A swaying between successive pandemic waves and pandemic fatigue: Where does Jordan stand?

Navigating Road Traffic Accidents in Jordan: A Retrospective Exploration of the Health and Economic Impacts

Background Road traffic accidents (RTAs) are considered a major public health threat. The causes of RTAs are multifactorial, comprising both human and non-human factors. RTAs may result not only in detrimental health consequences but also in serious economic burdens. This study aimed to provide a retrospective overview of the health and economic impacts of RTAs in Jordan during the period 2013-2021, including the implemented multisectoral mitigation strategies. Methodology This study presents a retrospective chart review of the traffic reports published by the Public Security Directorate (PSD) in Jordan during the period 2013-2021. The examined variables were the total number of road accidents involving human injuries per year, average road accidents per day, annual deaths, average deaths per day, deaths per 100,000 population, annual number of injuries, average number of injuries per day, severity of human injury, number of registered vehicles, and the annual financial costs. Data were extracted from PSD reports and presented descriptively. Results The number of registered vehicles has risen from 1,263,754 in 2013 to 1,795,215 in 2021 with a 42.1% increase. This was also associated with an increase in the average RTAs per day from 28.0 in 2013 to 30.8 in 2021. The total number of RTAs that involved human injuries during the period 2013-2021 fluctuated with 8,451 in 2020 (lowest) and 11,241 in 2021 (highest). In the same period, annual deaths caused by RTAs peaked in 2013 with 768 deaths (highest) compared to 461 in 2020 (lowest). In the five years from 2017 to 2021, the total financial cost of RTAs in Jordan was nearly 1.561 billion Jordanian Dinars (~2.2 billion U.S. dollars) compared to 1.363 billion Jordanian Dinars (~1.92 billion U.S. dollars) in the five years from 2012 to 2016. Conclusions Targeting human and road infrastructure factors through effective government-society partnerships is crucial in mitigating the health and economic burden of RTAs in Jordan. More strict enforcement of traffic laws, along with incremental increases in the penalties for dangerous traffic violations, and regular road safety campaigns are expected to provide more control over the human factors of RTAs. Further research is needed to evaluate the impact of the recently amended traffic law on the trends of RTAs in the country.

Evaluating airflow dynamics in common vertical circulation spaces of a multi-floor apartment building for mitigating airborne infection risks: A CFD modeling study

As more people increasingly inhabit indoor spaces, the importance of interior environment design has grown significantly. The focus of this research is to assess the air flow and air change per hour (ACH) within common service vertical circulation spaces in apartment buildings, emphasizing the potential role of these spaces in mitigating airborne infections. The intricate relationships between the design parameters of these spaces and variables related to air circulation are examined. To achieve this goal, the investigation employed a simulation-based approach, utilizing computational fluid dynamics (CFD) analysis to scrutinize the prevalent design of common vertical circulation spaces. The simulation outcomes unequivocally reveal that the design of these spaces has a direct impact on air circulation patterns, often influencing suboptimal conditions. Armed with these insights, this research advocates for a reevaluation of design considerations of common service vertical circulation in forthcoming housing projects. Furthermore, this research proposes innovative design solutions and strategies aimed at enhancing natural ventilation and overall air flow within common service vertical circulation spaces while evaluating their performance.

Risk Perception and Public Pandemic Fatigue: The Role of Perceived Stress and Preventive Coping

Purpose

This study explores the status of pandemic fatigue, predictors, and their mechanisms of action based on a stress-response framework and a parallel model of future-oriented response.

Patients and methods

Study 1 investigated 8426 Chinese adult residents' understanding of and willingness to cooperate with the pandemic prevention and control policies and Study 2 surveyed 1635 Chinese residents on their activeness of pandemic prevention and control (APPC), pandemic risk perception, perceived stress, and future-oriented coping.

Results

Study 1 found that public understanding of and willingness to cooperate with prevention policies were significantly lower in 2022 than in 2020 and 2021. Study 2 found that risk perception negatively predicted the APPC; perceived stress and preventive coping significantly mediated the relationship between risk perception and APPC; but perceived stress and proactive coping did not significantly mediate the relationship between risk perception and APPC.

Conclusion

This revealed an increase in public fatigue in the third year of the pandemic. Pandemic fatigue can be predicted by pandemic risk perception, but the direct pathway of action is not significant and requires the mediation of perceived stress and preventive coping.

Association between trust in COVID-19 information sources and engaging in infection prevention behaviors in Japan: A longitudinal study

OBJECTIVE

We examined changes in people's trust in information sources in Japan during the COVID-19 pandemic over the course of 1 year and investigated longitudinal associations between trust in such sources and engaging in infection prevention behaviors.

METHODS

We conducted a longitudinal survey of Japanese populations under a declared state of emergency at two time points, August 2020 and August 2021. We surveyed sociodemographic data, seven Trust in COVID-19 information sources and six COVID-19 preventive behaviors.

RESULTS

In all, 784 participants completed the two surveys. Physicians were the most consistently trusted information source over the 1-year period. We identified three preventive behaviors that were positively associated with trust in physicians as an information source (social distancing, wearing masks, and washing hands with soap), four preventive behaviors that were positively associated with trusting infected patients (social distancing, using ventilation, wearing masks, and using hand sanitizer), and one preventative behavior that was negatively associated with trust in government (avoiding closed spaces).

CONCLUSION

In the ongoing pandemic, information from physicians and patients may encourage people to engage in long-term preventive behaviors.

PRACTICE IMPLICATIONS

Physicians and patients should be promoted as trusted and behavior influencing sources of information during the pandemic.

Built environment factors moderate pandemic fatigue in social distance during the COVID-19 pandemic: A nationwide longitudinal study in the United States

Non-pharmaceutical interventions (NPIs) remain some of the most effective measures for coping with the ever-changing coronavirus disease 2019 (COVID-19) pandemic. Pandemic fatigue, which manifests as the declined willingness to follow the recommended protective behaviors (e.g., keeping social distance policies, wearing masks), has commanded increasing attention from researchers and policymakers after the prolonged NPIs and COVID-19 worldwide. However, long-term changes in pandemic fatigue are not well understood, especially amidst the ever-changing pandemic landscape. Built environment factors have been shown to positively affect mental and physical health, but it is still unclear whether built environments can moderate pandemic fatigue. In this study, we used Google mobility data to investigate longitudinal trends of pandemic fatigue in social distance since the onset of NPIs enforcement in the United States. The results indicated that pandemic fatigue continuously worsened over nearly two years of NPIs implementation, and a sharp increase occurred after the vaccination program began. Additionally, we detected a significant moderation effect of greenspace and urbanicity levels on pandemic fatigue. People living in areas with high levels of greenness or urbanicity experienced lower levels of pandemic fatigue. These findings not only shed new light on the effects of greenness and urbanicity on COVID-19 pandemic fatigue, but also provide evidence for developing more tailored and effective strategies to cope with pandemic fatigue.

