COVID-19 and its Challenges for the Healthcare System in Pakistan

Is Pakistan Well‑Positioned in the Global Health Security Scenario? An Exploratory Qualitative Study with Policy Experts and Public Health Professionals

Background: Pakistan's health system is expected to take a proactive position in the global health security arena amidst its own indigenous structural and systemic challenges. Henceforth, understanding the intricacies of this system is vital for creating effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability and overall global health security. Objectives: This study has ventured to understand the perspectives, hurdles, threats, and both international and national implications of Pakistan's current health system capacity and the requisites for meeting global health security commitments. Methods: This descriptive qualitative study, based on phenomenology theory, involved key informant interviews with 16 senior policy‑level experts and public health professionals from the public and private sectors, international non‑governmental organizations (NGOs), development partners, and United Nations (UN) bodies. Thematic analysis was employed to identify key themes related to Pakistan's health system and its role in global health security. Findings: The study uncovered significant insights into the strengths and weaknesses of Pakistan's health system, the impact of the coronavirus disease 2019 (COVID‑19) pandemic, and challenges such as funding constraints and fragmented healthcare delivery. It also highlighted threats like antimicrobial resistance and emphasized the importance of international collaboration. Areas needing special attention include multi‑drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety to reduce healthcare‑associated infections, and strengthening points of entry. Conclusion: The COVID‑19 pandemic has highlighted both the vulnerabilities and the potential within Pakistan's health system. To enhance its contribution to global health security, Pakistan needs a national policy stance, targeted health system reforms, improved resource allocation, workforce development, and strengthened partnerships with development agencies.

Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan

This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.

The influence of hospital services on patient satisfaction in OPDs: evidence from the transition to a digital system in South Punjab, Pakistan

BACKGROUND

Pakistani's health services delivery system has been rarely evaluated regarding patient satisfaction. This study examined the performance of the Pakistani health system from the perspective of doctor services (DS), digital payment system (DPS), nurses' services (NS), laboratory services (LS), pharmacy services (PHS), registration services (RS), physical services (environmentally and tangible) and doctor-patient communication (DPC) about patient satisfaction. A random sampling technique was adopted for data collection.

METHODOLOGY

The Social Science Statistical Package (SPSS), analysis of moment structures (AMOS), and structural equation modeling were used to analyze the data for reliability, validity, correlations, and descriptive findings. The 879 responses were used for study analysis.

RESULTS

The study revealed that patient satisfaction was found to be significantly affected positively by LS, PHS, DS, NS, and DPS, while DPC, RS, and PF were impacted non-significantly. Consequently, there is a considerable communication gap in the doctor-patient interaction, and Pakistan's healthcare system is confronted with a shortage of physical infrastructure and challenges in the digital system.

CONCLUSION

Furthermore, the insufficient emphasis on registration services necessitates immediate action to improve the entire patient experience and satisfaction. Identifying these shortcomings has the potential to result in a healthcare system that is more efficient and focused on the needs of the patients.

Lived experiences of COVID-19 patients admitted in isolation wards of healthcare centers in Peshawar, Pakistan: A phenomenological perspective

The emergence of COVID-19 caused a significant global threat, affecting populations worldwide. Its impact extended beyond just physical health, as it inflicted severe damage and challenges to individuals' well-being, leading to a deterioration in mental health. The lived experiences of patients hold a paramount position to explore and understand their perception of care which can ultimately strengthen the health system's delivery domain. This study explores the lived experiences of patients in the isolation ward, their recovery, and the quality of care being provided in the hospital and its effects on their mental health.

Study design

A phenomenological qualitative study using in-depth interviews.

Methods

We conducted 11 in-depth interviews of COVID-19 patients admitted to the isolation ward of the public hospitals of Peshawar, Pakistan. Participants who stayed for a minimum of 10 days in an isolation ward were included in this study. Interviews were transcribed and analyzed using NVivo 12 software and generated five themes through inductive analysis.

Results

Five themes emerged from the participants' lived experiences: Heading towards the hospital, Health Care Quality, Impact on Mental Health, Recovering from COVID-19 and Back on one's feet. These included all the positive and negative lived experiences. Socio-environmental factors along with their experiences of the disease itself and with the healthcare providers guided their reaction which was important conciliators in their experiences during the pandemic.

Conclusion

Based on the findings, the environment of isolation had a major influence on the mental well-being of the individuals involved. Considering the important role of the ward environment in shaping patient experiences and outcomes prompts a reevaluation of healthcare practices and policies. By addressing these factors healthcare systems can strive for greater effectiveness, resilience, and compassion in managing the pandemic's impact on patient care.

Hematological parameters to predict post-COVID-19 immune response among vaccinated and nonvaccinated individuals: a retrospective cross-sectional study

Background

This study finds the changes in the hematological parameters of healthy individuals to predict the immune status against coronavirus disease 2019 (COVID-19) among COVID -19 vaccinated and nonvaccinated individuals.

Methods

A comparative cross-sectional study among 210 healthy individuals was conducted. All individuals were divided into three groups, that is, IgG positive, IgG negative, and IgG and IgM positive, based on ELISA. Data analysis was done using SPSS version 25 for Windows.

Results

A statistically significant effect was found among the three groups in terms of mean levels of hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), red blood cells (RBC), RDW-CV, lymphocyte, neutrophil, eosinophils, and basophil count. The study also showed that 52.8% (n=74) had neither taken vaccination nor had any history of previous COVID-19 infection but were IgG antibody positive.

Conclusion

There was a statistically significant difference among hematological parameters between immune and nonimmune groups, and it can predict the COVID-19 immune status.

The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone

Background

Lassa fever is a critical public health issue in Sierra Leone that demands appropriate health system responses and interventions to mitigate infections and reduce mortality.

Methods

A qualitative study was conducted to delve into healthcare workers' experiences with Lassa fever management and interventions across diverse healthcare settings in Sierra Leone, including the Eastern Province and Freetown's Directorate of Health Security and Emergency (DHSE). Engaging ten key informants through purposive sampling, the study employed NVivo version 10 for a detailed thematic analysis using Query and Coding to systematically identify, classify, and organize key themes regarding knowledge, diagnostics, management roles, and community impact.

Results

The findings indicate a well-informed healthcare workforce but highlight gaps in early detection, diagnostic accuracy, and procedural standardization. Concerns were raised about the potential overestimation of disease incidence due to improved diagnostics, suggesting a historical under-detection of Lassa fever. The analysis underscores the need for a multifaceted management approach, emphasizing international collaboration and culturally sensitive community engagement to effectively tackle the disease. A significant concern identified is the high mortality rate resulting from delayed referrals and communication challenges within the health system, leading to actionable recommendations for enhancing Lassa fever response strategies. The study's thematic analysis provides a nuanced understanding of the challenges and areas for improvement, emphasizing the critical role of healthcare professionals in combating Lassa fever.

Conclusion

Combating Lassa fever in Sierra Leone demands an integrative strategy that extends beyond medical interventions to encompass educational and infrastructural enhancements. This research pays homage to the commitment of healthcare professionals, underscoring the importance of sustained support and recognition of their essential contributions to advancing Lassa fever management and interventions.

Factors Contributing to Increased Workplace Violence Against Nurses During COVID-19 in the Healthcare Settings of a Lower Middle-income Country: A Qualitative Study

PURPOSE

The aim of this study was to provide the perceptions of nurses, nursing supervisors, and nursing administrators about factors contributing to increased workplace violence (WPV) against nurses within the healthcare settings in Pakistan during the first wave of the COVID-19 pandemic.

METHODS

This study used a Descriptive Qualitative design, with a purposive sampling technique. From September to December 2021, In-depth interviews of 45 to 60 minutes, using a semistructured interview guide, we collected data from a private and a public healthcare setting in Pakistan. Given the travel restrictions during the COVID-19 pandemic, these interviews were conducted online, using Zoom audio features. Bedside nurses, nursing supervisors, and nursing administrators with at least six months of work experience participated in this study.

