical COVID-19 impact and to account for its multileveled, intersectional nature of associations.MethodsThis cross-sectional, multi-level, convergent mixed-methods study assessed a range of beliefs, practices, and experiences relating to COVID-19. We recruited a global sample (n=7,411) using both Facebook and Amazon mTURK platforms. We constructed a novel data-driven non-medical COVID-19 Impact Score and four subcomponents (“Personal Action,” “Supply-related,” “Cancellations,” and “Livelihood” impacts). We used generalized estimating equation models with identity link functions to determine concomitant association of individual, household, and country-level variables on the impact scores. We also classified 20,015 qualitative excerpts from 6859 respondents using an 80-code codebook.ResultsTotal and component impact scores varied significantly by region with Asia, Africa, and Latin America and the Caribbean observing the highest impact scores. Multilevel modeling indicated that individual-level sociocultural variables accounted for much of this variation with COVID-related worry, knowledge, struggles in accessing food and supplies, and worsening mental health most strongly associated with non-medical impact. Family responsibilities, personal COVID medical experience, and health locus of control – in addition to country-level variables reflecting social and health challenge – were also significantly and independently associated with non-medical impact.DiscussionNon-medical personal impact of COVID-19 affects most people internationally, largely in response to shutdowns, implementing prevention requirements, and through economic consequences. In the context where most of the world’s population does not have direct medical experience with COVID-19, this phenomena of non-medical impact is profound, and likely impacts sustainability of public health interventions aimed at containing COVID-19.