Local travel behaviour under continuing COVID-19 waves- A proxy for pandemic fatigue?

COVID-19 continues to threaten the world. Relaxing local travel behaviours on preventing the spread of COVID-19, may increase the infection risk in subsequent waves of SARS-CoV-2 transmission. In this study, we analysed changes in the travel behaviour of different population groups (adult, child, student, elderly) during four pandemic waves in Hong Kong before January 2021, by 4-billion second-by-second smartcard records of subway. A significant continuous relaxation in human travel behaviour was observed during the four waves of SARS-CoV-2 transmission. Residents sharply reduced their local travel by 51.9%, 50.1%, 27.6%, and 20.5% from the first to fourth pandemic waves, respectively. The population flow in residential areas, workplaces, schools, shopping areas, amusement areas and border areas, decreased on average by 30.3%, 33.5%, 41.9%, 58.1%, 85.4% and 99.6%, respectively, during the pandemic weeks. We also found that many other cities around the world experienced a similar relaxation trend in local travel behaviour, by comparing traffic congestion data during the pandemic with data from the same period in 2019. The quantitative pandemic fatigue in local travel behaviour could help governments partially predicting personal protective behaviours, and thus to suggest more accurate interventions during subsequent waves, especially for highly infectious virus variants such as Omicron.

Upholding Quality and Patient Safety during COVID-19 Pandemic-A Jordanian Case Study

BACKGROUND

The advent of the COVID-19 pandemic caused a rapid increase in demand for healthcare services over a prolonged period, and the hospital emergency preparedness system has been essential. Therefore, this study aimed to explore Jordanian hospitals' response to emergency situations and examine the underlying role and effect of accreditation programs as a "Quality and Patient Safety" tool to deal with emergency situations during the pandemic.

METHODS

An online survey for a cross-sectional study was conducted in Jordan between 1 March and 30 May 2022, to examine the opinions of hospitals' top, senior, and middle managers using a validated questionnaire.

RESULTS

A total of 200 healthcare providers from 30 hospitals participated in the study. From the areas within accreditation standards that were investigated, capacity building on emergency preparedness and communication abilities received the least scores (2.46 and 2.48, respectively). Additionally, hospitals with mature quality and patient safety culture (>3 accreditation cycles) demonstrated a statistically significant difference in score in two domains-emergency preparedness (p = 0.027) and infection prevention and control (p = 0.024).

CONCLUSIONS

During outbreaks, hospitals that are required to comply with accreditation standards that address all emergency preparedness aspects will fare better in quality performance.

Assessment of Hospital Readiness to Respond to COVID-19 Pandemic in Jordan-A Cross Sectional Study

During the global COVID-19 pandemic, hospitals faced tremendous pressure to cope with the emergency preparedness situations needed to cater for the influx of patients while maintaining their essential services. This study aimed to assess the level of readiness of hospitals in Jordan to respond to the COVID-19 pandemic using the WHO hospital readiness checklist. A cross-sectional survey using the modified and validated checklist was conducted in Jordan between 15 May and 15 June 2021. The checklist entailed ten key response functions with a total of 60 activities. Data from 22 hospitals were collected through a structured survey process by two surveyors for each hospital. The overall readiness score of hospitals was 1.77 ± 0.20, with a lower overall score in the northern region (1.65 ± 0.24) than the middle (1.86 ± 0.07) or southern (1.84 ± 0.14) regions. The diagnosis response function scored highest (1.95); but despite efforts, contingency plan development was not met by most hospitals, with a total score ≤ 1.45. Provision of psychological support and occupational health support to ensure the wellbeing of staff scored below average. Outcomes from this survey exposed gaps while offering a framework for upcoming endeavors to improve hospital readiness for any potential pandemic.

Overcoming the effect of pandemic fatigue on vaccine hesitancy-Will belief in science triumph?

PURPOSE

The study aims to examine the factors that impact vaccination uptake and additional protective behavior during the fourth wave of the pandemic in Israel, whereas the "pandemic fatigue" phenomenon has been identified as a hurdle to adherence to protective health behaviors against coronavirus disease 2019 (COVID-19).

DESIGN

A cross-sectional, structured questionnaire was utilized for this investigation in September 2021, during the fourth wave of the pandemic.

METHODS

A sample of the adult (18+) Israeli population was employed for the study. Recruiting participants for the study was conducted through an online internet panel company that consists of over 100,000 members, representing all geographic and demographic sectors of the Israeli population.

RESULTS

Our findings indicate that pandemic fatigue has begun to have cascading effects on vaccination efforts. In particular, this study found that at this stage of the COVID-19 pandemic, trust in authorities, and even threat perception components, such as concern and fear of contracting the disease, are incapable of predicting vaccination uptake. Instead, perception of the importance of the vaccine and its effectiveness are predictive of vaccination uptake.

CONCLUSION

The findings indicate that at this stage of the pandemic, focusing on the robustness of the science behind the vaccine is more important than trying to regain public trust. The findings also suggest that risk communication employing fear tactics is losing its capacity to generate motivation for vaccination.

CLINICAL RELEVANCE

The findings of this study reveal lessons learned from the COVID-19 global pandemic. Specifically, the study reveals how in times of prolonged crisis, we can currently and, in the future, prepare improved strategies for public communication in order to promote uptake of protective health behavior, such as vaccination.

Impact of media trust and personal epidemic experience on epidemic prevention behaviors in the context of COVID-19: A cross-sectional study based on protection motivation theory

Objective

This study aimed to elucidate the impact of media trust on epidemic prevention motivation and behaviors based on the Protection Motivation Theory (PMT) and to evaluate the moderation effect of personal epidemic experience, which focused on the differences in two groups with or without epidemic experience.

Methods

The exogenous constructs and PMT model and scale were constructed through literature analysis, and a web-based questionnaire survey was conducted among 428 individuals aged above 18 years in China. Statistical analysis and hypothesis testing were performed in SPSS 26 and SmartPLS 3.

