COVID-19 and Health Outcomes Spring 2021

The direct health effects of COVID-19 have been devastating for American Indians, with death rates over 1.5 times higher than for non-Hispanic whites. Further, access to health care and facilities was limited for many reservation-based households even prior to the COVID-19 pandemic. Randall Akee, Luis E. Quintero, and Emilia Simeonova estimate the effect of imposing and lifting lockdowns on utilization of different health care facilities by individuals residing on and off of American Indian reservations during the COVID-19 pandemic. They measure visits and visits characteristics like duration and distances traveled, to healthcare facilities at the census tract level for all US counties, and compare the patterns on and off reservations. The researchers find that lockdowns reduced the number and duration of visits to health care facilities for both groups (on and off-reservations). Overall, the response to NPIs from reservation dwellers was weaker. This could stem from lower elasticities of demand due to a lower share of elective services in the total healthcare usage of Native Americans, as well as to lower availability of services. Upon lifting of lockdowns, some types of facilities show catching up behavior when re-openings happen, suggesting that elective healthcare had been delayed. This is weaker on reservations, again evidence of lower elective usage. Overall, healthcare facilities show less than full adjustment upon reopening, indicating voluntary social distance outlives lockdowns.

Bailey, Johnston, Koenen, Kuchler, Russel, and Stroebel show that social network exposure to COVID-19 cases shapes individuals' beliefs and behaviors concerning the coronavirus. They use de-identified data from Facebook to document that individuals with friends in areas with worse COVID-19 outbreaks reduce their mobility more than otherwise similar individuals with friends in less affected areas. The effects are quantitatively large and long-lasting: a one standard deviation increase in friend-exposure to COVID-19 cases in March 2020 results in a 1.2 percentage point increase in the probability of staying home on a given day through at least the end of May 2020. As the pandemic progresses--and the characteristics of individuals with the highest friend-exposure vary--changes in friend-exposure continue to drive changes in social distancing behavior, ruling out many unobserved effects as drivers of their results. The researchers also show that individuals with higher friend-exposure to COVID-19 are more likely to publicly post in support of social distancing measures and less likely to be members of groups advocating to "reopen" the economy. These findings suggest that friends can influence individuals' beliefs about the risks of the disease and thereby induce them to engage in mitigating public health behavior.

Little is known about the effects of COVID-19 on family caregivers in the US. Using data from a national sample of 2,485 US adults aged ≥55 in April and May, 2020 Truskinovsky, Kobayashi, and Finlay aimed to describe the magnitude of disruptions to family care arrangements during the initial wave of the COVID-19 pandemic, and the associations between these disruptions and the mental health and employment outcomes of family caregivers. COVID-19 disrupted more than half of family caregiving arrangements, and disruptions were associated with poor mental health outcomes among caregivers, compared to both non-caregivers and caregivers who did not experience disruptions. Family caregivers who experienced pandemic-related employment disruptions were providing more care than caregivers who did not experience disruptions. These findings highlight the impact of the pandemic on a vital health care workforce that is vulnerable to shocks.

Bianchi, Bianchi, and Song adopt a time series approach to investigate the historical relation between unemployment, life expectancy, and mortality rates. They fit Vector-autoregressions for the overall US population and for groups identified based on gender and race. The researchers use their results to assess the long-run effects of the COVID-19 economic recession on mortality and life expectancy. Bianchi, Bianchi, and Song estimate the size of the COVID-19-related unemployment shock to be between 2 and 5 times larger than the typical unemployment shock, depending on race and gender, resulting in a significant increase in mortality rates and drop in life expectancy. They also predict that the shock will disproportionately affect African-Americans and women, over a short horizon, while the effects for white men will unfold over longer horizons. These figures translate in more than 0.8 million additional deaths over the next 15 years.

Annan and Archibong show that communication interventions - which have become globally pervasive during the COVID-19 pandemic - promote individuals' consumption and psychological well-being. Partnering with a major telecommunication company, they field communication programs that provide either a "lump-sum mobile phone calling credit" or "monthly tranches of mobile phone calling credit" to a nationally representative set of low-income adults in Ghana during the crises. Individuals' inability to make unexpected calls, unexpected need to borrow SOS airtime, and to seek digital loans decreased dramatically relative to a control group. As a result, the
programs led to a significant decrease in mental distress (-9.8%) and the likelihood of severe mental distress by -2.7 percentage points (quarter the mean prevalence), with null impact on consumption expenditure. Monthly mobile credits are more likely than lump-sum mobile credits to "sustain" larger impacts, suggesting that individuals may face time inconsistency and/or social pressure problems. The researchers emphasize the value of communication and need for many installments of communication transfers during pandemics.