Monitoring approaches for health-care workers during the COVID-19 pandemic

Heterologous and homologous COVID-19 mRNA vaccination schemes for induction of basic immunity show similar immunogenicity regarding long-term spike-specific cellular immunity in healthcare workers

Healthcare workers (HCWs) are recommended to receive at least three spike-antigen exposures to generate basic immunity and to mediate herd protection of vulnerable patients. So far, less attention has been put on the cellular immune response induced by homologous (three BTN162b2mRNA doses) or heterologous (mRNA-1273 as third dose building on two BTN162bmRNA doses) and the immunological impact of breakthrough infections (BTIs). Therefore, in 356 vaccinated HCWs with or without BTIs the Anti-SARS-CoV-2-Spike-IgG concentrations and avidities and B- and T-cell-reactivity against SARS-CoV-2-Spike-S1- and Nucleocapsid-antigens were assessed with Interferon-gamma-ELISpot and by flow-cytometry. HCWs who had hybrid immunity due to BTIs exhibited strong T-cell-reactivity against the Spike-S1-antigen. A lasso regression model revealed a significant reduction in T-cell immune responses among smokers (p < 0.0001), with less significant impact observed for age, sex, heterologous vaccination, body-mass-index, Anti-Nucleocapsid T-cell reactivity, days since last COVID-19-immunization, and Anti-SARS-CoV-2-Spike-IgG. Although subgroup analysis revealed higher Anti-SARS-CoV-2-Spike-IgG after heterologous vaccination, similar cellular reactivity and percentages of Spike-reactive T- and B-cells were found between homologous and heterologous vaccination. Anti-SARS-CoV-2-Spike-IgG concentrations and avidity significantly correlated with activated T-cells. CD4 + and CD8 + responses correlated with each other. A strong long-term cellular immune response should be considered as baseline for recommendations of booster doses in HCWs with prioritization of smokers. HCWs presented significant T-cellular reactivity towards Spike-S1-antigen with particularly strong responses in hybrid immunized HCWs who had BTIs. HCWs without BTI presented similar percentages of Spike-specific B- and T-cells between homologous or heterologous vaccination indicating similar immunogenicity for both mRNA vaccines, BNT162b2mRNA and mRNA-1273.

Career adaptability and career coping styles among Chinese medicine specialty students during the COVID-19: The mediating role of career decision-making self-efficacy

Over the past decade, the attrition rate of Chinese medical graduates has remained high, and the COVID-19 pandemic has exacerbated this situation. Medicine specialty students are the main force of the future healthcare industry. The career choices and career confidence of those entering the healthcare industry will have a huge influence on the quality of future healthcare provision. Considering the possible emergence of public health emergencies such as COVID-19 in the future, helping students develop good career adaptability will contribute to their future career development. However, the relationship between career adaptability, career coping styles and career decision-making self-efficacy remains unclear during the COVID-19. This study aims to examine the interconnections amongst career coping styles, career adaptability and career decision-making self-efficacy among Chinese medicine specialty students and the mediating role of career decision-making self-efficacy. Questionnaire survey was conducted on 747 medicine specialty students from China. The results showed that positive coping style has a significant positive correlation with career decision-making self-efficacy, career adaptability, and their sub-dimensions. There was a partial mediating effect of career decision self-efficacy between the predictor variable positive coping style and the outcome variable career adaptability. By promoting the level of positive coping style or career decision-making self-efficacy among medicine specialty students, the career adaptability can be directly or indirectly enhanced. This survey will help to guide future medical education decisions during a similar pandemic to prevent further loss of healthcare professionals in the medical service.

All hands on deck during the COVID-19 pandemic. Maintaining face-to-face medical education and clinical placements

Medical students must have robust educational experiences, graduate and commence timely employment. Here, we describe how the Royal College of Surgeons in Ireland (RCSI) delivered clinical placements in medical programmes over the first three waves of the COVID-19 pandemic in Ireland, including a student-centred, holistic approach to students' educational, social and health needs with strong student involvement, re-organising the university's primary care team, developing COVID-19 PCR testing on site and re-focusing communications and student services. This resulted in re-arranging the students into learning communities, and students and staff electronically recorded their COVID-19 symptom status daily. In-person observed structured clinical examination and other clinical exams progressed. No lockdown of any campus occurred. Over the two senior years, 693 students completed 15,000 weeks of clinical and experiential learning across 104 sites, similar to previous years, including anatomy practicals, procedural skills training, simulated ward rounds and patient encounters, case-based presentations and small group tutorials. The compliance rate with the daily symptom tracker was 91%. The percentage response rate and the number of students providing feedback from October 2020 to April 2021 was as high as 50%. The overall response rate was 33%. By mid-May, 93-95% of students in the two senior years had had at least one dose of the SARS-CoV-2 vaccine, with 99% fully vaccinated by the start of the next academic year in autumn 2021. Over the period of testing for SARS-CoV-2, just over 22,000 samples were processed, of which 0.79% were positive; no medical student acquired COVID-19 or was associated with nosocomial transmission. The total investment by the RCSI in Dublin, was €9.3m (€1.2 in capital expenditure and €8.1 in operational expenses). Continuing face-to-face clinical placements during a pandemic was possible through a multi-model approach that prioritised two-way communication, compliance with national public health advice and student screening.

Infection Prevention and Control Implications of Special Pathogens in Children

Special pathogens are broadly defined as highly transmissible organisms capable of causing severe disease in humans. Children's hospital healthcare personnel (HCP) should be prepared to identify patients possibly infected with a special pathogen, isolate the patient to minimize transmission, and inform key infection prevention, clinical, and public health stakeholders. Effective preparedness requires resources and practice with attention to education, policies and procedures, drills and training, and supplies. Successfully preparing for special pathogens is an important measure toward keeping communities, HCP, and patients and families safe in this global age that brings pathogens from across the world to our doorstep.

[Test Concept of the City of Cologne for Critical Infrastructure (KRITIS) during the First Wave of the COVID-19 Pandemic]

BACKGROUND

At the beginning of the COVID-19 pandemic, the Public Health Department of the City of Cologne established preferential testing for critical infrastructure (KRITIS) personnel. The aim of this study was to retrospectively analyze this concept.

METHODS

Test results as well as demographic and job-related data from March to April 2020 were collected and descriptively analyzed using a specially developed software. KRITIS personnel who tested positive were systematically interviewed over the phone.