Results

Traditional media trust accounted for the largest weight in media trust (w = 0.492, p-value < 0.001), followed by social media (w = 0.463, p-value < 0.001), and interpersonal communication (w = 0.290, p-value < 0.001). Media trust was positively and significantly related to both threat appraisal (β = 0.210, p-value < 0.001) and coping appraisal (β = 0.260, p-value < 0.001). Threat appraisal (β = 0.105, p-value < 0.05) and coping appraisal (β = 0.545, p-value < 0.001) were positively and significantly related to epidemic prevention motivation, which positively and significantly related to epidemic prevention behaviors (β = 0.492, p-value < 0.001). The R² values of epidemic prevention motivation and behavior are 0.350 and 0.240, respectively, indicating an acceptable explanation. Multiple-group analysis revealed five significant differences in paths between the two groups, indicating personal epidemic experience acting as a slight moderator on these paths.

Conclusion

Traditional media trust and social media trust were the important elements in COVID-19 prevention and control, and public health departments and governments should ensure the accuracy and reliability of information from traditional and social media. Simultaneously, the media should balance threat information and efficacy information in order to generate the public's prevention motivation and behaviors.

Workplace policies and quality of working life (QoWL) during the COVID-19 pandemic in Jordanian hospitals

BACKGROUND

Many healthcare organizations place a high value on quality of work-life (QoWL). The healthcare system's long-term sustainability and capability to offer high-quality services to patients depend on improving QoWL for their healthcare workers.

OBJECTIVE

The study aimed to explore the impact of Jordanian hospitals' workplace policies and measures in three main domains: (I) Infection prevention and control (IPC) measures, (II) Supply of personal protective equipment (PPE), and (III) COVID-19 precautionary measures on the QoWL among healthcare workers during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted from May to June 2021 through an online self-reported questionnaire (Google Form) targeting hospital healthcare professionals working at Jordanian hospitals (public, private, military, and university). The study used a valid work-related quality of life (WRQoL) scale to study the QoWL.

RESULTS

A total of 484 HCWs in Jordanian hospitals participated in the study with a mean age of (34.8 ± 8.28 years). 57.6% of the respondents were females. 66.1% were married, with 61.6% having children at home. An average QoWL among healthcare workers in Jordanian hospitals during the pandemic was observed. The study results also showed a significant positive correlation between workplace policies (IPC measures, supply of PPE, and COVID-19 preventive measures) and the WRQoL among healthcare workers.

CONCLUSION

Our findings highlighted the vital need for QoWL and psychological well-being support services for healthcare staff during pandemics. Improved IPC systems and other precautionary measures at the national and hospital management levels are required to help minimize the stress and fear that healthcare workers experience and lower the risk of COVID-19 and future pandemics.

The outbreak of Ebola virus disease in 2022: A spotlight on a re-emerging global health menace

Ebola virus disease (EVD) is a rare but highly contagious and lethal disease that occurs predominantly in African countries, with a case-fatality rate of 30-90%. The causative viral pathogens of EVD are within the genus Ebolavirus in the family Filoviridae. The primary route of human-to-human transmission is through direct contact with blood, bodily fluids and secretions from infected individuals. Direct contact with virally contaminated objects and sexual transmission have also been reported. Management of EVD is aggressive supportive care with possibly new therapeutic options. On 20 September 2022, an EVD outbreak was declared in Uganda, caused by Sudan ebolavirus. As of 7 November 2022, a total of 136 confirmed cases, 53 confirmed deaths have been reported, including 18 cases with seven deaths among healthcare workers. In the Democratic Republic of Congo (DRC), an EVD outbreak was also declared on 22 August 2022 (which ended on 27 September 2022); with only one case, a middle-aged woman. At the time when most countries in the world have been occupied with the coronavirus disease 2019 (COVID-19) pandemic and the recent human monkeypox outbreak, these two outbreaks of EVD have the potential to significantly add to the burden on global health. Authorities need to augment their multi-faceted response, including stringent contact tracing and border control, to avoid the catastrophe of the 2014-2016 EVD epidemic.

Improving Public Health Policy by Comparing the Public Response during the Start of COVID-19 and Monkeypox on Twitter in Germany: A Mixed Methods Study

Little is known about monkeypox public concerns since its widespread emergence in many countries. Tweets in Germany were examined in the first three months of COVID-19 and monkeypox to examine concerns and issues raised by the public. Understanding views and positions of the public could help to shape future public health campaigns. Few qualitative studies reviewed large datasets, and the results provide the first instance of the public thinking comparing COVID-19 and monkeypox. We retrieved 15,936 tweets from Germany using query words related to both epidemics in the first three months of each one. A sequential explanatory mixed methods research joined a machine learning approach with thematic analysis using a novel rapid tweet analysis protocol. In COVID-19 tweets, there was the selfing construct or feeling part of the emerging narrative of the spread and response. In contrast, during monkeypox, the public considered othering after the fatigue of the COVID-19 response, or an impersonal feeling toward the disease. During monkeypox, coherence and reconceptualization of new and competing information produced a customer rather than a consumer/producer model. Public healthcare policy should reconsider a one-size-fits-all model during information campaigns and produce a strategic approach embedded within a customer model to educate the public about preventative measures and updates. A multidisciplinary approach could prevent and minimize mis/disinformation.

Seroepidemiological and genomic investigation of SARS-CoV-2 spread in North East region of India

Purpose

Seroepidemiology and genomic surveillance are valuable tools to investigate infection transmission during a pandemic. North East (NE) India is a strategically important region being the gateway connecting the country with Southeast Asia. Here, we examined the spread of SARS-CoV-2 in NE India during the first and second waves of COVID-19 using serological and whole genome sequencing approaches.

Methods

qRT-PCR analysis was performed on a selected population (n ​= ​16,295) from June 2020 to July 2021, and metadata was collected. Immunoassays were studied (n ​= ​2026) at three-time points (August 2020, February 2021, and June 2021) and in a cohort (n ​= ​35) for a year. SARS-CoV-2 whole genomes (n ​= ​914) were sequenced and analyzed with those obtained from the databases.