RESULTS

The qualitative data analysis steps suggested by Braun and Clarke (2013) were used for thematic analysis. The overarching theme emerging from the data was "Factors perceived by nurses that contributed to increased WPV in their work settings during the first wave of COVID-19, in a lower middle-income country" The subthemes from the participants' narrations were (a) highly stressed patients, attendants, and healthcare workers; (b) the financial burden on patients and their families; (c) lack of resources and shortage of staff; (d) restricted visiting policy and a weak security system; (e) lack of awareness about the seriousness of COVID-19; (f) misconceptions about COVID-19 vaccines and nurses' role in disseminating awareness.

CONCLUSIONS

The current pandemic increased the intensity of WPV against nurses in healthcare settings in Pakistan. Despite any supposed reasons for WPV, exposure to violence should never be an acceptable part of nursing. The healthcare system in Pakistan needs to pay equal attention to funding, resource provision, and ensuring a safe working environment for healthcare workers.

Learning From COVID-19: What Would It Take to Be Better Prepared in the Eastern Mediterranean Region?

The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was influenced by various factors such as conflict, demographics, travel and social restrictions, migrant workers, weak health systems, and mass gatherings. The countries that responded well to COVID-19 had high-level political commitment, multisectoral coordination, and existing infrastructures that could quickly mobilize. However, some EMR countries faced challenges due to political instability and fragile health systems, which hindered their response strategies. The pandemic highlighted the region's weak health systems and preparedness, fragmented surveillance systems, and lack of trust in information sharing. COVID-19 exposed the disruption of access and delivery of essential health services as a major health system fragility. In 2020, the World Health Organization (WHO) conducted a global pulse survey, which demonstrated that the EMR experienced the highest disruption in health services compared to other WHO regions. However, thanks to prioritization by the WHO and its member states, significant improvement was observed in 2021 during the second round of the WHO's National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement, and trust and emphasized that investing in health security benefits everyone. Increasing vaccine coverage, building regional capacities, strengthening health systems, and working toward universal health coverage and health security are all priorities in the EMR. Emergency public health plays a key role in preparing for and responding to pandemics and biological threats. Integrating public health into primary care and investing in public health workforce capacity building is essential to reshaping public health and health emergency preparedness.

Assessment of Qatar's Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study

BACKGROUND

The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization.

OBJECTIVE

This study aims to comprehensively examine the community call center's operations and their significant role during the COVID-19 pandemic.

METHODS

Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations.

RESULTS

The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19-related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls.

CONCLUSIONS

The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises.

COVID-19 Testing Trend: A Retrospective Analysis of the Three Major Pandemic Waves in Punjab, Pakistan

BACKGROUND/OBJECTIVES

There is some evidence in the literature of under-testing of COVID-19 cases in Pakistan. This study aims to explore COVID-19 testing trends and the factors affecting them in a lower middle-income country for future infectious disease policy-making and intervention strategies.

METHODOLOGY

The study was conducted as a serial cross-sectional study during the three major peaks from March 2020 to June 2021 on 1616 participants in Punjab, Pakistan. This is the first study to explore COVID-19 testing trends in association with flu-like symptoms (FLS) and the factors affecting all three major waves in Pakistan.

RESULTS

The results show that in all three waves, only 18.8% reported COVID-19 tested despite that 86.7% thought they had already had COVID-19, with 51.3% reporting having FLS and 35.6% with exposure to FLS from their families and 19.8% of positive testing rate among their family members. Out of the survey participants, 66% received vaccination, and over 80% had their eligible family members immunized. Fear of contracting COVID-19 was 69.7% in all three waves. Factors positively associated with the uptake of testing were the age group of 31-40 years with an adjusted odds ratio of 3.27 (95% confidence interval (CI): 2.09-5.12) for the second wave and an adjusted odds ratio of 13.75 (95% CI: 9.43-20.01) for the third wave and traveling abroad with odds of 3.08 times when the reference was inland traveling. The adjusted odds ratio to test for FLS was 1.62 (95% CI: 1.21-2.16).

CONCLUSION

In this study, there is convincing evidence of COVID-19 under-testing and thus under-reporting. This study also suggests that fear-based interventions may be counterproductive; however, economic factors such as education, employment, and traveling are significant in guiding the behavior for infectious disease prevention and management.

Comparative impact assessment of COVID-19 policy interventions in five South Asian countries using reported and estimated unreported death counts during 2020-2021

There has been raging discussion and debate around the quality of COVID death data in South Asia. According to WHO, of the 5.5 million reported COVID-19 deaths from 2020-2021, 0.57 million (10%) were contributed by five low and middle income countries (LMIC) countries in the Global South: India, Pakistan, Bangladesh, Sri Lanka and Nepal. However, a number of excess death estimates show that the actual death toll from COVID-19 is significantly higher than the reported number of deaths. For example, the IHME and WHO both project around 14.9 million total deaths, of which 4.5-5.5 million were attributed to these five countries in 2020-2021. We focus our gaze on the COVID-19 performance of these five countries where 23.5% of the world population lives in 2020 and 2021, via a counterfactual lens and ask, to what extent the mortality of one LMIC would have been affected if it adopted the pandemic policies of another, similar country? We use a Bayesian semi-mechanistic model developed by Mishra et al. (2021) to compare both the reported and estimated total death tolls by permuting the time-varying reproduction number (Rt) across these countries over a similar time period. Our analysis shows that, in the first half of 2021, mortality in India in terms of reported deaths could have been reduced to 96 and 102 deaths per million compared to actual 170 reported deaths per million had it adopted the policies of Nepal and Pakistan respectively. In terms of total deaths, India could have averted 481 and 466 deaths per million had it adopted the policies of Bangladesh and Pakistan. On the other hand, India had a lower number of reported COVID-19 deaths per million (48 deaths per million) and a lower estimated total deaths per million (80 deaths per million) in the second half of 2021, and LMICs other than Pakistan would have lower reported mortality had they followed India's strategy. The gap between the reported and estimated total deaths highlights the varying level and extent of under-reporting of deaths across the subcontinent, and that model estimates are contingent on accuracy of the death data. Our analysis shows the importance of timely public health intervention and vaccines for lowering mortality and the need for better coverage infrastructure for the death registration system in LMICs.

'Immune-inflammatory markers & clinical characteristics for outcomes in hospitalized SARS-CoV-2 infected patients of Pakistan: a retrospective analysis'

OBJECTIVE

Accumulating evidence suggests the role of immune-inflammatory markers in early risk stratification and prognostication of COVID-19 patients. We aimed to evaluate their association with severity and the development of diagnostic scores with optimal thresholds in critical patients.

SETTING AND PARTICIPANTS

This retrospective case study includes hospitalized COVID-19 patients from March 2019 to March, 2022, in the developing area teaching hospital in Pakistan. Polymerase chain reaction (PCR) positive patients, n = 467 were investigated for clinical outcomes, comorbidities and disease prognosis. The plasma levels of Interleukin-6 (IL-6), Lactate dehydrogenase (LDH), C-reactive protein (CRP), Procalcitonin (PCT), ferritin and Complete blood count markers were measured.

RESULTS

Majority were males (58.8%) and patients with comorbidities had more severe disease. Hypertension and diabetes mellitus were the commonest comorbidities. Shortness of breath, myalgia and cough were the main symptoms. The hematological markers NLR, as well as the plasma levels of immune-inflammatory variables, IL-6, LDH, Procalcitonin, Erythrocyte sedimentation rate, Ferritin were markedly raised in severe and critical patients (p < 0.0001 for these markers). ROC analysis supports IL-6 as the most accurate marker with high prognostic relevance with proposed cut-off threshold (43 pg/ml), determining >90% of patients in terms of COVID-19 severity (AUC = 0.93, 91.7%, se; 90.3%sp). Furthermore, positive correlation with all other markers including NLR with cut-off = 2.99 (AUC = 0.87, se = 89.8%, sp = 88.4%), CRP with cut-offs at 42.9 mg/l, (AUC = 0.883, se = 89.3% and sp = 78.6%), LDH cut-off at 267μg/L, evidenced in >80% patients (AUC = 0.834 se = 84% and sp = 80%). Additionally, ESR and ferritin have the corresponding AUC 0.81 and 0.813 with cut-off at 55 mm/hr and 370, respectively.

