In May 2020, Penn LDI awarded 13 COVID-19 Rapid Response Research Grants, designed to produce policy insights directly relevant to the unfolding pandemic and its broad range of health effects. Thirteen LDI Senior and Associate Fellow principal investigators and twelve co-investigators are involved in the funded projects. Learn about the funded projects and resulting products below.

Estimating Intervention Effectiveness with Censored Testing


Principal Investigator: Hamsa Bastani, PhD | The Wharton School

Early in the pandemic, the lack of widespread COVID-19 testing made estimates of infection rates unreliable. In this study, the investigators used a novel approach to develop unbiased estimates of the true number of positive cases of COVID-19 in US counties. They based their estimate on observed demographic features, including age as a key factor. Using this approach, they estimated that the infection rate for Pennsylvania was nearly 1.5 times the reported infection rate, suggesting the numbers across the country were also likely far higher than reported numbers.

As demonstrated, publicly available data can be used to obtain estimated infection rates that exhibit significantly less bias than reported infection rates. With better demographic data and  more details on procedures for prioritizing testing, policymakers can obtain significantly better estimates of how COVID-19 is spreading in their communities. These estimates are crucial for guiding policy decisions on when to re-open businesses and schools and when to shut them down.

Resulting Product:
• Final Video Report

In Whose Best Interest: Nursing Regulation During a Crisis


Principal Investigator: Cynthia Connolly, PhD, RN, FAAN | School of Nursing
Co-Investigators: Patricia D'Antonio, PhD, FAAN, RN; Julie Fairman, PhD, RN, FAAN

The investigators compare nursing’s response in the 1918 Flu pandemic, when the discipline was lightly regulated, to today’s COVID-19 pandemic, a time of heavy regulation. Moreover, they provide a historically contextualized analysis of how the 1918 flu pandemic helped shape Pennsylvania nursing’s current regulatory apparatus. They found that both crises highlight the importance of having an adequate supply of well-educated nurses and the flexibility to deploy nurses across state lines. They conclude that state-based regulations and registration are inadequate to deal with pandemics and crises with national, if not global, reach. Based on these findings, they recommend moving from the current state-based licensing system to a national nurse registration in Pennsylvania and other states.

Resulting Products:
• Epidemics from the Perspective of Professional Nursing: Beyond Germs, Public Health, and Pot Banging
Final Video Report

COVID-19 Risk Perception, Knowledge, and Behaviors in 6 States


Principal Investigator: Karen Glanz, PhD, MPH | Perelman School of Medicine and School of Nursing
Co-Investigator: John Holmes, PhD

Despite efforts of public health officials and the media to share current and accurate information about COVID-19, there are many instances of conflicting information and misinformation being disseminated. Researchers, public health experts, and policymakers lack reliable information on a range of epidemiological factors. This study will assess risk perceptions, knowledge, and behaviors related to prevention and response to the pandemic, and the psychological impacts of quarantine and/or diagnosis of COVID-19. 

Safety Net Program Use Among Low-Income Families of Children with Developmental Disabilities During a Pandemic


Principal Investigator: James Guevara, MD, MPH | CHOP and Perelman School of Medicine

This study described changes in use of, need for, and adjustment to a virtual service delivery model for safety net programs among families of children with developmental disabilities during the COVID-19 pandemic in Philadelphia.

The investigators surveyed low-income families about the use of various safety net programs before and after the onset of the pandemic in March 2020. Current program participants were also interviewed about barriers and facilitators to participation, how services were delivered (e.g., virtually), and how well the current format meets their needs.

The survey findings show a substantial increase in applying for, and receiving, unemployment assistance, but for many of the other programs, the pandemic reduced the proportion of participants applying for services. In interview, participants pointed to poor communication regarding program changes, lack of available assistance, insufficient benefits to meet their growing needs, poor engagement with virtual services, and connectivity issues. Participants expressed a desire to receive program information using multiple modalities, receive more reliable and timely assistance, and the option to receive in-person or hybrid services. The results of this study could be used to improve the delivery of safety net services throughout the pandemic, and into post-pandemic times.