Results

Test positivity rates (TPR) in the first and second waves were 6.34% and 6.64% in Assam, respectively, and a similar pattern was observed in other NE states. Seropositivity in the three time points was 10.63%, 40.3%, and 46.33%, respectively, and neutralizing antibody prevalence was 90.91%, 52.14%, and 69.30%, respectively. Persistence of pan-IgG-N SARS-CoV-2 antibody for over a year was observed among three subjects in the cohort group. Normal variants dominated the first wave, while B.1.617.2 and AY-sublineages dominated the second wave in the region. The prevalence of the variants co-related well with high TPR and seropositivity rate in the region and identified mostly among vaccinated individuals.

Conclusion

The COVID-19 first wave in the region witnessed low transmission with the evolution of diverse variants. Seropositivity increased during the study period with over half of the individuals carrying neutralizing antibodies against SARS-CoV-2. High infection and seroprevalence in NE India during the second wave were associated with the dominant emergence of variants of concern.

Rasch Modeling and Multilevel Confirmatory Factor Analysis for the Usability of the Impact of Event Scale-Revised (IES-R) during the COVID-19 Pandemic

BACKGROUND

Several instruments are currently used to assess Coronavirus Disease 2019 (COVID-19) -induced psychological distress, including the 22-item Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered scale used to assess post-traumatic stress disorder (PTSD). The current study aimed to examine the construct validity of the IES-R, based on the Rasch model, with COVID-19-related data, as well as to test the multilevel construct validity of the IES-R within and among countries during the pandemic crisis.

METHODS

A multi-country web-based cross-sectional survey was conducted utilizing the 22-item IES-R. A total of 1020 participants enrolled in our survey, of whom 999 were included in the analyses. Data were analyzed using Rasch modeling and multilevel confirmatory factor analysis (MCFA).

RESULTS

The Rasch modeling results of the IES-R demonstrated that the IES-R is a satisfactory instrument with the five-point Likert scale, asserting that its 22 items are significant contributors to assessing PTSD as a unidimensional construct covered by the items of the IES-R. The MCFA confirmed that the 22-item IES-R, with its three factors, including intrusion, avoidance, and hyperarousal, demonstrates adequate construct validity at the within- and among-country levels. However, the results of the Akaike information criterion (AIC) model determined that the 16-item IES-R is better than the 22-item IES-R.

CONCLUSION

The results suggested that the 22-item IES-R is a reliable screening instrument for measuring PTSD related to the COVID-19 pandemic, and can be utilized to provide timely psychological health support, when needed, based on the screening results.

Public Opinions on COVID-19 Vaccines—A Spatiotemporal Perspective on Races and Topics Using a Bayesian-Based Method

The COVID-19 pandemic has been sweeping across the United States of America since early 2020. The whole world was waiting for vaccination to end this pandemic. Since the approval of the first vaccine by the U.S. CDC on 9 November 2020, nearly 67.5% of the US population have been fully vaccinated by 10 July 2022. While quite successful in controlling the spreading of COVID-19, there were voices against vaccines. Therefore, this research utilizes geo-tweets and Bayesian-based method to investigate public opinions towards vaccines based on (1) the spatiotemporal changes in public engagement and public sentiment; (2) how the public engagement and sentiment react to different vaccine-related topics; (3) how various races behave differently. We connected the phenomenon observed to real-time and historical events. We found that in general the public is positive towards COVID-19 vaccines. Public sentiment positivity went up as more people were vaccinated. Public sentiment on specific topics varied in different periods. African Americans’ sentiment toward vaccines was relatively lower than other races.

Intention to receive a COVID-19 vaccine booster dose and associated factors in Malaysia

This study aims to provide evidence of hesitancy in receiving the COVID-19 booster vaccine and associated factors in the vaccinated population that have completed a primary vaccination series. An anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years via social media platforms. A total of 1010 responses were collected, of which 43.0% (95%CI 39.9–46.0) declared a definite willingness to receive a COVID-19 vaccine booster, 38.2% (95%CI 35.2–44.3) reported being somewhat willing and only 5.7% (95%CI 4.5–7.4) reported being definitely unwilling. Demographically younger participants, those of higher income, Chinese ethnicity and those from the central region reported significantly higher odds of a definite willingness to receive the COVID-19 vaccine booster compared to the reference group (somewhat willing/undecided/somewhat unwilling/definitely unwilling). Having no side effects with past COVID-19 vaccination was associated with a significantly higher odds of definite willingness (OR = 2.82, 95% CI 1.33–5.99). A lower (range 6–22) pandemic fatigue score (OR = 2.34, 95% CI 1.75–3.22) and higher (range 24–30) preventive practices score (OR = 2.45, 95% CI 1.80–3.34) were also associated with higher odds of definite willingness. Regarding attitudes toward COVID-19 booster vaccine, having fewer concerns about the side effects of booster vaccination and the uncertain long-term safety of multiple COVID-19 vaccinations were found to create greater odds of a definite willingness to receive the COVID-19 vaccine booster. Findings from this study provided insights into demographic characteristics and important behavioral and attitudinal factors associated with COVID-19 vaccine booster hesitancy.

Meet Your Digital Twin in Space? Profiling International Expat’s Readiness for Metaverse Space Travel, Tech-Savviness, COVID-19 Travel Anxiety, and Travel Fear of Missing Out

The metaverse promises an unimaginable future for digital travelers by enabling them to gain unique experiences (e.g., space travel) that would otherwise be impossible in non-virtual reality. Moreover, COVID-19 travel anxiety has triggered growing interest in virtual environments (e.g., metaverse travel) in the aftermath of the pandemic. The cost-conscious and tech-savvy behavior of travelers has been resurrected in the ‘new normal’; however, the fear of missing out (FOMO) is now dictating travelers’ choices for newness, immersive and rewarding travel experiences. To address these emerging trends, promising new technologies, and untested relationships, the present study explored the effects of COVID-19 travel anxiety on the readiness for metaverse space travel. In addition, the moderating influence of tech savviness and travel FOMO was tested on this relationship. Drawing on data of international expats (N = 386) in UAE, the finding based on structural equation modeling (SEM) revealed that the international expat’s readiness for metaverse space travel is positively influenced by their COVID-19 travel anxiety. Moreover, expats with high tendencies of travel FOMO and tech savviness will experience a stronger impact of COVID-19 travel anxiety on their readiness for metaverse space travel. These novel findings guided by prominent theories (e.g., self-determination, SOR, and protection motivation) offer new insights for policy makers and practitioners to strategically achieve digital-tourism transformation and sustainability through emerging and immersive metaverse technologies.