CONCLUSION

Investigating the immune-inflammatory markers can assist physicians in providing prompt treatment and ICU admission in terms of COVID-19 severity. As a result, which may reduce the overall mortality of COVID-19 patients.

PLANNING TO 'NEW NORMAL' DURING COVID-19 PANDEMIC AT GENERAL SURGERY DEPARTMENT: A TURKEY EXPERIENCE

Planning of non-postponable treatments for cancer, trauma, emergency diseases, and follow-up and treatment of chronic diseases are inevitable for the ongoing pandemic and future pandemics. In this study, we evaluated the capacity of surgical applications and treatments made to the surgery department in the first 3 months of the onset of the COVID-19 pandemic. A retrospective cohort study was performed from March 12, 2020 to June 1, 2020. COVID-19 negative general surgery patients were included. Demographics, diagnosis and management were recorded, as well as bed turnover and length of stay in the hospital. Similar data were collected on patients admitted during the same period in 2019 and 2018 to allow for comparison. A total of 1764 operations were included. There was a reduction in surgeries when comparing 2020 with 2019 and 2018 (164 vs. 713 and 890); however, there was no difference in the length of stay in the hospital (4.12 vs. 4.37 and 4.07 days, p=0.626). During 2020, appendectomies decreased (53 vs. 102 and 100, p=0.013). There was no difference in the number of emergency oncologic surgeries during 2020 as compared with 2019 and 2018 (16 vs. 8 and 13, p=0.149). In conclusion, COVID-19 significantly impacted the number of admissions to general surgery. However, cancer and emergency operations continued to be required, thus provisions need to be made to enable planning these interventions.

A resilience perspective on healthcare personnels' experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and come care services

BACKGROUND

The COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services.

METHOD

This study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis.

RESULTS

The analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: "PHCP demonstrated high adaptive capacity while being put to the test", "Adapting to organizational measures, with varying degree of success" and "Safeguarding the patient's safety and quality of care, but at certain costs".

CONCLUSION

This study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed.

CanSino COVID-19 Vaccine: Comparison of Vaccine Adverse Effects Among Diabetic and Non-diabetic Recipients

Introduction The emergence of potent vaccines is crucial in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Two of the many factors influencing the acceptance of the vaccine are perceptions about its efficacy, effectiveness, safety, and side effects. Thus, this study compared patients with and without diabetes mellitus (DM) who received the CanSino (CanSinoBIO, Tianjin, China) COVID-19 vaccination to identify the prevalence of local and general side effects. Methods This was a multicenter, cross-sectional study performed using a non-probability sampling method. The study period was six months, from August 1, 2022, to January 31, 2023. The study included 600 participants who provided informed consent and had received the CanSino vaccine in a single dose. Demographic characteristics of the participants, including gender, age, weight, and height; comorbidities such as hypertension and diabetes; previous infection with COVID-19; and the prevalence of any local and systemic side effects following vaccination, were documented. Between diabetic and non-diabetic participants, the relationship between local and general side effects and satisfaction levels was assessed using the chi-square test. Results The study findings showed that out of 600 participants, 287 (95.7%) were males and 13 (4.3%) were females who had DM, whereas 229 (76.3%) males and 71 (23.7%) females did not. There was a statistically significant association between the two groups (p < 0.001). After receiving a single dose of the CanSino vaccine, the most frequently noticeable side effect was fever, which was noticed in 260 (86.75%) diabetic patients and 279 (93.0%) non-diabetic participants, with a significant association noted among them (p=0.010). Among the non-diabetic participants, 164 (54.7%) were satisfied, and 155 (51.7%) diabetics and 65 (21.7%) non-diabetic participants were extremely pleased with their vaccinations. Conclusion This study concluded that participants with comorbid diseases such as DM had both general and local side effects far more frequently than those without DM. The most noticeable side effects after a single dose of CanSino were fever, injection site pain, and burning. The CanSino vaccine did not require hospitalization and had a relatively low frequency of local and systemic side effects.

Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis

OBJECTIVE

To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DESIGN

Systematic review with meta-synthesis.

DATA SOURCES

Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus.

ELIGIBILITY CRITERIA

Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis.

RESULTS

Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services.

CONCLUSION

Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.

When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan

Introduction

Moral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distress, and impairment in social and occupational functioning. The COVID-19 pandemic predisposed healthcare providers to moral dilemmas, potentially morally injurious events (PMIEs), and MI. We aimed to assess the prevalence and predictors of MI in healthcare providers during the COVID-19 pandemic in Pakistan.

Materials and methods

This cross-sectional study was conducted in July-October 2021 among physician/clinician staff working at teaching hospitals in Lahore. The Moral Injury Symptoms Scale-Health Professionals (MISS-HP) was used to collect data. SPSS 26 was used for data analysis applying Wilcoxon Mann-Whitney U and Kruskal-Wallis tests on non-normally distributed data at α = 0.05. Predictors of MI were ascertained through Binary Logistic Regression analysis.

Results

Four hundred and twenty physicians responded to the questionnaires. The Median (IQR) MI scores were 37(28-47). Guilt, moral concerns, and shame were higher-scoring MI dimensions. 40.8% (n = 171) suffered from clinically significant distress and impaired functioning while 14.3% (n = 60) from severe distress. Gender, department, and history of psychiatric illness predicted higher levels of distress which were 1.9 times higher in females than males and 2.5 times higher with a history of psychiatric illness. Working on the front lines did not predict MI.

Conclusion

Our findings highlight the substantial burden of MI in our sample during COVID-19, having implications for healthcare providers' well-being, healthcare quality, and service delivery. This calls for concerted efforts from all stakeholders to better prepare for future disasters through effective human-resource policies, pre-trauma exposure soft-skills training, effective teamwork and communication strategies; self-stewardship and resilience modules, and mental health support for healthcare providers. The dimensional construct of MI may vary across cultures; hence we recommend further cross-cultural research on MI in healthcare providers, particularly in the context of public health disasters.

Assessment of COVID-19 management and its consequences on healthcare professionals: a cross-sectional study from Bangladesh

OBJECTIVE

This explorative study aims to identify the gaps in COVID-19 management and their consequences on physicians in terms of contracting infection and psychological well-being during the early phase of the pandemic.

DESIGN, SETTINGS AND PARTICIPANTS

We conducted a nationwide cross-sectional online study to collect information from 420 intern doctors who were at their internship in government medical colleges from February to August 2020.

METHODS

We performed univariate and bivariate analyses to assess COVID-19 management. We investigated the consequences of COVID-19 management on infection risk, experiencing stress, developing anxiety, depression and sleep disturbance using five sets of multivariable logistic regression analyses.

RESULTS

Findings indicate a delay in first-case detection and identify people's tendency to hide COVID-19 symptoms as one of the possible causes of that delay. About 56% of the intern doctors experienced that patients were trying to hide COVID-19 symptoms in the earlier phase of the pandemic. More than half of the respondents did not get any training on COVID-19 from their working institutions. About 30% and 20% of the respondents did not use personal protective equipment (PPE) and masks while treating patients. Respondents who treated patients without PPE, masks, face shields and gloves were almost two times as likely to be infected by COVID-19. The odds of experiencing COVID-19-related stress was almost twofold among respondents who treated patients without wearing PPE and masks. Experiencing COVID-19-related stress was further associated with an increased risk of developing anxiety and depression that led to sleep disturbance.

CONCLUSION

Ensuring the maximum utilization of limited resources during any public health crisis such as COVID-19 needs developing coping mechanisms by projecting future demand. Ensuring proper training and safety measures can reduce physical and psychological hazards among physicians.

