The direct effects of the covid-19 pandemic are hard enough for epidemiologists to measure. Keeping track of cases, hospitalizations, mortality, and the long-term symptoms among survivors takes tremendous resources. Measuring the secondary effects is an entirely different and in many ways more complex challenge. Such effects include the psychological strain put on the general population. Traditional social opportunities and ties have been significantly disrupted. Many people are now finding themselves isolated and removed from the social nutrients previously taken for granted and that we almost unknowingly are dependent on to "get by" in carrying out our normal everyday life activities. Adolescents may be particularly vulnerable. 

In a new research letter released today in JAMA Pediatrics, investigators in China surveyed a sample of 7,890 individuals aged 12-18 living in Wuhan, China during March 30-April 7, 2020, a time during which significant city-level health measures and social restrictions were in place. The data found that this diverse group of younger participants had significant rates of both anxiety (22 percent) and depression (25 percent). These rates were measured by using validated measures of depression and anxiety such as the Hospital Anxiety and Depression Scale.

When looking at the factors associated with related mental health symptoms, the authors found that anxiety and depression were closely associated with daily life under home restrictions among adolescents during the covid-19 pandemic period, especially with respect to "digital era" factors such as screen time and browsing information about covid-19. It is also important to emphasize that restrictions themselves are not the root of the problem. These restrictions are the safest response to them in areas where outbreaks are not sufficiently controlled. Rather, the problem is the virus. The mental strain on adolescents would likely be even worse if restrictions were lifted and death rates skyrocketed. Once the virus is gone, life will resume safely. 

The takeaway? Younger individuals may be suffering similar rates of mental health stress during the pandemic as adults. It is important for caregivers and other adults who may be interacting with children and adolescents to take the time to check in and support this vulnerable group. And it must also be said that the digital entertainment Swiss Army Knife of an iPad and internet may be a double-edged blade. These devices provide important avenues for work, education, connectivity, and entertainment that can enhance our lives during this period. But they are also conduits to doomscrolling and other behaviors that can make the situation worse for some. More traditional social interactions and time to make deeper connections may have significant positive effects for the well-being of younger people during this unusually trying time.

As the Trump administration and its Operation Warp Speed wind to a close, there have been many missed targets, including getting 20 million Americans vaccinated by the end of 2020. 

Now, with the Biden team poised to take over, the transition has laid out an even more ambitious plan: giving 100 million vaccines in the first 100 days of the new administration. This goal has been met with much skepticism from public health experts, as detailed in a prior Brief19, but officials are confident that they will be able to meet this goal. 

Over the past weekend, the administration's Chief Medical Advisor, Dr. Anthony Fauci, projected exceeding optimism about the likelihood of reaching this achievement, though other officials such as incoming director of the US Centers for Disease Control and Prevention, Dr. Rochelle Walensky, acknowledged that doing so will be "a hefty lift." 

It appears as though Biden plans to use the Defense Production Act to boost supplies of vaccines, as well as other needed supplies such as personal protective equipment and tests for covid-19. We briefed his ambitious plan announced last week, though the specifics and logistics around these priorities have not yet been made public. In addition, rolling these out will require Congress to approve the funding.

Another challenge that will not be as easily solved will be finding and training the high number of healthcare workers that will be needed to administer the 100 million doses. Coordination and delivery of the right amount of vaccine to the right places has proven difficult so far, with some areas of the country falling well short in their efforts to reach as many arms as they have vaccine doses, while others have found themselves scrambling to find enough patients to vaccinate before their supply expires. 

The Biden team previously announced that they hope to improve coordination through a centralized federal plan. The Trump administration left this to the state. The results have been chaotic at times.