The Bridge at the End of the World: Linking Expat’s Pandemic Fatigue, Travel FOMO, Destination Crisis Marketing, and Vaxication for “Greatest of All Trips”

The rebirth of global tourism with a massive rebound is anticipated due to an emerging touristic behavior coined as vaxication (i.e., post-vaccination travel). Despite the ongoing fatigue triggered by the COVID-19 pandemic, travelers’ fear of missing out (FOMO), and destination crisis marketing (DCM) can further accelerate travelers’ momentum towards vaxication. To address this critical knowledge gap in COVID-19 tourism, the present study aimed to examine the effect of pandemic fatigue on vaxication intention for the greatest of all trips (GOAT) under the moderating influence of travel FOMO and destination crisis marketing. Drawing on data of international expatriates in the United Arab Emirates (N = 356) and using covariance-based structural equation modeling with Mplus, the findings provide new evidence supporting a positive impact of international expat’s pandemic fatigue on vaxication intention for GOAT. Interestingly, this relationship is significantly reinforced by the international expat’s travel FOMO as well as tourism destinations switching gears from ‘managing crisis’ to ‘marketing crisis’. Based on prominent theories (i.e., theory of planned behavior, cognitive load theory, and protection motivation theory) and newly developed scales (i.e., travel FOMO and destination crisis marketing), the study implications are directed towards an outpacing trajectory of global tourism return prompted by pandemic fatigue, travel FOMO, destination crisis marketing, and vaxication intention for the greatest of all trips.

COVID-19 Vaccination Acceptance and Its Associated Factors Among the Iraqi Population: A Cross Sectional Study

PURPOSE

The Coronavirus Disease 2019 (COVID-19) pandemic poses a serious threat to countless lives. Development of an efficient vaccination can help end the pandemic. Vaccine hesitancy/refusal is a huge issue that could stymie attempts to combat the disease. The goal of this study is to examine COVID-19 vaccine hesitancy in Iraq where at the end of July 2021, only 7.4% of the population was vaccinated.

PARTICIPANTS AND METHODS

This is a cross-sectional web-based study. A survey was used to assess knowledge, attitudes and practice (KAP) toward COVID-19. Willingness to be vaccinated against COVID-19 was assessed, with a logistic regression used to identify variables associated with vaccine acceptance. Motives for vaccination refusal/hesitation were reported.

RESULTS

A total of 1542 participants (females = 56.7%) completed the questionnaire. Participants displayed high knowledge and good protective practices toward COVID-19 (median score = 15 out of 19 and 20 out of 25 respectively). 88.6% were willing to be vaccinated. Variables associated with vaccine acceptance included have not been infected with COVID-19 (OR=0.53, p=0.01), low- and moderate-income (ORs=0.42 and 0.63, p<0.01 respectively), low education level (OR=0.33, p-value<0.01) and perceived degree of vaccination importance (OR=1.30, P-value<0.01). The most mentioned reasons for vaccine refusal were concerns about vaccine safety and side effects (90.35%) and the need for more information about the vaccine (81.2%).

CONCLUSION

Participants showed high acceptance toward COVID-19 vaccination, nevertheless more efforts should be applied to overcome barriers mentioned by the participants.

Nationwide Routine Childhood Vaccination Coverage During the COVID-19 Pandemic in Jordan: Current Situation, Reasons, and Predictors of Vaccination

BACKGROUND

The healthcare system in Jordan faced substantial burden during the 2020 COVID-19 pandemic including disruption of routine childhood vaccination services.

AIMS

We sought, for the first time, to describe the impact of the 2020 pandemic on vaccination coverage of Jordanian children in Jordan and to identify the key contributing factors.

METHODS

Nationwide vaccination rates were retrieved from the electronic records at the Ministry of Health (2018-2020) enrolling crude births of 220,057 Jordanian children during 2020. Records of doses administered were compared for each month of 2020 with the baseline of 2018-2019. A cross-sectional survey (March-August 2021) was also conducted enrolling a convenient sample of adults aged ≥18 who were Jordanian caregivers for vaccine-eligible children (0-23 months) between 1 January 2020 and the date of the interview. The survey aimed to address caregivers' adherence to routine vaccination during 2020-2021 and to describe the determinants of the current and future adherence to vaccination where multiple logistic regression model was utilized.

RESULTS

The electronic records revealed a significant decline in vaccination coverage during 2020. The greatest decline was observed during the lockdown period from 21 March 2020 to 21 April 2020 (32.4%-46.8%) followed by the decline observed by the entry of the first wave during September-October 2020 (18.4%-22.8%). A drop of 14-16% was observed for the vaccines recommended under the age of 12 months and of 6-7% for those recommended in 1-2-year-old children. The yearly coverage rates for measles-1 (at 9 months), 2 (at 12 months as part of measles-mumps-rubella (MMR) vaccine), and 3 (at 18 months as part of MMR) were 76%, 90%, and 87%, respectively, and for hexavalent-1, 2, and 3 were 78%, 78%, and 77%, respectively. The results of the survey revealed that the main reason for vaccination delay for at least 1 month from the recommended administration time was the lockdown, followed by child illness and smart lockdowns (regional lockdown/health center closure). Vaccination delay was less likely to be observed in children aged ≥12 months (P value < 0.001; OR: 0.18; CI: 0.11-0.29) or children with chronic diseases (P value < 0.05; OR: 0.5; CI: 0.33-0.88).

CONCLUSION

The current study demonstrates a decline in vaccination coverage of Jordanian children during the 2020 COVID-19 pandemic. It is important to formulate future strategies to promote catch-up vaccination and to avoid future backsliding of vaccination rates during further waves of the COVID-19 pandemic or other pandemics. These include improving health services, allaying caregivers' concerns about contracting COVID-19, and arranging vaccination campaigns outside health centers.

Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan

BACKGROUND

The relationship between smoking and coronavirus disease-2019 (COVID-19) is still topical with mixed epidemiological evidence. However, the pandemic may affect people's beliefs toward smoking as well as their smoking behavior and quit intentions. Considering high smoking rates in Jordan, our current study aimed to assess the following domains in a community-based sample from Jordan: (i) the beliefs that surround smoking/vaping and COVID-19 and (ii) the pandemic impact on smoking behavior and quit intention.

METHODS

A cross-sectional study was conducted in Jordan from March 9 to March 16, 2021, utilizing a web-based structured questionnaire. The questionnaire comprised 13 items on sociodemographic, health, and smoking profiles, 14 items to assess beliefs surrounding COVID-19 and the use of combustible cigarettes (CCs), waterpipe (WP), and electronic cigarettes (ECs), and 12 items to assess the pandemic impact on smoking behavior and quit intention.