RESULTS

1521 individuals were tested, of whom 896 (59%) were from the healthcare sector, particularly from the nursing professions (35%). Testing and consultation services were also utilized by employees of non-profit organizations (8%), administration (7%), fire department (11%), and police (4%). KRITIS personnel who tested positive suspected increased risk from contacts at the workplace (58%), mostly without adequate protection (85%). Of those surveyed, 83% rated the KRITIS concept as 'good' or 'very good'. Processes at the testing center were rated as 'good' or 'very good' by 89%, while 47% rated phone support as 'good' or 'very good', and 30% as 'sufficient' or poor. Free comments showed that frequent phone contact from the Public Health Department was perceived as positive and even more often as negative interindividually. Communication and advice were positively highlighted, while lack of competence and coordination were criticized. The respondents criticized the comparatively lower provision of testing services for family members, for example, due to limited resources.

CONCLUSION

With the KRITIS concept, the Public Health Department of Cologne developed and implemented an offer for system-relevant professional groups that was intensively used and mostly assessed as positive. This concept can be used as a blueprint for other pandemics.

A COVID-19 monitoring process for healthcare workers utilizing occupational health

BACKGROUND

Hospital-based occupational health (HBOH) is uniquely positioned to not only prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, but to care for healthcare workers (HCWs) sick with coronavirus disease 2019 (COVID-19).

AIMS

The primary objective of this study is to describe a system where HBOH services were adapted to provide a monitoring programme whereby HCWs with SARS-CoV-2 received daily evaluations and treatment options in order to improve access to care, and to report the clinical outcomes and predictors of hospitalization in HCWs enrolled in the programme. A secondary objective is to compare clinical outcomes to data on national HCWs with COVID-19.

METHODS

This retrospective cohort study used survey data collected on HCWs at a university health system with COVID-19 from 1 March 2020 through 1 December 2021. A firth regression model was used to examine the unadjusted and adjusted association between clinical factors and hospitalization.

RESULTS

The study cohort included 4814 HCWs with COVID-19. Overall hospitalizations were 119 (2%), and there were six deaths (0.12%). Predictors of hospitalization include several co-morbidities and symptoms. A total of 1835 HCWs monitored before vaccine or monoclonal antibody availability were compared with data on U.S. HCWs in a similar time period. The monitored HCWs had a lower rate of co-morbidities (19% versus 44%, P < 0.001), a lower hospitalization rate (3% versus 8% P < 0.001) and case-fatality rate (0.11% versus 0.95% P < 0.001).

CONCLUSIONS

This monitoring strategy for COVID-19 may be feasible for HBOH systems to implement and improve access to care, but more data are needed to determine if it improves outcomes.

Patients' perception towards digital health services in Saudi Arabia: A cross-sectional study

The COVID-19 pandemic has highlighted the importance of the widespread use of digital health services (DHS). Despite evidence of the benefits of DHS, there are many barriers to their adaptation worldwide. This study aimed to measure the effectiveness of DHS from the patient perspective. A cross-sectional study was conducted in the Jazan region of Saudi Arabia from December 2022 to March 2023. Of the 323 participants who completed the online questionnaire, 63.5% were female, and 55.4% of participants found that DHS was satisfactory. 34% of the participants preferred DHS via telephone calls and 40.2% found that DHS was comparable to direct regular services in building trust between patients and doctors. A total of 79.2% agreed that DHS could reduce unnecessary outpatient visits and 70.9% agreed that it could be used effectively to follow patients with chronic diseases. DHS was found to be cost-effective in 76.8%. Digital healthcare has the potential to significantly improve health care outcomes and effectiveness in Saudi Arabia. Therefore, the use of a DHS for monitoring and dispensing care would be advantageous. However, difficulties such as lack of time or a packed schedule have prevented patients in Saudi Arabia from using telemedicine.

Project SAPPORO (StAff prescription – bluPORt optimization): Quality improvement report on the expanded use of secured medication lockers for hospital staff during COVID-19 pandemic

Background

Singapore General Hospital (SGH) Pharmacy department set up a novel 24-h medication locker service in November 2019 to serve hospital staff on work shifts who were unable to collect medication within the pharmacy operating hours. However, the initial uptake rate was modest.

Objectives

Primary objective was to increase the daily locker service uptake by staff from five lockers to 42 lockers (100%) in 6 months, starting from June 2020. Secondary objectives include exploring the cost savings and impact of the locker service on the pharmacy’s operational efficiency, as well as compare the medication collection experience of hospital staff using the locker service and in the pharmacy.

Methods

FOCUS-PDSA was the adopted QI methodology. Two Plan-Do-Study-Act (PDSA) cycles were used to implement the final identified solutions. PDSA cycle one focused on improving publicity and educational efforts. PDSA cycle two then focused on expanding the service to include the entire hospital campus staff and setting up a self-registration booth at the pharmacy entrance.

Results

The primary objective of achieving 100% locker utilization was attained in October 2020, with daily average service uptake rate increasing from 12.6 at baseline to 49.8 by the end of PDSA cycle 2. Annual pharmacist manpower savings of 0.88 Full Time Equivalent (FTE) was also achieved. Locker service users gave a higher average satisfaction score compared to those who collected from the pharmacy.

Conclusion

Project SAPPORO successfully increased the daily locker service, providing hospital campus staff with increased convenience and positive medication collection experience during the COVID-19 pandemic.

Detection of Reverse Transcriptase LAMP-Amplified Nucleic Acid from Oropharyngeal Viral Swab Samples Using Biotinylated DNA Probes through a Lateral Flow Assay

This study focuses on three key aspects: (a) crude throat swab samples in a viral transport medium (VTM) as templates for RT-LAMP reactions; (b) a biotinylated DNA probe with enhanced specificity for LFA readouts; and (c) a digital semi-quantification of LFA readouts. Throat swab samples from SARS-CoV-2 positive and negative patients were used in their crude (no cleaning or pre-treatment) forms for the RT-LAMP reaction. The samples were heat-inactivated but not treated for any kind of nucleic acid extraction or purification. The RT-LAMP (20 min processing time) product was read out by an LFA approach using two labels: FITC and biotin. FITC was enzymatically incorporated into the RT-LAMP amplicon with the LF-LAMP primer, and biotin was introduced using biotinylated DNA probes, specifically for the amplicon region after RT-LAMP amplification. This assay setup with biotinylated DNA probe-based LFA readouts of the RT-LAMP amplicon was 98.11% sensitive and 96.15% specific. The LFA result was further analysed by a smartphone-based IVD device, wherein the T-line intensity was recorded. The LFA T-line intensity was then correlated with the qRT-PCR Ct value of the positive swab samples. A digital semi-quantification of RT-LAMP-LFA was reported with a correlation coefficient of R2 = 0.702. The overall RT-LAMP-LFA assay time was recorded to be 35 min with a LoD of three RNA copies/µL (Ct-33). With these three advancements, the nucleic acid testing-point of care technique (NAT-POCT) is exemplified as a versatile biosensor platform with great potential and applicability for the detection of pathogens without the need for sample storage, transportation, or pre-processing.

