The University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) has announced the award of thirteen 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 thirteen projects. 

Special Grant Program

The grant program was created in March, three weeks after reports of the first COVID-19 related deaths in the U.S., and as the contagion raged out of control in Wuhan China. LDI then put out an urgent request for grant proposals to its Fellows. LDI Executive Director Rachel Werner, MD, PhD, explained that proposed projects “should address population health, health care, and system delivery issues needed to understand and address the current COVID-19 pandemic or improve responses to future infectious disease outbreaks, particularly related to disparities and underserved populations.” Some $73,000 in awards for the 13 projects were announced by the first week of May. All of the projects are due to be completed within six months of their award. Below are the recipients and their projects.

Estimating Intervention Effectiveness with Censored Testing

Principal Investigator: Hamsa Bastani, PhD | The Wharton School
A key component for addressing questions related to virus transmission and response effectiveness is an unbiased estimate of the actual number of positive COVID-19 cases. However, due to significant rationing of tests, this number is often not available. Data suggests censoring is significant in the U.S., with the number of actual positive cases likely far larger than the reported numbers. Using a predictive risk model, this study aims to recover unbiased estimates of the true number of positive cases in US counties.
Resulting Research Product:
• Final Video Report: Estimating COVID Intervention Effectiveness with ‘Censored’ Testing

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In Whose Best Interest: Nursing Regulation During a Crisis

Principal Investigator: Cynthia Connolly, PhD, RN, PNP | Penn Nursing
Co-Investigators: Patricia D’Antonio, PhD, FAAN, RN; Julie Fairman, PhD, FAAN
Nursing and medical students near the end of their training are being handled in very different ways when it comes to mobilization for clinical work in the current COVID-19 crisis. Why is it possible to expedite medical school graduations to get newly-minted physicians into practice, while the same time nursing students have been prevented from doing the same by their schools, state licensing and private certification bodies? This research will examine the response to the 1918 Flu Pandemic as a comparison situation.
Resulting Research Product:
• Final Video Report: In Whose Best Interest

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

Principal Investigator: Karen Glanz, PhD, MPH | Perelman School of Medicine and PennNursing
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. 

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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
Twelve to sixteen percent of young children are estimated to have developmental delays and disabilities. Widespread crises like the COVID-19 pandemic can exert extraordinary strain on families with these children. While government-funded safety net programs assist low-income families, what challenges are these families facing during the coronavirus crisis? This study’s goal is to determine changes in the use of, need for, and adjustment to a virtual service delivery model for these safety net programs during the current crisis.

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Health System Communication of Novel Pandemic-Era Policies

Principal Investigator: Joanna Hart, MD, MSHP | Perelman School of Medicine
During the current pandemic, inpatient health care facilities must enforce physical distancing, including severe restrictions or elimination of family member presence for admitted patients. While this aims to reduce viral transmission, the presence and manner in which these policies are communicated may influence the public perception of health system support for family-centered care and the alliance between the health system and surrounding community. This study seeks to identify ways to improve this health system communication.

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

Principal Investigator: Daniel Hopkins, PhD | School of Arts & Sciences
The full extent of the disruption caused by the COVID-19 pandemic across the social and economic life of Pennsylvania and the United States will hinge, to a critical extent, on people’s behavioral responses to warnings about the virus and the need to adhere to restrictive measures designed to contain and mitigate the contagion. This study will use a survey of 1,500 Pennsylvania residents to probe their sources of pandemic information and their views about government policies and recommendations aimed at stemming the pandemic’s spread.
Resulting Research Products:
• Final Video & Text Report: Study Finds Strong Support for Social Distancing and Public Health Experts’ Advice
• 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

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

Principal Investigator: Iliana Kohler, MA, PhD | School of Arts & Sciences
As COVID-19 continues its spread out of the high- and middle income countries where it is currently concentrated, there are important knowledge gaps essential for health policy responses in lesser resourced areas. This study is aimed at one of those areas — Malawi in southeastern Africa — where there is often no running water in houses and clinics, and health centers routinely lack even adequate supplies of thermometers. This project will collect critical information on providers there, and evaluate the unique COVID-19 challenges those health workers face.
Resulting Research Product:
• Final Video Report: Pandemic Health Care Frontline in Resource-Limited Malawi