RESULTS

Of 2424 survey respondents who participated in our study, there were 1163 never-smokers, 1044 current smokers, and 217 ex-smokers. The mean age of participants was 35.2 years (SD: 11.06). Most participants have reported anti-smoking beliefs with around 72.9% believed that WP smoking is related to the risk of contracting COVID-19. Also, 71.7% believed that smoking CC may worsen the COVID-19 clinical course, while 74.1% of respondents believed that smoking has no protective effect against COVID-19. During the pandemic, about 28.1% and 19.3% of current smokers reported increased or reduced smoking, respectively. Besides, 459 current smokers have expressed their plans/intention to quit smoking during the pandemic, of whom 27.5% (n = 126) confirmed that the driving force for their decision is a COVID-19-related reason, such as self-protection (n = 123) and protection of family members (n = 121) which were the most cited reasons. Also, around 63 participants have successfully ceased smoking during the pandemic. However, only 22 of them reported that the main driving motivation of their successful quit attempt was the COVID-19 pandemic.

CONCLUSION

Most participants' beliefs and attitudes were against smoking during the pandemic. Nevertheless, the double-edged effect of the pandemic on smoking habits should be carefully considered, and reliable anti-smoking measures should be strengthened and sustained in the country.

Attitudes and Commitment Toward Precautionary Measures Against COVID-19 Amongst the Jordanian Population: A Large-Scale Cross-Sectional Survey

Aims: This study aimed to (1) assess the non-pharmaceutical intervention (NPI) measures that were used by the Jordanian population against COVID-19, and (2) determine the sociodemographic and behavioral predictors of contracting COVID-19 with a focus on the utilization of personal precautionary measures. Methods: A descriptive questionnaire-based cross-sectional survey was used in this study. A structured web-based questionnaire was disseminated to the Jordanian community through social media platforms. Participants were asked a series of questions about socio-demographic characteristics, in addition to the knowledge, attitudes, and commitment toward using various personal precautionary measures (e.g., face mask, hand washing, social distancing) against the COVID-19. Data were analyzed using descriptive statistics, cross-tabulation, and binary logistic regression through SPSS®. Results: Responses from 7,746 participants were included in our final analyses. Descriptive statistics showed that most participants (82.6%) believed that face mask protects against COVID-19. Around 69.5% of the participants were completely committed to wearing a face mask, while 65% of the participants were completely committed to hand washing. The results of the regression analysis revealed that female gender (AOR = 1.2; 95% CI: 1.07-1.35; p = 0.002), having a family member infected with COVID-19 (AOR = 8.5; 95% Cl: 7.51-9.70; p = 0.001), having a health-related work or study (AOR = 1.2; 95% Cl: 1.09-1.38; p = 0.001), believing that face masks do not protect against COVID-19 (AOR = 1.3; 95% Cl: 1.12-1.47; p = 0.001), and partial commitment to handwashing (AOR = 1.2; 95% Cl: 1.11-1.75; p = 0.006) were all associated with an increased odds of contracting COVID-19 among the participants. Conclusion: Overall, commitment to non-pharmaceutical intervention (NPI) measures, such as wearing a face mask, hand washing, and physical distancing, was not optimal among Jordanians. This might explain the dramatic increase in the infectivity rate of the COVID-19 virus in the past few months in the country. More sustainable efforts regarding health promotion and strict policies are required to prevent a third wave of hitting the country and to prevent similar infectious threats in the future.

The untold story of the COVID-19 pandemic: perceptions and views towards social stigma and bullying in the shadow of COVID-19 illness in Jordan

Stigmatization towards COVID-19 patients can lead to negative outcomes like social exclusion and bullying, and it may hinder the willingness of people to undergo testing. This study aimed to measure and explore the perception of stigmatization and bullying towards COVID-19 patients in Jordan. This was a web-based cross-sectional survey. Participants were recruited from social media platforms employing a snowball convenience sampling. The perception of bullying, beliefs regarding social consequences of infection, views on measures towards violators of patients' privacy, and how to reduce the stigma were assessed by self-reported measures. 397 participants returned completed questionnaires. The majority of respondents believed that COVID-19 patients in Jordan are getting bullied (n = 255, 64.3%) and over 80% believed that people enjoy sharing identities, or news about COVID-19 patients. Although most respondents had adequate knowledge regarding transmission/prevention of COVID-19, they believed that all or some of the COVID-19 patients practiced something wrong to get infected (n = 358, 90.2%). Moreover, 86.9% of respondents reported that people in Jordan were crossing their lines with bullying behaviors towards COVID-19 patients. However, these negative views would not discourage most respondents to get tested and follow the government's instructions if they or any of their acquaintances were suspected to be infected. Our study sheds the light on a high degree of stigma and bullying of COVID-19 patients during the early stage of the pandemic in Jordan. Hence, there is a need to develop and implement effective anti-stigma/anti-bullying campaigns that refute the misperception, raise public knowledge about COVID-19, and spread encouraging messages.

Key factors affecting people's unwillingness to be confined during the COVID-19 pandemic in Spain: a large-scale population study

Population confinements have been one of the most widely adopted non-pharmaceutical interventions (NPIs) implemented by governments across the globe to help contain the spread of the SARS-CoV-2 virus. While confinement measures have been proven to be effective to reduce the number of infections, they entail significant economic and social costs. Thus, different policy makers and social groups have exhibited varying levels of acceptance of this type of measures. In this context, understanding the factors that determine the willingness of individuals to be confined during a pandemic is of paramount importance, particularly, to policy and decision-makers. In this paper, we study the factors that influence the unwillingness to be confined during the COVID-19 pandemic by the means of a large-scale, online population survey deployed in Spain. We perform two types of analyses (logistic regression and automatic pattern discovery) and consider socio-demographic, economic and psychological factors, together with the 14-day cumulative incidence per 100,000 inhabitants. Our analysis of 109,515 answers to the survey covers data spanning over a 5-month time period to shed light on the impact of the passage of time. We find evidence of pandemic fatigue as the percentage of those who report an unwillingness to be in confinement increases over time; we identify significant gender differences, with women being generally less likely than men to be able to sustain long-term confinement of at least 6 months; we uncover that the psychological impact was the most important factor to determine the willingness to be in confinement at the beginning of the pandemic, to be replaced by the economic impact as the most important variable towards the end of our period of study. Our results highlight the need to design gender and age specific public policies, to implement psychological and economic support programs and to address the evident pandemic fatigue as the success of potential future confinements will depend on the population's willingness to comply with them.