Resulting Products:
• Safety Net Program Use During the COVID-19 Pandemic Among Families of Children With Developmental Delays (Slide Deck)

Health System Communication of Novel Pandemic-Era Policies


Principal Investigator: Joanna Hart, MD, MSHP | Perelman School of Medicine

To reduce COVID-19 transmission, many health care facilities changed their policies on visitation. The investigators analyzed the content of visitation policies published online by inpatient facilities in Pennsylvania in April and May 2020.  They characterized the content and qualities of consumer-facing communication of these visitation policies, and recommended ways to improve how these policies are presented.

They found that policies served several major functions, including: communication of rules (including exceptions); justification of the policy that restricted visitation; indication that this is a policy change; and statements of the values of the health system. Expressions of empathy and compassion, such as recognition of hardship caused by the restrictive policies, were included in only a minority of the policy statements. The policies did not explain how restricting visitation would reduce COVID-19 transmission. Furthermore, they were written at a high-literacy level, and rarely translated into languages other than English. Based on these findings, the investigators conclude that health systems should use language accessible to those with lower literacy levels, provide clear explanations for novel policies, and more frequently incorporate statements of empathy and compassion when communicating crisis-era policies affecting the general public.
Resulting Product:
• Family Presence for Critically Ill Patients During a Pandemic

Measuring Pandemic-Related Attitudes and Behaviors in Pennsylvania: A Wave of a Panel Survey


Principal Investigator: Daniel Hopkins, PhD | School of Arts & Sciences

Prompted by concerns that some Americans may resist advice about COVID-19 from government officials or public health experts, this study explored how political views affect people’s reactions to policies to stop the spread of COVID-19. The investigators conducted two online surveys from April-June 2020 with 1,912 Pennsylvania residents. Though the study uncovered partisan differences in views on several COVID-related policies, overall, respondents reported strong support for social distancing policies and high levels of trust in medical experts. Support remained strong when social distancing policies were advocated by “elites,” including public health experts. However, there was a cross-party decline in support for the same policy when backed by government officials. This suggests that, in politically polarized times, public health experts might be better advocates for beneficial public policies during public health crises than government officials. The investigators note the importance of continuing to assess partisan gaps in support for, and adherence to, expert and government recommendations as the pandemic unfolds.

Resulting Products:
• Final Video & Text Report

Penn Researcher Documents Strong Pennsylvania Support for COVID Restrictions
• Pa. Republicans and Democrats Disagree On Reopening the Economy, but There is a Lot They Do Agree On, Survey Says
• Daniel Hopkins on WHYY Radio Times
• Partisan Polarization and Resistance to Elite Messages: Results from a Survey Experiment on Social Distancing

At the Frontline of the Pandemic in a Resource-Limited Setting: Health Care Providers and Covid-19 in Malawi


Principal Investigator: Iliana Kohler, PhD | School of Arts & Sciences

This study surveyed health care providers in Malawi to assess the unique COVID-19 challenges they face in the sub-Saharan African low-income context, and to evaluate their preparedness to address the pandemic. One hundred and eleven health care providers, including doctors, nurses, and health surveillance assistants, participated in phone-based interviews in July and August 2020. The questionnaire focused on topics such as mental health, life satisfaction, and job stress. The results showed that providers in Malawi have experienced high emotional burnout during the pandemic, compounded by the ongoing HIV/AIDS epidemic. Based on these findings, the investigators recommend that public health policies directly target the needs of health care providers.

Resulting Product:
Final Video Report

Multi-State Study of U.S. Nurse Burnout in Minority-Serving and non-Minority-Serving Hospitals, Before and After COVID-19


Principal Investigator: Karen Lasater, PhD, RN | School of Nursing

This study evaluated nurse working conditions in hospitals just prior to the COVID-19 pandemic and analyzed the relationship between these working conditions and nurse burnout and intentions to leave.