Protecting healthcare workers and patients during the COVID-19 pandemic: a comparison of baseline and follow-up infection prevention and control needs in Nigerian military healthcare facilities delivering HIV services

BACKGROUND

Protecting the HIV health workforce is critical for continuity of services for people living with HIV, particularly during a pandemic. Early in the COVID-19 pandemic, the Nigerian Ministry of Defence, in partnership with the US Military HIV Research Program, took steps to improve infection prevention and control (IPC) practices among staff working in select PEPFAR-supported Nigerian military health facilities.

METHODS

We identified a set of IPC activities a priori for implementation at four Nigerian military hospitals in HIV and related departments in early 2021, including continuous medical masking, physical distancing, placement of additional hand washing stations and hand sanitizers throughout facilities, and training. We fine-tuned planned intervention activities through a baseline needs assessment conducted in December 2020 that covered eight IPC components: 'IPC program structure, funding and leadership engagement'; 'IPC policies, guidelines and standard operating procedures (SOPs)'; 'infrastructure'; 'triage and screening'; 'training, knowledge and practice'; 'personal protective equipment (PPE) materials, availability and adequacy'; 'biosafety and waste management'; and 'monitoring and remediation' prior to implementation. Baseline results were compared with those of a follow up assessment administered in August 2021, following intervention implementation.

RESULTS

IPC readiness remained high at both baseline and follow-up assessments for 'IPC guidelines, policies, and SOPs' (96.7%). The components 'infrastructure' and 'monitoring and remediation', which needed improvement at baseline, saw modest improvements at follow-up, by 2% and 7.5%, respectively. At follow-up, declines from high scoring at baseline were seen in 'IPC program structure, funding and leadership engagement', 'training, knowledge and practice', and 'biosafety and waste management'. 'PPE materials availability and adequacy' improved to 88.9% at follow-up. Although unidirectional client flow was newly implemented, the score for 'triage and screening' did not change from baseline to follow-up (73%).

CONCLUSION

Variability in IPC component readiness and across facilities highlights the importance of building resilience and employing a quality improvement approach to IPC that includes regular monitoring, re-assessment and re-training at set intervals. Results can be used to encourage solutions-oriented dialogue between staff and leadership, determine needs and implement action plans to protect staff and people with HIV.

Prevalence of SARS-CoV-2 infection among health care workers in a reference hospital in Brazil

Health care workers (HCW) are the frontline workforce for COVID-19 patient care and, consequently, are exposed to SARS-CoV-2 infection due to close contact to infected patients. Here, we evaluate the prevalence of SARS-CoV-2 infection among HCW from an infectious disease hospital, reference center for COVID-19 care in the metropolitan area of Sao Paulo city, Brazil. Among 2,204 HCW, 1,417 (64.29%) were subjected to detection of anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay. Out of the total, 271 (19.12%) presented anti-SARS-CoV-2 antibodies. Prevalence varied according to HCW categories. The highest prevalence was observed in workers from outsourced companies, cooks and kitchen assistants, hospital cleaning workers, and maintenance workers. On the other hand, resident physicians and HCW from the institution itself presented lower prevalence (nurses, nursing assistants, physicians, laboratory technicians). Social and environmental factors are important determinants, associated with exposure in the hospital environment, which can determine the greater or lesser risk of infection by pathogens that spread rapidly by air.

SARS-Cov-2 Infection and Seroconversion Rates in Healthcare Providers Prior to COVID-19 Vaccine Rollout

OBJECTIVE

A 6-month longitudinal surveillance study of asymptomatic healthcare providers (HCP) was carried out at a large urban academic medical center in the United States to assess whether their job occupation with higher exposure risks to SARS-CoV-2 would equate with higher risk of contracting COVID-19 at the beginning of the pandemic before COVID-19 vaccines were available.

METHODS

A longitudinal cohort study design was used to collect and analyze immunological and virological monitoring data and self-report survey assessments of personal protective equipment (PPE) availability, adherence to infection control guidelines, and time spent on COVID-19 wards.

RESULTS

Among 289 eligible participants, SARS-CoV-2 exposure risk was high with 48-69% participants working in COVID-19 units and more than 30% of them caring for COVID-19 patients. However, the seroconversion rate was low with only 2.1% of participants developing humoral or cellular immunity against SARS-CoV-2.

CONCLUSION

Our study findings suggest that, for this HCP cohort working at a large urban academic medical center, a low incidence of SARS-CoV-2 infection could be maintained under conditions of strict infection prevention protocols and reliable PPE availability.

Effect of Optimizing Medical Rehabilitation System for Patients with Coronavirus Disease 2019 Using the Functional Resonance Analysis Method

Objectives

Coronavirus infection 2019 (COVID-19) is an indication for rehabilitation medicine, especially in severe cases. However, there has been no system analysis of safe and continuous provision of medical rehabilitation for COVID-19 patients. The aim of this study was to confirm the effectiveness of rehabilitation for severe COVID-19 and to analyze the optimization of the medical rehabilitation system using the Functional Resonance Analysis Method (FRAM).

Methods

The subject of the analysis was the medical rehabilitation system itself, which had been implemented by the Rehabilitation Center of our hospital in response to the increased number of COVID-19 patients. In the FRAM analysis, Functions were identified, and their relationships were examined. Functions were established using a hierarchical cross-check by the authors. Patient outcomes resulting from optimization of the rehabilitation system were length of hospital stay, patient independence in daily living, and rehabilitation-related medical costs, and these were statistically validated.

Results

In repeated optimizations of the rehabilitation system, the main issues were "handling of infected patients and isolation of usual clinical practice," "staff rotation," and "remote consultation". The modification of the medical rehabilitation system was associated with shorter hospital stays, shorter periods of time without prescription, faster improvement in independence of daily living, and lower rehabilitation-related medical costs.

Conclusions

Optimization at each stage of medical rehabilitation resulted in positive effects on patient outcomes. FRAM is useful for identifying and the optimization of key functions.

Healthcare practitioners' construction of occupational risk during the COVID-19 pandemic

RATIONALE AND OBJECTIVE

In the pandemic's first year, frontline healthcare practitioners (HCPs) experienced a disproportionate burden of COVID-19's negative effects, including infection, death, trauma and burnout. Qualitative research is needed to understand practitioners' experiences to address the unique challenges they face. To this end, this article investigates occupational factors identified by practitioners as relevant to their risk perceptions. By positioning HCPs as a distinctive risk group in the hierarchical space of risk group prioritization, this analysis extends thinking about such classifications within medicine.

METHODS

Remote interviews were conducted between 2020 and 2022 with 45 U.S. practitioners, including physicians, nurse practitioners, physician associates, registered nurses and technicians. Interviews were audio recorded, transcribed, and coded using NVivo to analyze how practitioners understood their occupational risk.