Impact of COVID-19 pandemic on health care workers (HCWs) in Sindh Province of Pakistan

BACKGROUND

In Pakistan, the COVID-19 outbreak posed a significant challenge for healthcare workers in the country's public hospitals. The HCWs faced several problems in terms of the COVID-19 pandemic. Therefore this study investigated how the COVID-19 pandemic has affected the medical staff at the public hospital in Sindh Province, Pakistan.

METHODS

In this study, a qualitative exploratory design was used. Semi-Structure interviews (SSI) were conducted by using an open-indeed questionnaire (OIQ) for data collection. An inductive approach was used for theoretical data analysis. A total of 320 HCWs participated to complete the criteria of the study from 10 different public hospitals.

RESULTS

The study result showed the Sindh public hospital's insufficient infrastructure, lack of health protective equipment, shortages of isolation rooms and beds, and emergencies during the COVID-19 pandemic caused HCWs to experience physical and psychological weariness, sleep disturbance, mental stress, and fear of infection.

CONCLUSION

The study concluded that public hospitals' insufficient infrastructure, furniture, emergency wards, and safety equipment during the COVID-19 pandemic significantly damaged HCWs' physical and psychological health, generating fear of infection and sleep disturbance. Additionally, Sindh healthcare workers' fear of illness and isolation may impair family connections.

Advancements in SARS-CoV-2 Testing: Enhancing Accessibility through Machine Learning-Enhanced Biosensors

The COVID-19 pandemic highlighted the importance of widespread testing for SARS-CoV-2, leading to the development of various new testing methods. However, traditional invasive sampling methods can be uncomfortable and even painful, creating barriers to testing accessibility. In this article, we explore how machine learning-enhanced biosensors can enable non-invasive sampling for SARS-CoV-2 testing, revolutionizing the way we detect and monitor the virus. By detecting and measuring specific biomarkers in body fluids or other samples, these biosensors can provide accurate and accessible testing options that do not require invasive procedures. We provide examples of how these biosensors can be used for non-invasive SARS-CoV-2 testing, such as saliva-based testing. We also discuss the potential impact of non-invasive testing on accessibility and accuracy of testing. Finally, we discuss potential limitations or biases associated with the machine learning algorithms used to improve the biosensors and explore future directions in the field of machine learning-enhanced biosensors for SARS-CoV-2 testing, considering their potential impact on global healthcare and disease control.

Quality of care in the course of subcutaneous versus intravenous trastuzumab administration in patients with breast cancer: an integrated time-motion study with mixed-methods research

OBJECTIVES

This study aimed to compare the time required and concerns raised by various perspectives of participants regarding administering subcutaneous and intravenous trastuzumab for patients with breast cancer (BC).

DESIGN

This observational time-motion study design with mixed-methods research (cross-sectional surveys and semistructured interviews) was conducted. The time spent on preparing or administering trastuzumab by different healthcare professionals (HCPs) was recorded. The data were analysed by descriptive/inferential statistical analyses, followed by thematic analyses.

SETTING

Outpatient and inpatient administration units of a single medical centre in Taiwan.

PARTICIPANTS

The study included patients with early-stage BC who received subcutaneous or intravenous trastuzumab (n=93), and HCPs including two attending physicians, a nurse practitioner, two pharmacists and two nurses.

RESULT

Based on the perspectives of patients and HCPs, the subcutaneous form of trastuzumab was more efficient, less expensive and produced less discomfort in outpatient units than inpatient units. More participants preferred the subcutaneous form over the intravenous form in both outpatient and inpatient units. Pharmacists and nurse practitioners spent threefold more time on patients when preparing and administering the intravenous form in both outpatient and inpatient units. The concerns raised by patients and HCPs varied in certain aspects, including the injection skills, speed, mental distress (eg, needle phobia) and pain associated with the subcutaneous form. Almost all patients preferred receiving the subcutaneous form in outpatient units after the initial COVID-19 outbreak.

CONCLUSION

Patients with early-stage BC preferred receiving subcutaneous trastuzumab in outpatient units rather than inpatient units or the intravenous form before and after the COVID-19 outbreak. Such findings may serve as real-world evidence to facilitate better quality of care regarding administration of subcutaneous or intravenous trastuzumab in medical settings, and its feasible resolutions to balance the quality, concerns and efficiency of anticancer administration during the COVID-19 pandemic.

Adherence to Infection Prevention and Control Measures Among Health-Care Workers Serving in COVID-19 Treatment Centers in Punjab, Pakistan

OBJECTIVE

Infection prevention and control (IPC) measures are easily adoptable activities to prevent the spread of infection to patients as well as among health-care workers (HCWs).

METHODS

This cross-sectional study evaluated the adherence to IPC measures among HCWs working at coronavirus disease 2019 (COVID-19) treatment centers in Punjab, Pakistan. HCWs were recruited by means of convenient sampling through Google Form^® using the World Health Organization risk assessment tool. All data were analyzed using SPSS 20.

RESULTS

A total of 414 HCWs completed the survey (response rate = 67.8%), and majority of them were males (56.3%). Most of the HCWs were nurses (39.6%) followed by medical doctors (27.3%). Approximately 53% reported insufficiency of personal protective equipment (PPE), 58.2% did not receive IPC training and 40.8% did not have functional IPC team at their health facilities. The majority of HCWs (90%) used disposable gloves and N95 facemasks while interacting with COVID-19 patients. Nearly 45% used protective face shields and gowns before providing care to their patients. Hand hygiene practices while touching, and performing any aseptic procedure was adopted by 70.5% and 74.1% of HCWs, respectively.

CONCLUSIONS

In conclusion, the adherence to IPC measures among Pakistani HCWs working in COVID-19 treatment centers is good despite the limited availability of PPEs. Their practices can be optimized by establishing institutional IPC teams, periodic provision of IPC training, and necessary PPE.

Impact of COVID-19 on cardiovascular clinics: Are we ready for telemedicine?

Objective

The need for telemedicine was felt more than ever during the COVID-19 pandemic, which impacted health care worldwide. Therefore, this study aimed to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19, along with assessing the awareness and acceptability of telemedicine.

Methods

In this cross-sectional study, selected patients presenting to outpatient department of a tertiary care cardiac hospital were interviewed regarding the difficulties faced by patients in visiting the outpatient department during COVID-19 and their awareness and acceptability of telemedicine using a self-designed structured questionnaire.

Results

Of the 403 patients, 58.3% were male, the mean age was 53.04 ± 11.73 years, and most (77.7%) were urban residents. Ischemic heart disease was present in 69.5%, followed by hypertension (38.7%) and heart failure (29.3%). A total of 26.6% required emergency room visits. Limited appointments (55.6%) was the most common problem faced by patients during COVID-19, followed by financial issues (17.1%), fear of acquiring infection (13.4%), and limited mobility due to lockdown (22.6%). Only 12.2% were aware of telemedicine, 4.5% had previously used it, and 41.2% were willing to opt for telemedicine in the future. No internet access (39.2%) was the key barrier to the usage of telemedicine, followed by a lack of free medicine (39%) and a lack of a smart device (31.5%).

Conclusion

Limited appointments due to COVID-19 restrictions has made it difficult for patients to visit the clinics, which has led to increased emergency room visits. Telemedicine awareness was found to be limited; however, many patients were willing to adopt it provided their limitations could be overcome.

Impact of facemasks on the mouth as an emerging dental concern: A survey among residents of Karachi

Background

The illness known as "mask-mouth syndrome," which is brought on by constantly covering one's mouth and nose with a mask, was particularly prevalent among healthcare personnel. The covid-19 pandemic, however, had far-reaching effects on people's daily lives all around the world, to the point where mask use became practically mandatory. With Covid-19 posing a new threat to dental health, this study aims to assess the public's awareness of the issue and investigate how wearing a facemask affects oral hygiene.