Mental Health and Well-Being During the First vs. Second COVID-19 Pandemic Lockdown in Cyprus

Abstract. Introduction: Following the onset of the COVID-19 pandemic, most countries imposed strict governmental lockdowns. Research investigating the psychological impact of pandemic-induced lockdowns is accumulating, though to date no study has examined the psychological health and associated parameters of well-being in countries that underwent additional lockdowns as the pandemic continued into resurgence “waves.” Aim: The present study provides an overview of the psychological impact of COVID-19 across the two lockdowns in the Cypriot population. Methods: In total, 957 participants completed an online survey during the first lockdown, 134 of whom completed a similar survey again during the second lockdown. The outcomes assessed included stress, positive and negative affect, and well-being. Results: The results indicated no population-wide severe reactions in the participants. Repeated measures analyses showed similar mental health levels during both the first and the second lockdowns. Further inspection of participants’ scores indicated that, for all mental health variables, approximately half of the participants improved, while the other half deteriorated. Discussion: Perceived social support and psychological flexibility predicted most psychological outcomes during both lockdowns. Further research is necessary to understand the continuing effects of the pandemic and associated lockdowns on mental health.

Construction and Validation of a Brief Pandemic Fatigue Scale in the Context of the Coronavirus-19 Public Health Crisis

Objectives: The chronic restrictions to mitigate the new SARS-CoV-2 virus may result in pandemic fatigue. This study set out to develop a short, reliable, valid, and gender-invariant instrument-the Pandemic Fatigue Scale (PFS). Methods: In the first phase, 300 students responded to a pilot questionnaire that allowed the reduction and refinement of the items. In the second phase, the validity, reliability, and invariance of the scale were explored among a sample of 596 participants. Results: Factor exploratory and confirmatory analyses confirmed a robust adjustment for the bifactorial structure that explained 79,36% of the variance. The two factors identified were 1) people's demotivation in continuing to follow the recommended protective behaviors (neglect) and 2) people's boredom regarding the pandemic-related information (boredom). The pattern of relations between the Pandemic Fatigue Scale and other variables-find through correlation, mediation, and path analyses-and the gender differences-find in the ANOVA analyses-provided strong evidence of the construct validity. Moreover, the PFS was shown to be invariant regarding gender in a multigroup factor confirmatory analysis. Conclusion: The instrument can be of utility for professionals and researchers to assess pandemic fatigue, a variable that can affect the adoption of protective measure to avoid catching and spreading the virus.

The Experiences of Nurses and Physicians Caring for COVID-19 Patients: Findings from an Exploratory Phenomenological Study in a High Case-Load Country

Various changes have affected health services delivery in response to the repercussions of the COVID-19 pandemic, and this may exhibit unprecedented effects on healthcare workers (HCWs). This study aimed to explore the lived experience of physicians and nurses caring for patients with COVID-19 in Jordan. An interpretative phenomenology approach was used, and sampling was purposively performed. Data were collected through semi-structured interviews using an online meeting platform (Zoom®). Interviews were audio-recorded, transcribed verbatim, and analyzed. The data were obtained from 26 physicians and nurses caring for patients with COVID-19. The mean age of the participants was 29.41 years (SD = 2.72). Six main themes and 17 subthemes were identified: (i) emotional reactions; (ii) preparation; (iii) source of support; (iv) extreme workload; (v) occupational challenges, and (vi) work-related concerns. The results showed that nurses and physicians caring for COVID-19 patients in Jordan were experiencing mental and emotional distress and were practicing under inadequate work conditions. This distress could be multifactorial with personal, organizational, or cultural origins. Our findings may guide policymakers to consider the potential factors that significantly affect working environment in healthcare settings, the physical and mental wellbeing of HCWs, and the required professional training that can help in enhancing resilience and coping strategies amidst crises.

Predicting the epidemic curve of the coronavirus (SARS-CoV-2) disease (COVID-19) using artificial intelligence: An application on the first and second waves

Objectives

The COVID-19 pandemic is considered a major threat to global public health. The aim of our study was to use the official epidemiological data to forecast the epidemic curves (daily new cases) of the COVID-19 using Artificial Intelligence (AI)-based Recurrent Neural Networks (RNNs), then to compare and validate the predicted models with the observed data.

Methods

We used publicly available datasets from the World Health Organization and Johns Hopkins University to create a training dataset, then we employed RNNs with gated recurring units (Long Short-Term Memory - LSTM units) to create two prediction models. Our proposed approach considers an ensemble-based system, which is realized by interconnecting several neural networks. To achieve the appropriate diversity, we froze some network layers that control the way how the model parameters are updated. In addition, we could provide country-specific predictions by transfer learning, and with extra feature injections from governmental constraints, better predictions in the longer term are achieved. We have calculated the Root Mean Squared Logarithmic Error (RMSLE), Root Mean Square Error (RMSE), and Mean Absolute Percentage Error (MAPE) to thoroughly compare our model predictions with the observed data.

Results

We reported the predicted curves for France, Germany, Hungary, Italy, Spain, the United Kingdom, and the United States of America. The result of our study underscores that the COVID-19 pandemic is a propagated source epidemic, therefore repeated peaks on the epidemic curve are to be anticipated. Besides, the errors between the predicted and validated data and trends seem to be low.

Conclusion

Our proposed model has shown satisfactory accuracy in predicting the new cases of COVID-19 in certain contexts. The influence of this pandemic is significant worldwide and has already impacted most life domains. Decision-makers must be aware, that even if strict public health measures are executed and sustained, future peaks of infections are possible. The AI-based models are useful tools for forecasting epidemics as these models can be recalculated according to the newly observed data to get a more precise forecasting.

Predicting the epidemic curve of the coronavirus (SARS-CoV-2) disease (COVID-19) using artificial intelligence: An application on the first and second waves

OBJECTIVES

The COVID-19 pandemic is considered a major threat to global public health. The aim of our study was to use the official epidemiological data to forecast the epidemic curves (daily new cases) of the COVID-19 using Artificial Intelligence (AI)-based Recurrent Neural Networks (RNNs), then to compare and validate the predicted models with the observed data.