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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 will focus on how the COVID-19 pandemic has exacerbated nurse burnout, particularly in minority-serving institutions (MSIs) where the coronavirus burden is falling more heavily. The researchers will conduct a survey in collaboration with the National Council of State Boards of Nursing — the only organization with a national database of virtually all registered nurses’ email addresses. The goal will be to evaluate working conditions before the pandemic, as well as how levels of burnout/intent to leave have changed in MSIs and non-MSIs after the pandemic.
Resulting Research Product:
• Chronic Hospital Nurse Understaffing Meets COVID-19: An Observational Study

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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, MHSC; and Jorge Galvez, MD, MBI
Screening for COVID-19 is an essential public health strategy; positive test results facilitate the detection of disease but may lead to a false sense of safety for health care workers. Hospitals may use a negative result to triage limited resources such as personal protective equipment and operating room staff, and eventually use it in the planning of scheduling elective procedures. This work will review COVID-19 screening test literature and quantify the risks of using a COVID-19 screening test negative result to make policy.

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

Principal Investigator: Harsha Thirumurthy, PhD | Perelman School of Medicine
Focused on the impact of the COVID-19 pandemic in India, this study will track household well-being and assess whether temporary or bolstered welfare programs for low-income households are adequately protecting those households. The goal is to inform an evolving pandemic policy response in India and enhance future preparedness for similar events. The work will build on an ongoing study among 580 low-income households in the Indian state of Tamil Nadu and implement phone-based surveys to support the project’s goals.
Resulting Research Product:
• Final Video Report: COVID-19 Impact on Income in Low-Income African Households

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

Principal Investigator: Nadim Mahmud, MD, MS, MPH | Perelman School of Medicine
Co-Investigator: Marina Serper, MD, MS
The current pandemic has resulted in massive shifts in health care delivery across the U.S. Many systems have supplanted in-person visits with telemedicine, limited hospital transfers, and set more stringent hospitalization criteria for non-COVID-19 related conditions. At this early stage, the overall impacts of COVID-19 in high-risk and vulnerable populations of patients with cirrhosis are unknown. This study will use Veterans Health Administration data to evaluate the effect of the pandemic on inpatient utilization, post-acute care, long-term care, and other aspects of patient care.
Resulting Research 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

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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, Rachel Kishton, MD, Atheendar Venkataramani, MD, PhD, and Joanne Wood, MD
The combination of isolation, emotional and financial distress, and school closures has led child welfare experts to predict a surge in family violence in the wake of the COVID-19 outbreak. However, recent data from Michigan and other states shows that Child Protective Services (CPS) reports significant decreases of such incidents in March 2020 as social distancing and school closure policies were adopted, compared to 2019. This study will analyze child helpline calls to identify trends in family distress and child maltreatment during the pandemic.
Resulting Research Product:
• Final Video Report: Child Helpline Inquiries During COVID-19

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Capturing Social Distancing While Immunocompromised: A Photo-Elicitation Study

Principal Investigator: Laura Sinko, PhD | Perelman School of Medicine
Co-Investigator: Raina Merchant, MD, MS
Photography can provide compelling data that can be used to showcase the unique experiences of those who are high risk for COVID-19 complications during this time. This study will use photographs to build our understanding of the lived wellness experiences of those who are immunocompromised in order to better understand how social distancing may look and feel different for these individuals. The project hopes to leverage these images to advocate for improved health and welfare supports for high-risk individuals during periods of quarantine. Any individual over 18 and who has a health condition or takes medications that may compromise their immune system is eligible for this study.
Resulting Research Product:
• Final Video & Text Report: The Unique Pandemic Challenges Faced by Immunocompromised Individuals

• Publication in Journal of Community Psychology