Methods

Cross-sectional research was conducted at Karachi's Jinnah Medical & Dental College. From February to May of 2022, it was carried out in the Dental Opd. A survey of 400 people was conducted, representing a cross-section of society in terms of age, gender, occupation, and other criteria. The poll had 11 closed-ended questions. The data was analyzed using SPSS 24. Descriptive analysis was used to examine the responses.

Results

Men made up 44.5% (n = 174) of responses and women 56.5% (n = 226). Mean participant age was 27.31, ranging from 18 to 50. 99% (n = 396) of respondents wear masks. 48% (n = 192) of participants were uncomfortable using facemasks. Disposable face masks were voted the best option by 60.5% of respondents (n = 242). Negative effects or conditions brought on by mask use, such as halitosis (47.3%, n = 189) and dehydration (64.3%, n = 257).

Conclusion

Mask-mouth syndrome can occur as a result of using a face mask for prolonged periods of time. Mask benefits outweigh the danger of mask mouth syndrome.

Impact of COVID-19 on mental health of primary healthcare workers in Pakistan: lessons from a qualitative inquiry

OBJECTIVES

The existing literature regarding the mental health consequences of COVID-19 among healthcare workers revolves predominantly around specialised hospital settings, while neglecting primary healthcare workers (PHCW) who are the first point of contact for patients. In view of negligible evidence, this study explored the mental health impact of COVID-19 and health system response, and sought suggestions and recommendations from the PHCWs to address their mental health needs during the pandemic crisis.

DESIGN

We employed a qualitative exploratory design.

SETTING

A total of 42 primary healthcare facilities across 15 districts in Sindh and Punjab provinces of Pakistan.

PARTICIPANTS

We telephonically conducted 47 in-depth interviews with health service providers and hospital managers. A combination of inductive and deductive approach was used for data analyses using NVivo V.11.0.

RESULTS

There was immense fear, stress and anxiety among PHCWs being infected and infecting their families at the beginning of this outbreak and its peak which tapered off over time. It was triggered by lack of information about the virus and its management, false rumours, media hype, lack of personal protective measures (personal protective equipment, PPE) and non-cooperation from patients and community people. Trainings on awareness raising and the PPEs provided by the healthcare system, with emotional support from coworkers and supervisors, were instrumental in addressing their mental health needs. Additionally, they recommended appreciation and recognition, and provision of psychosocial support from mental health professionals.

CONCLUSION

Primary healthcare system should be prepared to provide timely informational (eg, continuous updates in training and guidelines), instrumental (eg, provision of PPE, appreciation and recognition), organisational (eg, safe and conducive working environment) and emotional and psychosocial support (eg, frequent or needs-based session from mental health professionals) to PHCWs in order to mitigate the mental health impact of pandemic crisis.

Understanding the mental health impact and needs of public healthcare professionals during COVID-19 in Pakistan : a qualitative study

OBJECTIVES

A dearth of qualitative studies constrains in-depth understanding of health service providers' perspectives and experiences regarding the impact of COVID-19 on their mental health. This study explored the mental health impact and needs of of public sector healthcare workers during COVID-19 who working in secondary-level and tertiary-level healthcare settings of Pakistan.

DESIGN

An exploratory qualitative study.

SETTING

Twenty-five secondary-level and eight tertiary-level public hospitals of Sindh and Punjab provinces of Pakistan.

PARTICIPANTS

In-depth interviews were conducted with 16 health service providers and 40 administrative personnel. Study data were analysed on NVivo V.11 using the conventional content analysis technique.

RESULTS

The study identified three overarching themes: (1) mental health impact of COVID-19 on health service providers that included the fear of acquiring the infection and transmitting it to their family members, fear of social isolation and stigma, anxiety related to the uncertainty of COVID-19, nervousness due to media exaggeration and stress associated with excessive workload; (2) mental health needs of health service providers involved in the COVID-19 crisis and available support from the healthcare system, including the expression of the need for counselling services and safe working conditions, the need for paid rest periods, and the need for appreciation and motivation to work in the pandemic; and (3) suggestions to address mental health needs of healthcare workers, including provision of specialised mental healthcare/services, formal training of health managers on managing mental health needs of health facility staff, and assessment and addressing of these needs of the health workforce.

CONCLUSION

The study emphasises the need to strengthen health system preparedness for recognising and addressing the needs of healthcare professionals. At the system level, there is a need for a specialised unit to provide mental health services and better communication strategies. At the staff level, continuous motivation and appreciation should be given to healthcare professionals either through monetary incentives or formal acknowledgement of their performance.

Consortium Framework Using Blockchain for Asthma Healthcare in Pandemics

Asthma is a deadly disease that affects the lungs and air supply of the human body. Coronavirus and its variants also affect the airways of the lungs. Asthma patients approach hospitals mostly in a critical condition and require emergency treatment, which creates a burden on health institutions during pandemics. The similar symptoms of asthma and coronavirus create confusion for health workers during patient handling and treatment of disease. The unavailability of patient history to physicians causes complications in proper diagnostics and treatments. Many asthma patient deaths have been reported especially during pandemics, which necessitates an efficient framework for asthma patients. In this article, we have proposed a blockchain consortium healthcare framework for asthma patients. The proposed framework helps in managing asthma healthcare units, coronavirus patient records and vaccination centers, insurance companies, and government agencies, which are connected through the secure blockchain network. The proposed framework increases data security and scalability as it stores encrypted patient data on the Interplanetary File System (IPFS) and keeps data hash values on the blockchain. The patient data are traceable and accessible to physicians and stakeholders, which helps in accurate diagnostics, timely treatment, and the management of patients. The smart contract ensures the execution of all business rules. The patient profile generation mechanism is also discussed. The experiment results revealed that the proposed framework has better transaction throughput, query delay, and security than existing solutions.

Impact of COVID-19 on the wellbeing of micro and small entrepreneurs of rural Pakistan

According to the constitution of Pakistan, the state is responsible for the provision of necessities of life to its citizens whenever their livelihood is permanently or temporarily threatened. COVID-19 and its associated lockdowns were a series of events where amenities of life around the world were seriously endangered. Especially, hard hit were the small- and medium-sized entrepreneurs (SMEs) of rural Pakistan. To quantitatively assess the social and economic impact of COVID-19, we interviewed the local microenterprise owners in rural Pakistan from January to February 2021 and then June 2021. Mean comparison tests were estimated for pre- and post-COVID-19 periods. Results reveal that the COVID-19 pandemic has significantly and negatively affected wellbeing of micro and small entrepreneurs in the regions as the income of most of the sampled entrepreneurs significantly decreased during the pandemic. Disaggregated consumption analysis however revealed that nominal consumption of food, clothing, energy, health, and education all increased, except for communication, during the pandemic. Furthermore, the regression analysis revealed that changes in income, occupation, borrowing during COVID-19, and family type of the respondents were significant factors in mitigating the effects of COVID-19. Based on the findings, policy recommendations are also spelled out in the last section.

COVID-19 stress and wellbeing: A phenomenological qualitative study of Pakistani Medical Doctors

The COVID-19 stress and increased job pressure have largely affected healthcare professionals’ various life domains. This study particularly explores the effect of stress caused by treating COVID-19 patients on medical doctors’ wellbeing. To explore this phenomenon, we interviewed 12 doctors treating COVID-19 patients in hospitals of metropolitan cities in Pakistan. The thematic analysis using NVivo V.12 Plus software of interviews resulted in four major themes, COVID-19 Stressors, Effects of Stress, Nature and Personality, Stress Relievers, and Stress Coping Strategies. Physicians were physically and emotionally stressed as a result of the intense work. Although they were carrying a lot of pain and hurt on their insides, participants demonstrated a sense of professional determination to overcome obstacles. Physicians are currently dealing with their emotional issues, and they should have access to complete professional help to ensure their wellbeing. The COVID-19 pandemic’s mental health effects are anticipated to last far longer than the physical health effects. This study is well-positioned to investigate frontline physicians’ opinions and attitudes concerning the COVID-19 and its impact on their daily lives and mental health. This research will help implement context-specific innovative mental health solutions to help the frontline workers.