RESULTS

Participants' risk perceptions focused on three concerns. First, working within spatial concentrations of COVID-19 required adapting procedures and reimagining their bodies as potentially hazardous. Second, the limitations of protective measures elevated concerns about healthcare work, and were perceived as pitting practitioners' health against patient care and administrative needs. Third, managing the many uncertainties about COVID-19 meant HCPs risked both its known and unknown effects.

CONCLUSION

This study examines frontline practitioners' perceptions of occupational risk during the pandemic. It argues two tensions underlie practitioners' risk perceptions. First, like other essential workers, HCPs constituted a unique risk group that distinguished them from other vulnerable populations - due to risks arising from occupational rather than biomedical factors. Second, unlike other essential workers, practitioners were directly exposed to infectious patients that posed risks to their health. These elements each highlight a perceived gap between practitioners' and administrators' risk perceptions that facilitated HCP cynicism about guidelines. Future research may fruitfully investigate if these themes persist outside the U.S. and across healthcare systems.

Changes in the clinico-functional characteristics of stroke patients in the acute phase during the COVID-19 pandemic

OBJECTIVE

To compare the sociodemographic and clinico-functional characteristics of patients admitted to a stroke unit immediately before and during two different COVID-19 pandemic phases.

METHODS

This exploratory study was conducted in the stroke unit of a public hospital in Brazil. Patients consecutively admitted to a stroke unit for 18 months with primary stroke aged ≥20 years were included and divided into three groups: G1: Pre-pandemic; G2: Early pandemic; and G3: Late pandemic. The sociodemographic and clinico-functional characteristics of the groups were compared (α=0.05).

RESULTS

The study included 383 individuals (G1=124; G2=151; G3=108). The number of risk factors (higher in G2; p≤0.001), smoking (more common in G2; p≤0.01), type of stroke (ischemic more common in G3; p=0.002), stroke severity (more severe in G2; p=0.02), and level of disability (more severe in G2: p≤0.01) were significantly different among the groups.

CONCLUSION

A greater number of serious events and risk factors including smoking and higher level of disability was observed in patients in the beginning of the pandemic than in the late phases. Only the occurrence of ischemic stroke increased in the late phase. Therefore, these individuals may have an increased need for rehabilitation services monitoring and care during their lifespan. Additionally, these results indicate that health promotion and prevention services should be strengthened for future health emergencies.

A systematic outbreak investigation of SARS-CoV-2 transmission clusters in a tertiary academic care center

BACKGROUND

We sought to decipher transmission pathways in healthcare-associated infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within our hospital by epidemiological work-up and complementary whole genome sequencing (WGS). We report the findings of the four largest epidemiologic clusters of SARS-CoV-2 transmission occurring during the second wave of the pandemic from 11/2020 to 12/2020.

METHODS

At the University Hospital Basel, Switzerland, systematic outbreak investigation is initiated at detection of any nosocomial case of SARS-CoV-2 infection, as confirmed by polymerase chain reaction, occurring more than five days after admission. Clusters of nosocomial infections, defined as the detection of at least two positive patients and/or healthcare workers (HCWs) within one week with an epidemiological link, were further investigated by WGS on respective strains.

RESULTS

The four epidemiologic clusters included 40 patients and 60 HCWs. Sequencing data was available for 70% of all involved cases (28 patients and 42 HCWs), confirmed epidemiologically suspected in house transmission in 33 cases (47.1% of sequenced cases) and excluded transmission in the remaining 37 cases (52.9%). Among cases with identical strains, epidemiologic work-up suggested transmission mainly through a ward-based exposure (24/33, 72.7%), more commonly affecting HCWs (16/24, 66.7%) than patients (8/24, 33.3%), followed by transmission between patients (6/33, 18.2%), and among HCWs and patients (3/33, 9.1%, respectively two HCWs and one patient).

CONCLUSIONS

Phylogenetic analyses revealed important insights into transmission pathways supporting less than 50% of epidemiologically suspected SARS-CoV-2 transmissions. The remainder of cases most likely reflect community-acquired infection randomly detected by outbreak investigation. Notably, most transmissions occurred between HCWs, possibly indicating lower perception of the risk of infection during contacts among HCWs.

Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation

BACKGROUND

The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public health crisis.

METHODS

Our integrated governance framework considers system, sector, organizational and socio-cultural dimensions of health workforce policy. The COVID-19 pandemic serves as the policy field and Brazil, Canada, Italy, and Germany as illustrative cases. We draw on secondary sources (literature, document analysis, public statistics, reports) and country expert information with a focus on the first COVID-19 waves until the summer of 2021.

RESULTS

Our comparative investigation illustrates the benefits of a multi-level governance approach beyond health system typologies. In the selected countries, we found similar problems and governance gaps concerning increased workplace stress, lack of mental health support, and gender and racial inequalities. Health policy across countries failed to adequately respond to the needs of HCWs, thus exacerbating inequalities during a major global health crisis.

CONCLUSIONS

Comparative health workforce policy research may contribute new knowledge to improve health system resilience and population health during a crisis.

Preventive Measures among Healthcare Workers (HCWs) during the COVID-19 Pandemic

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), placed health systems worldwide under immense pressure, and healthcare workers (HCWs) were at the front lines. The Puerto Rico Department of Health confirmed the first case of COVID-19 in March 2020. We aimed to assess whether COVID-19 preventive measures implemented by HCWs were effective in a work scenario before vaccine availability. We conducted a descriptive cross-sectional study from July to December 2020 to evaluate the use of personal protective equipment (PPE), hygiene guidelines, and other measures taken by HCWs to prevent the spread of SARS-CoV-2. We collected nasopharyngeal specimens for molecular testing at the beginning of the study and follow-up. We recruited 62 participants aged 30-59 (79% women). Participants recruited from hospitals, clinical laboratories, and private practice included medical technologists (33%), nurses (28%), respiratory therapists (2%), physicians (11%), and others (26%). Among our participants, nurses were at higher risk (p < 0.05) of infection. We identified that 87% of participants followed the hygiene recommendation guidelines. In addition, all participants practiced handwashing or disinfection before or after caring for each patient. All participants tested negative for SARS-CoV-2 during the study period. On follow-up, all study participants reported being vaccinated against COVID-19. The implementation of PPE and hygiene measures showed high efficacy as a prevention method against SARS-CoV-2 infection when vaccines and treatment were not widely available in Puerto Rico.

Sources of exposure and risk among employees infected with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a large, urban, tertiary-care hospital in the United States

Objective

Hospital employees are at risk of SARS-CoV-2 infection through transmission in 3 settings: (1) the community, (2) within the hospital from patient care, and (3) within the hospital from other employees. We evaluated probable sources of infection among hospital employees based on reported exposures before infection.