The study collected survey data between December 2019 through February 2020 from direct-care nurses in 254 New York and Illinois hospitals. It was found that at the start of the COVID-19 pandemic most of the hospitals did not meet benchmark patient-to-nurse staffing ratios for medical-surgical or intensive care units. New York City hospitals had especially low staffing ratios. Understaffed hospitals were associated with less job satisfaction among nurses, unfavorable grades for patient safety and quality of care, and hesitance by nurses and patients to recommend their hospitals.

The findings show that even before the pandemic strained health care systems, hospital nurses were already working in understaffed conditions, leading to frequent process failures that jeopardized patient safety, and contributing to emotional distress and high turnover among nurses. Patient reviews of hospitals corroborated these findings. These working conditions left hospitals ill-prepared to meet the increased demands of the pandemic.

Resulting Products:
Chronic Hospital Nurse Understaffing Meets COVID-19: An Observational Study
LDI Research Brief: Nurse Understaffing and COVID-19
Multi-State Study of Nurse Staffing and Burnout and its Consequences (Slide Deck)
• Is Hospital Nurse Staffing Legislation in the Public's Interest?: An Observational Study in New York State
• Safe Nurse Staffing Levels Will Improve Care and Save Money
• Covid-19 Surge Leaves Doctors, Nurses Reeling From Burnout
• Nurse Research Is Influencing Health Care Across the Nation
• Testimony at New York Joint Legislative Budget Hearing:
   Research Shows New York State’s Nurse Staffing Legislation Predicted to Save Lives and Money

Understanding the Risk of COVID-19 Exposure Based on a Strategy of Routine Pre-Procedure Screening During a Pandemic


Principal Investigator: Jonathan Tan, MD, MPH, MBI | Perelman School of Medicine
Co-Investigators: Grace Hsu, MD; Allan Simpao, MD, MBI; John Fiadjoe, MD; Clyde Matava, MBCHb, MMed, MHSCJorge Galvezm MD, MBI

What are the implications of using COVID-19 screening before medical procedures as a way to protect health care workers and patients? This study reviews the literature on COVID-19 screening and discusses the limitations of using negative test results to guide policy, given the sensitivity of the test. Simulations using four different scenarios demonstrate that false-negative results are not only expected, but also increase as the pandemic spreads, and as the prevalence of COVID-19 increases. These findings suggest that policies built on negative test results of pre-procedure screening may create a false sense of safety for health care workers and lead to unintended risks.

The results of the study have been used to help guide local discussion and considerations for using a COVID-19 screening programming before elective procedures. They also have helped educate pediatric anesthesiologists and anesthesiologists on how care for patients for elective surgery during the COVID-19 pandemic. Lastly, they have been used to help guide hospital/department policy at several institutions.

Resulting Product: 
Coronavirus Disease 2019 and Pediatric Anesthesia

Health and Economic Outcomes Among Low-Income Households in India During the COVID-19 Pandemic


Principal Investigator: Harsha Thirumurthy, PhD | Perelman School of Medicine

This study evaluated the impact of the COVID-19 pandemic on the economic security, food security, health, and sexual behavior of women at high risk of HIV infection in rural Kenya. From May-June 2020 – after the introduction of COVID-19 social distancing measures – phone surveys were conducted with 1,725 women who were HIV-negative and had two or more sexual partners in the past month.

During COVID-19, participants reported a decline in weekly income, difficulty obtaining food, and concern about having enough to eat. Participants also reported significantly fewer sexual partners and transactional sex partners during the COVID-19 period than before. Additionally, women reliant on transactional sex for income were especially burdened by economic and food insecurity.

The COVID-19 pandemic has contributed to large reductions in income and food security among women at high risk of HIV infection in Kenya. However, shifts in sexual behavior may have temporarily decreased women’s risk of HIV infection. These findings inform ongoing policy debates about how to address COVID-19 in low and middle-income countries.