Level of Trust in Health Care Systems During COVID-19 Pandemic Among Health Care Workers f Pakistan

This survey aimed to evaluate the levels of trust and satisfaction among healthcare workers towards the national healthcare delivery system and whether it has been affected by the global disruption created by COVID-19. This was an analytical cross-sectional study that took place from January to October 2021 at a tertiary level health care facility in Rawalpindi, Pakistan, using an online data collection tool. Our sample included 10, 133 healthcare workers of all cadres. Our study found a significant level of distrust of healthcare workers towards multiple aspects of the healthcare delivery system, particularly towards government agencies and other members of healthcare delivery. We noted a significant gender disparity between male and female respondents with males showing more trust than female healthcare workers. We conclude that significant efforts need to be made by policymakers in the government to alleviate this trust deficit before it worsens.

How Did Work-Related Depression, Anxiety, and Stress Hamper Healthcare Employee Performance during COVID-19? The Mediating Role of Job Burnout and Mental Health

The study objective was to examine the psychological impact of the COVID-19 pandemic on the performance of healthcare employees. The study was informed by a theoretical framework that incorporates different psychological issues (i.e., stress, depression, and anxiety) that influence healthcare workers' performance through the mediating roles of job burnout and mental health. The study data was gathered through structured questionnaires from 669 participants working in the healthcare sector in Pakistan. A structured equation modeling (SEM) technique was used for data analysis and hypothesis development. It was found that stress, depression, and anxiety positively affected healthcare employees' job performance during COVID-19. Psychological factors had a positive and significant impact on job burnout and mental health. Job burnout and mental health mediated the relationship between stress, anxiety, depression, and employee performance. The ongoing repercussions of COVID-19 include their impact on employee performance in the healthcare sector. Healthcare worker performance is critical to fostering industrial economic growth. Elevated levels of stress, depression, and anxiety have profoundly exacerbated employee mental health issues. COVID-19 has created challenging working conditions in organizations requiring that they address the growing psychological issues which impact negatively on worker performance.

Reasons behind declining of cases during the COVID-19 wavelets in Pakistan: public healthcare system or government smart lockdown policy?

The latest statistics show that COVID-19 is still very active, and cases are on the rise across various countries and regions. On the other hand, statistics from Pakistan show a declining trend, especially during the first wave of the COVID-19 pandemic. To understand this declining trend and answering our established question, "What are the reasons behind the decline of the COVID-19 cases in Pakistan - public healthcare facilities or government smart lockdown policy?" narrative literature-based evidence collected from government official websites, reports and also Google Scholar. Our findings suggest that the government's innovative smart lockdown strategy and its execution at the right time with the consensus of all stakeholders accompanied with the observing of COVID-19 standard operation procedures resulted in controlling the pandemic. Effective smart lockdown policy allows the government to identify shortcomings of and improve the capabilities of healthcare for the continuation of balanced socio-economic activities to avoid future spread-out of the pandemic in the time of crisis under national and World Health Organization guidelines.

Diagnosis of coronavirus disease 2019 and the potential role of deep learning: insights from the experience of Cairo University Hospitals

OBJECTIVES

Early detection of coronavirus disease 2019 (COVID-19) is crucial for patients and public health to ensure pandemic control. We aimed to correlate clinical and laboratory data of patients with COVID-19 and their polymerase chain reaction (PCR) results and to assess the accuracy of a deep learning model in diagnosing COVID-19.

METHODS

This was a retrospective study using an anonymized dataset of patients with suspected COVID-19. Only patients with a complete dataset were included (n = 440). A deep analytics framework and dual-modal approach for PCR-based classification was used, integrating symptoms and laboratory-based modalities.

RESULTS

Participants with loss of smell or taste were two times more likely to have positive PCR results (odds ratio [OR] 1.86). Participants with neutropenia, high serum ferritin, or monocytosis were three, four, and five times more likely to have positive PCR results (OR 2.69, 4.18, 5.42, respectively). The rate of accuracy achieved using the deep learning framework was 78%, with sensitivity of 83.9% and specificity of 71.4%.

CONCLUSION

Loss of smell or taste, neutropenia, monocytosis, and high serum ferritin should be routinely assessed with suspected COVID-19 infection. The use of deep learning for diagnosis is a promising tool that can be implemented in the primary care setting.

Epidemiology, Clinico-Pathological Characteristics, and Comorbidities of SARS-CoV-2-Infected Pakistani Patients

SARS-CoV-2 is a causative agent for COVID-19 disease, initially reported from Wuhan, China. The infected patients experienced mild to severe symptoms, resulting in several fatalities due to a weak understanding of its pathogenesis, which is the same even to date. This cross-sectional study has been designed on 452 symptomatic mild-to-moderate and severe/critical patients to understand the epidemiology and clinical characteristics of COVID-19 patients with their comorbidities and response to treatment. The mean age of the studied patients was 58 ± 14.42 years, and the overall male to female ratio was 61.7 to 38.2%, respectively. In total, 27.3% of the patients had a history of exposure, and 11.9% had a travel history, while for 60% of patients, the source of infection was unknown. The most prevalent signs and symptoms in ICU patients were dry cough, myalgia, shortness of breath, gastrointestinal discomfort, and abnormal chest X-ray (p < 0.001), along with a high percentage of hypertension (p = 0.007) and chronic obstructive pulmonary disease (p = 0.029) as leading comorbidities. The complete blood count indicators were significantly disturbed in severe patients, while the coagulation profile and D-dimer values were significantly higher in mild-to-moderate (non-ICU) patients (p < 0.001). The serum creatinine (1.22 μmol L^-1; p = 0.016) and lactate dehydrogenase (619 μmol L^-1; p < 0.001) indicators were significantly high in non-ICU patients, while raised values of total bilirubin (0.91 μmol L^-1; p = 0.054), C-reactive protein (84.68 mg L^-1; p = 0.001), and ferritin (996.81 mg L^-1; p < 0.001) were found in ICU patients. The drug dexamethasone was the leading prescribed and administrated medicine to COVID-19 patients, followed by remdesivir, meropenem, heparin, and tocilizumab, respectively. A characteristic pattern of ground glass opacities, consolidation, and interlobular septal thickening was prominent in severely infected patients. These findings could be used for future research, control, and prevention of SARS-CoV-2-infected patients.

COVID-19, Vaccination, and Conspiracies: A Micro-Level Qualitative Study in Islamabad, Pakistan

Although vaccination is the only hope to fight against COVID-19, existing vaccine hesitancy is a thought-provoking phenomenon. Significantly, vaccine hesitancy is worsening the situation in Pakistan, leading to an increased number of COVID cases. In this context, this study aims to examine people's perceptions and attitudes towards vaccination. Here the focus was on determining the factors causing disease hesitancy among the masses. The researchers randomly selected a sample of n=17 individuals and gathered data by using telephone interviews and assessed data by using the Interpretive Phenomenological Analysis (IPA) approach. Results revealed that the increased vaccine hesitancy is due to misinformation, conspiracies, myths, and rumors about the side effects of the vaccination. It was also notable that the participants indicated digital media as the primary source of information, showing a potential relationship between social media and misinformation. Also, an intense uncertainty about the healthcare system in Pakistan is hindering the efforts to sustain herd immunity. Thus, due to several myths, rumors, and distrust of the healthcare system, vaccine hesitancy is halting the country's ability to overcome the COVID-19 outbreak. Misinformation is vigorously circulating due to ease of access to different communication platforms, instilling fear of presumed side effects. Hence, the researchers suggest some practical considerations for the government, healthcare workers, and media platforms to counteract the misinformation and increase vaccine acceptance among the masses.

Documenting response to COVID-individual and systems successes and challenges: a longitudinal qualitative study

Background

This study aimed to document the evolution of perceptions of frontline healthcare workers (FHCW) regarding their well-being and the quality of health systems' response to the COVID-19 pandemic over four months in Pakistan.