Design

A structured survey was distributed to participants to evaluate presumed COVID-19 exposures (ie, close contacts with people with known or probable COVID-19) and mask usage. Participants were stratified into high, medium, low, and unknown risk categories based on exposure characteristics and personal protective equipment.

Setting

Tertiary-care hospital in Boston, Massachusetts.

Participants

Hospital employees with a positive SARS-CoV-2 PCR test result between March 2020 and January 2021. During this period, 573 employees tested positive, of whom 187 (31.5%) participated.

Results

We did not detect a statistically significant difference in the proportion of employees who reported any exposure (ie, close contacts at any risk level) in the community compared with any exposure in the hospital, from either patients or employees. In total, 131 participants (70.0%) reported no known high-risk exposure (ie, unmasked close contacts) in any setting. Among those who could identify a high-risk exposure, employees were more likely to have had a high-risk exposure in the community than in both hospital settings combined (odds ratio, 1.89; P = .03).

Conclusions

Hospital employees experienced exposure risks in both community and hospital settings. Most employees were unable to identify high-risk exposures prior to infection. When respondents identified high-risk exposures, they were more likely to have occurred in the community.

Outbreak investigation in a COVID-19 designated hospital: The combination of phylogenetic analysis and field epidemiology study suggesting airborne transmission

BACKGROUND

Healthcare-associated COVID-19 infections caused by SARS-CoV-2 have increased morbidity and mortality. Hospitals and skilled nursing facilities (SNFs) have been challenged by infection control and management.

METHODS

This case study presents an outbreak investigation in a COVID-19-designated hospital and a hospital-based SNF. Real-time polymerase chain reaction (PCR) and other studies were performed on samples obtained from SNF residents, hospital patients, and healthcare workers (HCWs). The results of the laboratory tests and field epidemiological data were analyzed. Genome sequencing and phylogenetic analysis of SARS-CoV-2 were performed to identify the associations between cases. The tracer gas was released and recorded by a thermal imaging camera to investigate the spatial relations within clusters.

RESULTS

During the outbreak, 29 COVID-19 infections in 3 clusters were identified through hospital-wide, risk-guided, and symptom-driven PCR tests. This included 12 HCWs, 5 patients, and 12 SNF residents who had been hospitalized for at least 14 days. Serology tests did not identify any cases among the PCR-negative individuals. The phylogenetic analysis revealed that viral strains from the 3 clusters shared a common mutation of G3994T and were phylogenetically related, which suggested that this outbreak had a common source rather than multiple introductions from the community. Linked cases exhibited vertical spatial distribution, and the sulfur hexafluoride release test confirmed a potential airborne transmission.

CONCLUSIONS

This report addressed the advantage of a multi-disciplinary team in outbreak investigation. Identifying an airborne transmission within an outbreak highlighted the importance of regular maintenance of ventilation systems.

Immunogenicity and safety of coadministration of COVID-19 and influenza vaccination

Seasonal influenza vaccination is established as important infection prevention measure, especially among highly exposed healthcare workers (HCWs) [1]. Coadministration with the third dose of COVID-19 vaccine could be an efficient strategy protecting HCWs from two major viral respiratory infections [2–4]. To date, the humoral immunogenicity and side-effects of a coadministered third COVID-19 and a seasonal quadrivalent influenza vaccine are still unclear, and the available data is limited in transferability to the general public [5–7]. This preference-based non-randomised controlled study examines the antibody-mediated immunogenicity and vaccine-related side-effects of mRNA-based COVID-19 and seasonal influenza vaccine coadministration in HCWs.

Coadministration of seasonal quadrivalent influenza and COVID-19 booster vaccination is safe and does not increase vaccine-related side-effects, but may limit anti-SARS-CoV-2 antibody formation https://bit.ly/3uKFUie

Control of an outbreak of COVID-19 at a tertiary hospital in Taiwan

BACKGROUND

Coronavirus disease 2019 (COVID-19) has circulated in Taiwan since late 2019. Healthcare facilities are vulnerable to COVID-19 outbreaks due to clusters of symptomatic patients and susceptible hosts. Prompt control of outbreaks is crucial. In May 2021, an index case of COVID-19 was detected at Far Eastern Memorial Hospital (FEMH) in New Taipei City, Taiwan, 3 days after hospital admission, spreading to 26 patients and staff. Herein we evaluate control of this COVID-1 outbreak.

METHODS

To control the outbreak, the index case ward was closed, and large-scale COVID-19 testing (RT PCR) was performed for all inpatients, caregivers and healthcare workers (HCWs). All exposed persons were quarantined. Thorough investigation was conducted to analyze the transmission route.

RESULTS

The outbreak comprised 12 patients, 12 caregivers, and 3 HCWs. Seven patients expired and the remaining cases recovered. Overall, 456 patients/caregivers and 169 HCWs were quarantined. Analysis showed that longer exposure time was the main cause of HCW infection; all three infected HCWs were primary-care nurses related to the index case. To diminish hidden cases, all hospitalized patients/caregivers received PCR examinations and all results were negative. Thereafter, all patients/caregivers routinely received PCR examination on admission. Hospital-wide PCR screening for HCW detected 4 positive HCWs unrelated to this outbreak, and a second-round of screening detected 2 more cases, with no additional cases during the following 6 months.

CONCLUSION

Prompt infection control measures and large-scale PCR screening can control a COVID-19 outbreak within 2 weeks. Exposure time is the major risk factor for HCW infection.

Impact of COVID-19 pandemic on nurses' burnout and related factors: A rapid systematic review

AIM

This study aimed to investigate the effect of COVID-19 pandemic on nurses' burnout and related factors.

BACKGROUND

Nurses at the frontlines in every field of the health system and composed most of the health service industry closely experience all negative events during the pandemic.

METHODS

This study is a rapid systematic review.

RESULTS

A total of 751 studies were selected, of which 13 studies were compatible with the inclusion criteria. The sample size ranged from 107 to 12.596. The studies determined that nurses' burnout levels were generally moderate level and above during the COVID-19 pandemic. Sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout.

CONCLUSION

The results of this review may use to make implications that would ease the effect of the pandemic on nurses and develop strategies to protect nurses from burnout in similar possible situations. The protocol information is included here for blind peer review.

PROSPERO REGISTRATION NUMBER (ID)

CRD42021244849.

REGISTRATION AND PROTOCOL

Prior to undertaking the review, we registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021244849. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244849. The changes made during the review process were registered in PROSPERO with an update.

COVID-19 hospital admissions and mortality among healthcare workers in South Africa, 2020-2021

Objectives

This study describes the characteristics of admitted HCWs reported to the DATCOV surveillance system, and the factors associated with in-hospital mortality in South African HCWs.