Resulting Product:
Final Video Report

• Health and Economic Outcomes Associated With COVID-19 in Women at High Risk of HIV Infection in Rural Kenya

The Impact of Rapidly Shifting Care Delivery on Inpatient Health Care Utilization, Access, and Quality among Patients with Cirrhosis in the Era of the Coronavirus Pandemic


Principal Investigator: Nadim Mahmud, MD, MS, MPH, MSCE | Perelman School of Medicine
Co-Investigator: Marina Serper, MD, MS

This study evaluated the impact of the COVID-19 pandemic on health care utilization and delivery in Veterans Health Administration Hospitals among patients with cirrhosis, a historically vulnerable patient population. National data showed a substantial decline in cirrhosis hospitalizations. Additionally, as the pandemic evolved, patients presenting to the hospital did so with higher severity of liver disease, and patients were less likely to be discharged to post-acute care facilities. The investigators identified important changes in the late-COVID era, including significant declines in academic center hospitalizations, decreased length of stay, fewer hospital transfers, and more frequent discharge to home rather than facilities.

These changes in inpatient care may adversely impact outcomes such as short-term mortality, and changes in post-hospital disposition away from facilities may increase hospital readmissions and outpatient acuity. The investigators note that it is unclear how these acute care patients are being managed as outpatients, and it is likely that many do not currently have adequate health care access. The study data can inform changes in resource allocation during future pandemics based on expected shifts in utilization.

Resulting Products:
• Dramatic Nationwide Decline in Cirrhosis Hospitalizations Due to COVID-19
• National Shifts in Outpatient Care for Patients With Cirrhosis
• Declining Cirrhosis Hospitalizations in the Wake of the COVID-19 Pandemic: A National Cohort Study

Answering the Call to Support Family Social Health: Assessing Demand for Child Helpline Inquiries in the Wake of COVID-19


Principal Investigator: Robin Ortiz, MD | Perelman School of Medicine
Co-Investigators: Laura Sinko, PhD, RN, CCST-IRachel Kishton, MDAtheendar Venkataramani, MD, PhDJoanne Wood, MD, MSHP

As school closed and stay-at-home orders were issued, did the volume and nature of calls and texts to a national child abuse hotline change?  This study looked at call and text volume to the hotline from January-May 2019 and compared it to 2020. 

Looking at data from 58,561 calls and texts, the study found that youth and parents sought support at higher levels in 2020 compared to 2019. Further, calls from (mandated) school reporters significantly decreased when in-person schools closed at the beginning of March 2020. Inquiries by text platform were more stable over time than calls, with youth equally likely to reach out through calls or texts, but adults almost exclusively through calls.

The investigators conclude that children and concerned adults may need more support in the wake of the pandemic, and recommend innovative methods, such as text platforms, to engage vulnerable youth and improve access to trusted adults.

Resulting Products:
Assessing Child Abuse Hotline Inquiries in the Wake of COVID-19: Answering the Call
• Child Abuse Hotline Calls and Texts Rose During the Pandemic. Here's How to Help
• "The Stay at Home Order is Causing Things to Get Heated Up”: Family Conflict Dynamics During COVID-19 From The Perspectives of Youth Calling a National Child Abuse Hotline
Final Video Report

Capturing Social Distancing While Immunocompromised: A Photo-Elicitation Study


Principal Investigator: Laura Sinko, PhD, RN, CCST-I | Perelman School of Medicine
Co-Investigator: Raina Merchant, MD, MSHP, FAHA

This study described the wellness and distress experiences of immunocompromised individuals during the COVID epidemic, and suggested ways to better support them going forward. Forty-seven study participants, all at high risk of disease transmission, submitted several photographs to showcase how their lives had changed during the pandemic.

Several distress-related themes emerged, such as deteriorating mental health, health management concerns, safety fears, and isolation. It also identified wellness-related themes, such as finding comfort, managing uncertainty, maintaining connection, and maintaining physical health. While most participants experienced negative changes to their wellbeing as a result of COVID, for some, particularly those with more severely compromised immune systems, “not much had changed.”  

The researchers highlight the need that immunocompromised individuals have for daily supports outside of pandemic times. They recommend that individuals at highest risk for infection be consulted to develop creative ways to improve the wellbeing of the public.

Resulting Products:
Photographic Exhibit
Final Video Report