Methods

We conducted this prospective longitudinal qualitative study during the four months (June–September 2020) coinciding with the peak and trough of the first wave of Pakistan's COVID-19 pandemic. We approached frontline healthcare workers (physicians and nurses) working in emergency departments (ED) in two hospitals using the WhatsApp group of the Pakistan Society of Emergency Physicians (PSEM). Participants were asked to self-record their perception of their wellness and their level of satisfaction with the quality of their hospitals' response to the pandemic. We transcribed, translated, and analysed manually using MAXQDA 2020 software and conducted the thematic analysis to identify themes and sub-themes.

Results

We invited approximately 200 FHCWs associated with PSEM to participate in the study. Of the 61 who agreed to participate, 27 completed the study. A total of 149 audio recordings were received and transcribed. Three themes and eight sub-themes have emerged from the data. The themes were individual-level challenges, health system-level challenges, and hope for the future. Sub-themes for individual-level challenges were: fear of getting or transmitting infection, feeling demotivated and unappreciated, disappointment due to people’s lack of compliance with COVID-19 protocols, physical exhaustion, and fatigue. For the healthcare system, sub-themes were: Infrastructure, logistics, management, and communications response of the hospital/healthcare system and financial stressors. For sub-themes under hope for the future were the improved disease knowledge and vaccine development. The overall perceptions and experiences of FHCWs evolved from fear, grief, and negativity to hope and positivity as the curve of COVID-19 went down.

Conclusion

This study shows that the individuals and systems were not prepared to deal with the challenges of the COVID-19 pandemic. The findings highlight the challenges faced by individuals and health systems during the wake of the Covid-19 pandemic. The healthcare workers were emotionally and physically taxed, while the health systems were overwhelmed by COVID-19. The overall perceptions of FHCWs evolved with time and became negative to positive as the curve of COVID-19 went down during the first wave of COVID-19 in Pakistan.

Unmediated connection of mental health decline and suicide among medical and nonmedical undergraduates during the pandemic of COVID-19: A cross-sectional comparative study

Background and Objectives

All medicine and healthcare undergraduates were encountered with terminations and delays of professional examinations. These alterations were on topmost of other tasks the COVID-19 pandemic carried out for instance not roaming, covered faces with masks and specifically segregation. This interruption of normal life was a major cause of mental health disaster and it is no surprise that medicine and healthcare undergraduate has had high rates of psychological effects including hopelessness, stress and suicidal thoughts. This study aimed to investigate the unmediated connection of anxiety and stress related mental health decline and suicide among medical and nonmedical undergraduates during the pandemic of covid-19.

Methods

A multidiscipline online cross-sectional comparative study design was chosen for this study conducted from November 2020 to January 2021 with a pre-validated questionnaire to collect responses from sample size 1290. SPSS- 21 used for descriptive analysis of means, S.D, ANOVA and spearman's correlations. Forward step-wise model of linear regression applies for true significant bivariate relationship (p<.001).

Results

The result shows that all three cohorts were affected. Among the non-medical cohorts, B-Pharmacy students had the high level (p<.001) of anxiety with suicide ideation response (n=200; 39.2%), along with lowest level of envisions care (19.5%; p<.001) in pandemic. Control and independent variable had a strong negative effects on B-Pharmacy and medical students with p<.000.

Conclusions

This study offered more data that the concerns, anxieties and uncertainties caused by pandemic COVID-19, don't roll out alone but remain as long-lasting problems demanding ongoing attention.

Management Strategies During the COVID-19 Pandemic Crisis: The Experiences of Health Managers from Iran, Ardabil Province

OBJECTIVE

The coronavirus disease 2019 (COVID-19) outbreak is the most threatening public health challenge in the 21th century, and more than 200 countries are affected. Considering that Iran was one of the first countries influenced by the COVID-19 pandemic, this study aimed to explain the crisis management strategies during the COVID-19 pandemic in Ardabil province.

METHODS

This study used a qualitative method using content analysis in which 12 health-care managers or decision-makers involved in the management of the COVID-19 crisis were recruited through purposeful sampling. In-depth, semi-structured interviews were used to collect data, which continued until data saturation.

RESULTS

Data analysis led to nine categories, including prior preparation for the COVID-19 crisis; challenges and management of workforce shortages; benefiting from the participation of volunteer staff; challenges and strategies for physical space, supplies, and personal protective equipment (PPE); designation of referral centers for COVID-19; protocolized patient transport; benefiting from donations and charity support; management of information about COVID-19; and learning from the prior stages of crisis.

CONCLUSION

This study revealed that, in critical situations, managers use multiple and, to some extent, unique strategies for decision-making and crisis control. Therefore, the health system can use the findings of the current study for proper response to similar crises and training of future managers.

Climate change and COVID-19: shared challenges, divergent perspectives, and proposed collaborative solutions

Pandemics leave their mark quickly. This is true for all pandemics, including COVID-19. Its multifarious presence has wreaked havoc on people's physical, economic, and social life since late 2019. Despite the need for social science to save lives, it is also critical to ensure future generations are protected. COVID-19 appeared as the world grappled with the epidemic of climate change. This study suggests policymakers and practitioners address climate change and COVID-19 together. This article offers a narrative review of both pandemics' impacts. Scopus and Web of Science were sought databases. The findings are reported analytically using important works of contemporary social theorists. The analysis focuses on three interconnected themes: technology advancements have harmed vulnerable people; pandemics have macro- and micro-dimensions; and structural disparities. To conclude, we believe that collaborative effort is the key to combating COVID-19 and climate change, while understanding the lessons learnt from the industrialised world. Finally, policymakers can decrease the impact of global catastrophes by addressing many socioeconomic concerns concurrently.

Risk assessment of COVID-19 pandemic using deep learning model for J&K in India: a district level analysis

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic with high morbidity and mortality rates. Current epidemiological studies urge the need of implementing sophisticated methods to appraise the evolution of COVID-19. In this study, we analysed the data for 228 days (1 May to 15 December 2020) of daily incidence of COVID-19 cases for a district level analysis in the region of Jammu and Kashmir in the northern Himalayan belt of India. We used a deep learning-based incremental learning technique to model the current trend of COVID-19 transmission and to predict the future trends with 60-day forecasting. The results not only indicate high rates of morbidity and mortality but also forecast high rise in the incidence of COVID-19 in different districts of the study region. We used geographic information system (GIS) for storing, analysing, and presenting the spread of COVID-19 which provides key insights in understanding, planning, and implementing mitigating measures to tackle the current spread of the pandemic and its possible future scenarios. The existing disparity in health care facilities at district level is shown in relation to the spread of disease. The study results also highlight the need to upgrade health care infrastructure in the study region to control the current and future pandemics. These results could be useful for administration and scientific community to develop efficient short-term and long-term strategies against such diseases.

Vaccination-hesitancy and vaccination-inequality as challenges in Pakistan's COVID-19 response

This study explores the mechanism for timely and equitable distribution of coronavirus disease 2019 (COVID-19) vaccination among the various communities in Pakistan. It examines the factors that support and/or impede peoples' access and response towards COVID-19 vaccination in Pakistan. The study uses a literature synthesis approach to examine and analyze the situation of the COVID-19 vaccination in Pakistan. The research results show "hesitancy" and "inequality" as two fundamental challenges that hinder the successful delivery of COVID-19 vaccination in Pakistan. People are reluctant to use vaccines due to conspiracy theories and religious beliefs. However, inequality, especially unequal accessibility to all social groups appears to be a more significant barrier to getting a vaccine. We argue that there is a need to mobilize community influence, social media, and mass media campaigns for public education on vaccination programs along with the engagement of religious leaders to endorse the vaccination for the masses. The area of this study is underdeveloped; thereby, future studies are recommended to investigate the possible way for equitable distribution of vaccines in multiple regions.

Preparedness of Public Hospitals for the Coronavirus (COVID-19) Pandemic in Lahore District, Pakistan

Background

Pakistan reported more than a million cases during the coronavirus disease 2019 (COVID-19) pandemic, shuffling the already resource-constrained health system that is known for its high vulnerability and lack of adaption.