Methods

Data from March 5, 2020 to April 30, 2021 were obtained from DATCOV, a national hospital surveillance system monitoring COVID-19 admissions in South Africa. Characteristics of HCWs were compared with those of non-HCWs. Furthermore, a logistic regression model was used to assess factors associated with in-hospital mortality among HCWs.

Results

In total, there were 169 678 confirmed COVID-19 admissions, of which 6364 (3.8%) were HCWs. More of these HCW admissions were accounted for in wave 1 (48.6%; n = 3095) than in wave 2 (32.0%; n = 2036). Admitted HCWs were less likely to be male (28.2%; n = 1791) (aOR 0.3; 95% CI 0.3-0.4), in the 50-59 age group (33.1%; n = 2103) (aOR 1.4; 95% CI 1.1-1.8), or accessing the private health sector (63.3%; n = 4030) (aOR 1.3; 95% CI 1.1-1.5). Age, comorbidities, race, wave, province, and sector were significant risk factors for COVID-19-related mortality.

Conclusion

The trends in cases showed a decline in HCW admissions in wave 2 compared with wave 1. Acquired SARS-COV-2 immunity from prior infection may have been a reason for reduced admissions and mortality of HCWs despite the more transmissible and more severe beta variant in wave 2.

Who Is at Higher Risk of SARS-CoV-2 Reinfection? Results from a Northern Region of Italy

The SARS-CoV-2 pandemic continues to spread worldwide, generating a high impact on healthcare systems. The aim of the study was to examine the epidemiological burden of SARS-CoV-2 reinfections and to identify potential related risk factors. A retrospective observational study was conducted in Liguria Region, combining data from National Vaccines Registry and Regional Chronic Condition Data Warehouse. In the study period (September 2021 to May 2022), 335,117 cases of SARS-CoV-2 infection were recorded in Liguria, of which 15,715 were reinfected once. During the Omicron phase (which predominated from 3 January 2022), the risk of reinfection was 4.89 times higher (p < 0.001) than during the Delta phase. Unvaccinated and vaccinated individuals with at least one dose for more than 120 days were at increased risk of reinfection compared with vaccinated individuals with at least one dose for ≤120 days, respectively (odds ratio (OR) of 1.26, p < 0.001; OR of 1.18, p < 0.001). Healthcare workers were more than twice as likely to be reinfected than non-healthcare workers (OR of 2.38, p < 0.001). Lower ORs were seen among people aged 60 to 79 years. Two doses or more of vaccination were found to be protective against the risk of reinfection rather than a single dose (mRNA vaccines: OR of 0.06, p < 0.0001, and OR of 0.1, p < 0.0001; vector vaccines: OR of 0.05, p < 0.0001). Patients with chronic renal failure, cardiovascular disease, bronchopneumopathy, neuropathy and autoimmune diseases were at increased risk of reinfection (OR of 1.38, p = 0.0003; OR of 1.09, p < 0.0296; OR of 1.14, p = 0.0056; OR of 1.78, p < 0.0001; OR of 1.18, p = 0.0205). Estimating the epidemiological burden of SARS-CoV-2 reinfections and the role played by risk factors in reinfections is relevant for identifying risk-based preventive strategies in a pandemic context characterized by a high circulation of the virus and a high rate of pathogen mutations.

One year of COVID-19 pandemic: Health care workers' infection rates and economical burden in medical facilities for oral and maxillofacial surgery

The aim of this study was to create an overview on the COVID-associated burdens faced by the oral and maxillofacial surgery (OMS) workforce during 1 year of the pandemic. OMS hospitals and private practices nationwide were surveyed regarding health care worker (HCW) screening, infection status, pre-interventional testing, personal protective equipment (PPE), and economic impact. Participants were recruited via the German Society for Oral and Maxillofacial Surgery. A total of 11 hospitals (416 employees) and 55 private practices (744 employees) participated. The HCW infection rate was significantly higher in private practices than in clinics (4.7% vs. 1.4%, p<0.01), although most infections in HCW occurred in private environment (hospitals 88.2%, private practice 66.7%). Pre-interventional testing was performed significantly less for outpatients in private practices than in hospitals (90.7% vs. 36.4%, p<0.01). Polymerase chain reaction (PCR) was used significantly more for inpatients in hospitals than in private practices (100.0% vs. 27.3%, p<0.01). FFP2/3 use rose significantly in hospitals (0% in second quarter vs. 46% in fourth quarter, p<0.05) and private practices (15% in second quarter vs. 38% in fourth quarter, p<0.01). The decrease in procedures (≤50%) was significantly higher in hospitals than in private practices (90.9% vs. 40.0%, p<0.01). Despite higher infection rates in private practices, declining procedures and revenue affected hospitals more. Future COVID-related measures must adjust the infrastructure especially for hospitals to prevent further straining of staff and finances.

Experiences, emotions, and expectations of nurse mothers during the COVID-19 process

PURPOSE

This study was designed to investigate the life experiences, emotions, and expectations of nurse mothers (NMs) during the COVID-19 process.

DESIGN AND METHODS

A phenomenological approach was used in this qualitative research. The study was carried out with 18 nurses who worked in a hospital, had at least one child in the 0-18 age group, and agreed to participate in the study. Study data were collected through individual in-depth interviews and analyzed by using the content analysis method.

RESULTS

The analysis of the findings related to the experiences, emotions, and expectations of NMs during the COVID-19 process yielded three main themes, namely, difficulties experienced, emotions experienced, and coping.

CONCLUSIONS

Nurse mothers should be supported mentally during the pandemic period so that they can maintain a healthier relationship with their children.

PRACTICE IMPLICATIONS

When we consider that NMs have experienced negative emotions in the COVID-19 period, investigation of the problems they have experienced during the pandemic, and the situation they have been in and the development of strategies and coping methods to better manage the process will support NMs.

Vaccination Confidence among Healthcare Workers: Results from Two Anamnestic Questionnaires Adopted in the COVID-19 and Influenza Campaign

BACKGROUND

Following the announcement of the development of COVID-19 vaccines, hesitancy about the safety of vaccinations and their side effects have spread, despite having the approval of international drug agencies. The aim of this study was to test the hypothesis that concern about side effects may have led people to fill out the COVID-19 anamnestic vaccine questionnaire with greater attention compared to the similar instrument used for the influenza vaccination.

METHODS

We analyzed vaccination questionnaires of 218 healthcare workers (HCWs) who underwent both COVID-19 and influenza vaccines in 2020/2021. Outcomes included self-reported allergies, chronic pharmacological treatments, and chronic diseases. We tested the difference in prevalence, analyzed differences using the kappa statistics and concordance correlation, and explored factors associated with differences in reporting.

RESULTS

HCWs reported more allergies to substances other than drugs and a higher prevalence of chronic drug intake in the COVID-19 questionnaires than in the influenza ones. Technical staff reported more drug allergies than physicians, and other HCWs reported more outcomes than physicians in the COVID-19 questionnaire.