METHODS

We used publicly available datasets from the World Health Organization and Johns Hopkins University to create a training dataset, then we employed RNNs with gated recurring units (Long Short-Term Memory - LSTM units) to create two prediction models. Our proposed approach considers an ensemble-based system, which is realized by interconnecting several neural networks. To achieve the appropriate diversity, we froze some network layers that control the way how the model parameters are updated. In addition, we could provide country-specific predictions by transfer learning, and with extra feature injections from governmental constraints, better predictions in the longer term are achieved. We have calculated the Root Mean Squared Logarithmic Error (RMSLE), Root Mean Square Error (RMSE), and Mean Absolute Percentage Error (MAPE) to thoroughly compare our model predictions with the observed data.

RESULTS

We reported the predicted curves for France, Germany, Hungary, Italy, Spain, the United Kingdom, and the United States of America. The result of our study underscores that the COVID-19 pandemic is a propagated source epidemic, therefore repeated peaks on the epidemic curve are to be anticipated. Besides, the errors between the predicted and validated data and trends seem to be low.

CONCLUSION

Our proposed model has shown satisfactory accuracy in predicting the new cases of COVID-19 in certain contexts. The influence of this pandemic is significant worldwide and has already impacted most life domains. Decision-makers must be aware, that even if strict public health measures are executed and sustained, future peaks of infections are possible. The AI-based models are useful tools for forecasting epidemics as these models can be recalculated according to the newly observed data to get a more precise forecasting.

Arabic COVID-19 Psychological Distress Scale: development and initial validation

Objective

To develop a psychometrically reliable instrument to assess psychological distress during the COVID-19 pandemic across Arab countries.

Design

The new instrument was developed through the review of relevant literature. We adapted multiple items from the following tools: The Fear of COVID-19 Scale, Social Phobia Inventory, Health Anxiety Inventory, Swine Influenza Anxiety Scale and the Arabic Scale of Death Anxiety to design our new assessment tool which is called COVID-19 Psychological Distress Scale (CPDS). For psychometric analyses and validation, we conducted a cross-sectional study that solicited data through a web-based survey using the newly developed CPDS.

Setting and participants

This validation study was conducted in four Arab countries, including Algeria, Kuwait, Saudi Arabia and Yemen. A total of 1337 participants from these countries have voluntarily responded to our survey questionnaire that included the newly developed scale.

Results

The final version of the CPDS comprised 12 items. Participants from Algeria (n=447), Kuwait (n=437), Saudi Arabia (n=160) and Yemen (n=293) have completed the 12-item CPDS. Exploratory factor analysis (used on the Algerian sample) suggested a two-factor structure of the CPDS. The two-factor structure was then supported by the confirmatory factor analysis with an independent sample. Additionally, Rasch analyses showed that all the items fit well in their embedded construct; only one item showed somewhat substantial differential item functioning across gender and country.

Conclusion

The 12-item CPDS was found to be measurement invariant across country and gender. The CPDS, with its promising psychometric properties, might help healthcare professionals to identify people with COVID-19-induced psychological distress.

Beyond equity: Advocating theory-based health promotion in parallel with COVID-19 mass vaccination campaigns

Despite the challenges in managing the COVID-19 pandemic waves in different contexts and capacities, the vaccines that were recently approved for use have created a window of hope to fight this pandemic more effectively by achieving herd immunity. However, the rates of vaccination coverage vary considerably between countries. While looking at COVID-19 vaccination from a different perspective, it brings up the following question: is equitable vaccine delivery and access the only critical issue? Assessing facilitators and barriers to successful vaccination initiatives should be carefully considered and addressed by subsequent actions. The COVID-19 vaccination campaigns as part of disease prevention programs could be embedded in the core of theories for a more systematic approach to enhance vaccine acceptance among people. For effective implementation of public health programs, it is imperative to understand human health behaviours and to have sufficient knowledge about cultural and environmental influences. Sufficient and satisfactory COVID-19 vaccine uptake is not only challenged by the availability of vaccines or their distribution, but also by cultural and social norms in the community as well as the complexity of human behaviours. Therefore, the global efforts should target communities with theory-based health promotion and awareness programs in parallel with vaccination campaigns as a part of public health practice.

•

The COVID-19 pandemic is one of the most devastating events that impacted

various life domains globally.

•

The recent development and approval of various COVID-19 vaccines has created

a window of hope to effectively combat the pandemic.

•

Social, political, economic, and behavioural factors may play important roles in

COVID-19 vaccine uptake among people.

•

Theory-based health promotion initiatives better be side by side with COVID-19

vaccination campaigns to enhance vaccine acceptance among people.

Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study

BACKGROUND

Healthcare professionals including physicians were subjected to an increased workload during the COVID-19 crisis, leaving them exposed to significant physical and psychological distress. Therefore, our present study aimed to (i) assess the prevalence of burnout and levels of job satisfaction among physicians in Jordan, and (ii) explore physicians' opinions, experiences, and perceptions during the pandemic crisis.

METHODS

This was a mixed-method study that utilized a structured web-based questionnaire and semi-structured individual interviews. The 10-Item Burnout Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction (SIJS) were adopted to assess occupational burnout and job satisfaction, respectively. Semi-structured interviews were conducted, based on a conceptual framework that was developed from Herzberg's Two-Factor Theory of Motivation and Job Demands-Resources Model. Descriptive statistics and regression models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data, respectively.

RESULTS

A total of 973 survey responses and 11 interviews were included in our analysis. The prevalence of burnout among physicians was (57.7%). Several significant factors were positively associated with burnout, including female gender, working at highly loaded hospitals, working for long hours, doing night shifts, lack of sufficient access to personal protective equipment, and being positively tested for SARS-CoV-2. Regarding job satisfaction, regression analysis revealed that age was positively associated with higher levels of job satisfaction. On contrary, being a general practitioner or specialist, working at highly loaded hospitals, low salaries, and suffering from burnout have predicted lower levels of job satisfaction. Besides, four themes have emerged from the thematic analysis: (i) Work-induced psychological distress during the pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, (iii) Impact of the pandemic on doctor-patient communication and professional skills, and (iv) Economic impacts of the pandemic crisis and lockdown.

CONCLUSION

A significant physical and psychological burden was associated with the COVID-19 pandemic. Reliable efforts should be implemented aiming at protecting physicians' physical and mental wellbeing, enhancing their working conditions, and raising awareness about burnout. Evidence-based decisions and proper utilization of financial and human resources at institutional and national levels are believed to be crucial for the sustainability of the health workforce, especially in crises.