Objective

To find out the level of preparedness of public hospitals for the novel COVID-19 pandemic in Lahore district.

Methods

A descriptive cross-sectional study was conducted from April to July 2021 among all 18 public hospitals under Specialized Health Care and Medical Education (SHC&ME) in Lahore by administering World Health Organization (WHO) and SHC&ME modified and pre-tested interviewer based and observation checklist. The level of preparedness was assessed for 11 domains, and each domain was scored as a dichotomous variable (Yes and No). Hospital preparedness was labeled as ‘acceptable,’ ‘insufficient,’ and ‘unacceptable.’ Descriptive statistics were run by using SPSS version 26 (IBM Corp., Armonk, NY), and data are presented in the form of tables and bar graphs.

Results

Out of 18 hospitals, only three (17%) had an acceptable level of preparedness for COVID-19 (>70%). An unacceptable level of preparedness (<35%) was seen in one hospital (5%). Fourteen hospitals (78%) were insufficiently prepared (35-70%).

Conclusion

The study highlights the suboptimal preparedness in 83% of the public hospitals with a consistent pattern of deficiencies in surge capacity, logistics and resource management, essential services, including diagnostics, infection prevention, and control.

Dengue Virus Cases Surge Amidst COVID-19 in Pakistan: Challenges, Efforts and Recommendations

Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two. Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians. Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan’s government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.

Home Management of COVID-19 Patients: A Successful Model in Non-severe COVID-19 Patients in the Developing World

Background

Around 80-85% of coronavirus disease 2019 (COVID-19) cases were reported to have mild disease and home treatment of such patients was proved to be effective without significant morbidity or mortality. Therefore, the aim of this study was to assess the outcome of home management of non-severe COVID-19 infection in healthcare providers in the developing world.

Methods

This observational cohort study was conducted at the National Institute of Cardiovascular Diseases from June 2020 till January 2021. It included health care workers who tested positive for COVID-19 with non-severe infection and received home treatment. The COVID-19 management team monitored their symptoms and oxygen saturation over the phone. Need-based lab tests, X-rays, home proning, steroids, and oxygen were administered along with the standard intuitional management strategies. Study outcomes included duration of recovery, need for hospitalization, and expiry.

Results

A total of 128 patients were included, out of which 98 (76.6%) were male, and the mean age was 32.9 ± 5.9 years. Fever was the most common symptom, seen in 89.8% of patients. Most of the patients (85.9%) had no pre-existing comorbidities. Five patients received home oxygen therapy, seven received steroid therapy, and one received home pruning. The average time of recovery was 13.8 ± 8.1 days with no mortality; however, 14 (10.9%) patients were hospitalized due to worsening of symptoms.

Conclusion

Home treatment for COVID-19 patients with mild to moderate disease after appropriate risk assessment can be a safe and effective option to preserve hospital capacities for more needy and severely ill patients.

Embedded AI-Based Digi-Healthcare

Healthcare is an indispensable part of human life and chronic illnesses like cardiovascular diseases (CVD) have a deeply negative impact on the healthcare sector. Since the ever-growing population of chronic patients cannot be managed at hospitals, therefore, there is an urgent need for periodic monitoring of vital parameters and apposite treatment of these patients. In this paper, an Internet of Medical Things (IoMT) -based remote patient monitoring system is proposed which is based on Artificial Intelligence (AI) and edge computing. The primary focus of this paper is to develop an embedded prototype that can be used for remote monitoring of cardiovascular patients. The system will continuously monitor physiological parameters like body temperature, heart rate, and blood oxygen saturation, and then report the health status to the authenticated users. The system employs edge computing to perform multiple functionalities including health status inference using a Machine Learning (ML) model which makes predictions on real-time data, alert notifications in case of an emergency, and transferring data between the sensor network and the cloud. A web-based application is developed for the depiction of raw data and ML results and to provide a direct communication channel between the patient and the doctor. The ML module achieved an accuracy of 96.26% on the test set using the K-Nearest Neighbors (KNNs) algorithm. This solution aims to address the sense of emergency due to the alarming statistics that highlight the mortality rate of cardiovascular patients. The project will enable a smart option based on IoT and ML to improve standards of living and prove crucial in saving human lives.

Sustained ethical analysis of global dilemmas and country-level decision making during and post the COVID-19 pandemic: A systematic review

The COVID-19 pandemic has highlighted the vulnerability of countries worldwide and their abilities to cope with the fast-paced demands of the research and medical community. A key to promoting ethical decision-making frameworks is by calibrating the sustainability at regional, national, and global levels to incorporate coordinated reforms. We performed a sustained ethical analysis and critically reviewed evidence addressing country-level responses to practices during the COVID-19 pandemic using PubMed (MEDLINE), Scopus, and CINAHL. The World Health Organization's ethical framework proposed for the entire population during the pandemic was applied to thematically delineate findings under equality, best outcomes (utility), prioritizing the worst off, and prioritizing those tasked with helping others. The findings demarcate ethical concerns about the validity of drug and vaccine trials in developing and developed countries, hints of unjust healthcare organizational policies, lack of equal allocation of pertinent resources, miscalculated allocation of resources to essential workers and stratified populations.

Public Perception and Preparedness to Fight Against the Third Wave of COVID-19 in Kabul, Afghanistan

The avalanche of Corona Virus 2019 (COVID-19) cases has placed an unprecedented load on Afghanistan’s government and public health authorities, putting the country in jeopardy. The primary goal of this research was to shed light on the country’s capital, Kabul, and to examine the existing preparedness and perceptions of its population in the midst of COVID-19’s third wave, which could result in decentralization and fragmentation of the already overburdened health-care system. An online, cross-sectional survey was conducted by the lecturers of the Kabul University of Medical Sciences between April 15, 2021 and April 25, 2021, to evaluate the preparedness of the Kabul citizens amidst the third wave of COVID-19. About 1736 citizens from Kabul participated in the survey. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. All categorical variables were reported using frequencies and percentages. The findings revealed that the most common source of COVID-19-related information was social media (74.8%). In addition, 34.4% of subjects had previously been infected with COVID-19. It was reassuring to see that 78.4% of residents said they knew more about COVID-19 than they did about prior COVID-19 waves. A majority (81.5%) expressed willingness to resist the third wave, but 89.4% said that the country’s government would be unable to develop an effective COVID-19 vaccine within the next 6 months. The findings of this present study indicates that citizens of Kabul are active in obtaining accurate information and disseminating it in the community. The citizens also reported sufficient COVID-19 related knowledge; however, they were more motivated to fight against the third wave of COVID-19. In regards to vaccination, they believed that the government could not vaccinate the public anytime soon. Hence, the enactment of non-pharmaceutical measures is important in the fight against the pandemic.

EFFECT OF FAMILY-FRIENDLY PRACTICES ON EMPLOYEES’ INTENTION TO QUIT: THE MEDIATING ROLE OF ORGANIZATIONAL CITIZENSHIP BEHAVIOR

Turnover intention has become one of the most serious issues in organizations around the world. Hence, most organizations encourage family-friendly practices (FFPs) to retain employees and to reduce high turnover risk. A plethora of research has confirmed FFPs as a fruitful predictor of turnover intention. However, what is not yet known is whether FFPs directly influence turnover intention or indirectly through organizational citizenship behavior (OCB). To fill the gap, the present study examined the effect of FFPs on employees’ intention to quit. On top of that, the mediating role of OCB in the purported link was also examined. Data were collected from 338 health sector employees using a structured questionnaire. The results of the structural equation modeling using AMOS indicated a significant negative relationship between FFPs and employees’ intention to quit. Moreover, OCB negatively influences employees’ intention to quit and partially mediates the path between family-friendly practices and intention to quit. Based on theoretical and empirical evidence, this study advances existing knowledge and further understanding of organizational work practices. This study recommends that organizations should encourage FFPs to mitigate turnover rate among employees.