CONCLUSIONS

We found that this population of HCWs reported higher conditions during the 2020 COVID-19 vaccination campaign compared to that of the influenza vaccine. The identification of socio-demographic characteristics of the less vaccine-confident HCWs could help in planning targeted interventions to enhance vaccine adherence.

Lessons learnt for enhancing hospital resilience to pandemics: A qualitative analysis from Italy

The COVID-19 pandemic has outlined the need to strengthen the resilience of healthcare systems. It has cost millions of human lives and has had indirect health impacts too. Hospital buildings have undergone extensive modifications and adaptations to ensure infection control and prevention measures, and, as it is happened following past epidemics, the COVID-19 experience might change the design of hospital buildings in the future. This paper aims to capitalise on the knowledge developed by the stakeholders directly involved with the hospital response during the pandemic to generate new evidence that will enhance resilience of hospital buildings to pandemics. The research adopted qualitative research methods, namely literature review and interviews with Italian experts including doctors and facility managers to collect data which were analysed through a thematic analysis. The findings include the identification of new needs for hospital buildings and the related actions to be taken or already performed at hospital building and service level which are viable for long term implementation and are aimed at improving hospital resilience to pandemics. The results specify how to improve resilience by means of structural modifications (e.g. placing filter zones among different wards, ensuring the presence of airborne infection isolation rooms at least in the emergency departments), technological changes (e.g. oversizing capacity such as medical gases, information technology improvement for delivering healthcare services remotely), and operational measures (e.g. assessing the risk of infection before admission, dividing acute-care from low-care assets). The needs discussed in this paper substantiate the urge to renovate the Italian healthcare infrastructures and they can be considered useful elements of knowledge for enhancing hospital resilience to pandemics in the extended and in the post-COVID-19 era.

Trends in Occupational Infectious Diseases in South Korea and Classification of Industries According to the Risk of Biological Hazards Using K-Means Clustering

Against the backdrop of the COVID-19 pandemic, it is necessary to identify these risks and determine whether the current level of management is appropriate to respond to the risk of biological hazards depending on the occupation. In this study, the incidence and fatality rates of occupational diseases were calculated using industrial accident statistics of South Korea, and trends by year using joinpoint regression and relative risk by industry using k-means clustering were evaluated for infectious diseases. We found that infectious diseases had the third highest incidence and fourth highest fatalities among all occupational diseases. In the incidence rate, joinpoints appeared in 2009 and 2018, and the annual percent change changed to 7.79, -16.63, and 82.11. The fatality rate showed a consistent increase with an annual percent change of 4.37, but it was not significant. Industries were classified into five groups according to risk, and the legal control measures of certain industries were not sufficient. Follow-up studies are needed to rectify the structural limitations of industrial accident statistics.

Comparing swab- and different symptoms-based strategies to ascertain COVID-19 recovery in healthcare workers: a cost-effectiveness analysis

Objective

Given the human and economic cost of the COVID-19 pandemic, protecting healthcare workers (HCW) and ensuring continuity of care is critical. The aim of this study is to evaluate the cost-effectiveness of different strategies to ascertain COVID-19 recovery in HCWs.

Methods

Data were collected from the hospital health surveillance program on HCWs at the University Hospital of Verona between 29/02/2020 and 14/04/2021. The diagnosis of SARS-CoV-2 infection and the assessment of the recovery were made through RT-PCR on oro-nasopharyngeal swab-sample. Recovery time and probability were estimated through Kaplan–Meier estimate. For each recovery assessment strategy costs (laboratory diagnostics and human resources), expressed in local currency (euro—€), and working days saved (WDS—effectiveness) were estimated. A decision-tree was created where each knot was a time point scheduled by the different recovery assessment strategies. A Monte Carlo simulation method was used, and probabilistic sensitivity analysis assessed the effect of input uncertainty.

Results

In the study period 916 (9.9%) HCWs tested positive. Recovery time through symptom-based strategy (21 days 0.95 CI 16–24) was significantly lower compared to swab-based one (25 days 0.95 CI 23–28, p < 0.001). The swab-based strategy was dominated by all symptoms-based ones. Symptoms-based with a swab on days 14 and 17 had an ICER of 2 €/WDS and 27 €/WDS compared to the one scheduled on days 10 and 17 and with only one swab on the 17th day.

Conclusions

Scheduling swabs on days 14 and 17 in a symptom-based strategy was the most cost-effective, saving 7.5 more working days than the standard one with swabs on days 10 and 17.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12962-022-00385-w.

The influences of corporate policies for COVID-19 on work stress and anxiety among healthcare employees

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, if it is considered that educated manpower is the most valuable resource of countries, it can be thought that various policies should be developed both at the macro- and micro-levels to minimize the loss of healthcare employees. OBJECTIVE: This study aims to determine the effects of the corporate policies for COVID-19 on the work stress and anxiety of healthcare employees. METHOD: The sample of the study consists of 136 of 265 healthcare employees in Sakarya Provincial Health Directorate Emergency Health Services in Turkey. The average age of the participants was 34.43 years old; the average duration of professional experience was 12.12 years. Approximately 61% of the participants are male and 51% have a bachelor’s degree or higher level. A questionnaire form was used in the study as the data collection tool consisting of socio-demographic characteristics, institutional policies on COVID-19, work stress, and the Status Anxiety Scale. Process Macro Model 4, descriptive statistics and correlation analysis were used for the data analysis. RESULTS: According to the results of the study, the corporate policies for COVID-19 perception of participants was above average (3.30±0.82) while work stress (2.99±0.88) and anxiety (2.65±0.56) were below average. The corporate policies for COVID-19 perception of participants reduced their work stress (β= – 0.430) and anxiety (β= – 0.361). Additionally, anxiety played a mediating role in the effect of the corporate policies for COVID-19 perception on work stress, and it further raised the impact of corporate policies for COVID-19 perception on the work stress reduction (β= – 0.169). CONCLUSIONS: During the COVID-19 pandemic, health managers should determine and control the anxiety and stress levels of the health employees on their staff and take a number of steps to reduce their anxiety and stress.

Remote Monitoring and Holistic Care of Home-Isolated COVID-19 Positive Healthcare Workers Through Digital Technology During the Omicron (B1.1.529) Wave: A Prospective Cohort Study From India

Background

Remote monitoring through digital technology offers a promising solution for the diverse medical, psychological and social issues that plague patients with COVID-19 under home-isolation, but remain neglected due to a lack of streamlined medical services for these patients.

