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      The CHASMS Conceptual Model of Cascading Disasters and Social Vulnerability: the COVID-19 Case Example

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          Abstract

          Complex environmental, economic, and social conditions in the places we live provide strong cues to our longevity, livelihood, and well-being. Although often distinct and evolving relatively independently, health disparity, social vulnerability and environmental justice research and practice intertwine and inform one another. Together, they increasingly provide evidence of how social processes intensify disasters almost predictably giving rise to inequitable disruptions and consequences. The domino and cumulative effects of cascading disasters invariably reveal inequities through differential impacts and recovery opportunities across communities and subgroups of people. Not only do cascading disasters reveal and produce inequitable effects, the cascade itself can emerge out of compounded nested social structures. Drawing on, and integrating, theory and practice from social vulnerability, health inequity, and environmental justice, this paper presents a comprehensive conceptual model of cascading disasters that offers a people-centric lens. The CHASMS conceptual model ( C ascading H azards to dis A sters that are S ocially constructed e M erging out of S ocial Vulnerability) interrogates the tension between local communities and the larger structural forces that produce social inequities at multiple levels, capturing how those inequities lead to cascading disasters. We apply the model to COVID-19 as an illustration of how underlying inequities give rise to foreseeable inequitable outcomes, emphasizing the U.S. experience. We offer Kenya and Puerto Rico as examples of cumulative effects and possible cascades when responding to other events in the shadow of COVID-19.

          COVID-19 has vividly exposed the dynamic, complex, and intense relevance of placing social conditions and structures at the forefront of cascading disaster inquiry and practice. The intensity of social disruption and the continuation of the pandemic will, no doubt, perpetuate and magnify chasms of injustice.

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          Most cited references54

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients

            Background Due to the general susceptibility of new coronaviruses, the clinical characteristics and outcomes of elderly and young patients may be different. Objective To analyze the clinical characteristics of elderly patients with 2019 new-type coronavirus pneumonia (COVID-19). Methods This is a retrospective study of patients with new coronavirus pneumonia (COVID-19) who were hospitalized in Hainan Provincial People's Hospital from January 15, 2020 to February 18, 2020. Compare the clinical characteristics of elderly with Young and Middle-aged patients. Results A total of 56 patients were enrolled 18 elderly patients (32.14%), and 38 young and middle-aged patients (67.86%). The most common symptoms in both groups were fever, followed by cough and sputum. Four patients in the elderly group received negative pressure ICU for mechanical ventilation, and five patients in the young and middle-aged group. One patient died in the elderly group (5.56%), and two patients died in the young and middle-aged group (5.26%). The PSI score of the elderly group was higher than that of the young and middle-aged group (P < 0.001). The proportion of patients with PSI grades IV and V was significantly higher in the elderly group than in the young and middle-aged group (P < 0.05). The proportion of multiple lobe involvement in the elderly group was higher than that in the young and middle-aged group (P < 0.001), and there was no difference in single lobe lesions between the two groups. The proportion of lymphocytes in the elderly group was significantly lower than that in the young and middle-aged group (P < 0.001), and the C-reactive protein was significantly higher in the young group (P < 0.001). The Lopinavir and Ritonavir Tablets, Chinese medicine, oxygen therapy, and mechanical ventilation were statistically different in the elderly group and the young and middle-aged group, and the P values were all <0.05. Interpretation The mortality of elderly patients with COVID-19 is higher than that of young and middle-aged patients, and the proportion of patients with PSI grade IV and V is significantly higher than that of young and middle-aged patients. Elderly patients with COVID-19 are more likely to progress to severe disease.
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              Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

              Abstract Background Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region. Methods After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health–Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control. Results As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County. Conclusions In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.
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                Author and article information

                Journal
                Int J Disaster Risk Reduct
                Int J Disaster Risk Reduct
                International Journal of Disaster Risk Reduction
                Elsevier Ltd.
                2212-4209
                2 September 2020
                2 September 2020
                : 101828
                Affiliations
                [a ]Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina 28223, USA
                [b ]Department of Political Science & Public Administration, University of North Carolina at Pembroke, Pembroke, NC 28372, USA
                [c ]Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado 80217, USA
                Author notes
                []Corresponding author.
                Article
                S2212-4209(20)31330-3 101828
                10.1016/j.ijdrr.2020.101828
                7467012
                32895627
                cdfd530f-abed-426c-b8b1-3ce37619bcbf
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 1 July 2020
                : 22 August 2020
                : 26 August 2020
                Categories
                Article

                social vulnerability,health inequity,cascading disasters

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