Methods

This prospective cohort study determined the feasibility of remote telemonitoring of healthcare workers with mild COVID-19 under home isolation during the Omicron (B1.1.529) wave and characterized their clinico-demographic profile. A holistic monitoring model comprising of mandatory phone calls at the beginning and end of isolation, assisted by home oximetry, predesigned google forms, and opt-in software-based (eSanjeevani OPD) teleconsultation was employed. Factors associated with development of symptomatic disease were also determined.

Results

Out of 100 COVID-19 positive healthcare workers under home-isolation, data for 94 participants was available [median age 27(20–52) years, 56(60%) females]. 93(99%) patients were previously vaccinated for COVID-19 (median time from last dose = 248 days); 34(36%) had a past history of COVID-19. Fever (67%), myalgia (69%), sore throat/dry cough (70%), and running nose (45%) were the most common symptoms. No patient progressed to moderate-severe disease or required care escalation during the remote monitoring period. Most participants reported several additional psychosocial concerns which were adequately addressed. Symptomatic patients had higher BMI (24.1 vs. 21.8kg/m2, p = 0.01) compared to asymptomatic patients. Age, past infection with COVID-19, and time since last vaccine dose were not different between symptomatic and asymptomatic patients.

Conclusion

COVID-19 patients under home isolation have multi-faceted medical and psychosocial issues which can be holistically managed remotely through digital technology.

Psychological Responses of Health Care Workers Are Strongly Associated With Pandemic Management

Background

Globally, governments adopted protective measures to stabilize the worsening COVID-19 pandemic situation. These measures had a large impact on health care workers (HCWs) and could make the work environment more stressful for them. Therefore, we explored the associations of the psychological responses of HCWs and pandemic management among Slovak health care workers during the second wave of the pandemic.

Materials and Methods

We obtained data about psychological responses, COVID-19 experiences, information overload, non-adherence of the public, work stress and barriers and facilitators of health care provision from HCWs at the COVID-19-related departments of one hospital that mainly covered eastern Slovakia (215 health care professionals, 77.7% females, M/SD = 44.4). Data were analyzed using logistic regression models adjusted for gender.

Results

Pandemic management was most strongly associated with psychological responses, such as irritability, sadness, anxiety, dizziness, and back pain, in health care workers. The non-adherence of the public had the strongest associated psychological impact on HCWs, mostly affecting anxiety and irritability (odds ratios, ORs varying from 3.9 to 7.0). From the barriers and facilitators of health care provision, the use of personal protective equipment had the most impact psychologically, whereas efficient department management was most protective, with ORs around 0.3.

Conclusion

Pandemic management has a large impact on health care workers, and promoting resilience may seriously decrease job-related stress and associated psychological responses of HCWs.

Analyses on ICU and non-ICU capacity of government hospitals during the COVID-19 outbreak via multi-objective linear programming: An evidence from Istanbul

The current infectious disease outbreak, a novel acute respiratory syndrome [SARS]-CoV-2, is one of the greatest public health concerns that the humanity has been struggling since the end of 2019. Although, dedicating the majority of hospital-based resources is an effective method to deal with the upsurge in the number of infected individuals, its drastic impact on routine healthcare services cannot be underestimated. In this study, the proposed multi-objective, multi-period linear programming model optimizes the distribution decision of infected patients and the evacuation rate of non-infected patients simultaneously. Moreover, the presented model determines the number of new COVID-19 intensive care units, which are established by using existing hospital-based resources. Three objectives are considered: (1) minimization of total distance travelled by infected patients, (2) minimization of the maximum evacuation rate of non-infected patients and (3) minimization of the infectious risk of healthcare professionals. A case study is performed for the European side of Istanbul, Turkey. The effect of the uncertain length of the stay of infected patients is demonstrated via sensitivity analyses.

The Italian COVID-19 Anxiety Syndrome Scale (C-19ASS): investigation of the COVID-19 Anxiety Syndrome and its association with psychological symptoms in an Italian population

Introduction

The COVID‐19 Anxiety Syndrome Scale (C‐19ASS) is a quick and reliable scale assessing dysfunctional coping strategies activated in response to COVID‐19 fear and threat. The present study aimed to provide a preliminary validation of the Italian version of the C‐19ASS and investigated whether the C‐19ASS would mediate the relationship between the Big Five personality traits and psychological outcomes.

Method

In Study 1, a community sample of 271 participants completed the Italian version of the C‐19ASS and results were subjected to a Principal Component Analysis. In study 2, a community sample of 484 participants completed the Italian version of the C‐19ASS and a series of measures assessing COVID‐19 anxiety, COVID‐19 fear, functional impairment, personality traits, depression, generalized anxiety and health anxiety. Internal consistency, concurrent and incremental validity were assessed. Path analyses were run.

Results

Factor analysis identified a two‐factor solution (i.e., C‐19ASS Perseveration and C‐19ASS Avoidance) and confirmatory factor analysis suggested a two‐factor model best fits the data. The Italian version of the C‐19ASS showed good internal consistency. There was also evidence of convergent validity and incremental validity. Path analyses showed that C‐19ASS Perseveration mediates the relationship between emotional stability and psychological symptoms (depression, generalized anxiety and health anxiety).

Conclusion

The Italian version of the C‐19ASS appears to be a reliable and valid measure of the COVID‐19 anxiety syndrome. The COVID‐19 anxiety syndrome could be a suitable therapeutic target to reduce psychological symptoms typically linked to pandemic events, such as depression generalized anxiety and health anxiety.

Compliance of healthcare workers with the infection prevention and control guidance in tertiary care hospitals: quantitative findings from an explanatory sequential mixed-methods study in Bangladesh

OBJECTIVES

To assess healthcare workers' (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework.

DESIGN

Quantitative data from an explanatory sequential mixed-methods study were employed in this research.

PARTICIPANTS AND SETTINGS

From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Compliance with the WHO's guidance on IPC measures, as well as the associated factors, was the primary outcome.

RESULTS

A mean compliance score of 0.49 (±0.25) was observed on a 0-1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers.

CONCLUSION

Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs' IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.

COVID-19 heterogeneity in islands chain environment

Background

It is critical to capture data and modeling from the COVID-19 pandemic to understand as much as possible and prepare for future epidemics and possible pandemics. The Hawaiian Islands provide a unique opportunity to study heterogeneity and demographics in a controlled environment due to the geographically closed borders and mostly uniform pandemic-induced governmental controls and restrictions.

Objective

The goal of the paper is to quantify the differences and similarities in the spread of COVID-19 among different Hawaiian islands as well as several other archipelago and islands, which could potentially help us better understand the effect of differences in social behavior and various mitigation measures. The approach should be robust with respect to the unavoidable differences in time, as the arrival of the virus and promptness of mitigation measures may vary significantly among the chosen locations. At the same time, the comparison should be able to capture differences in the overall pandemic experience.

Methods

We examine available data on the daily cases, positivity rates, mobility, and employ a compartmentalized model fitted to the daily cases to develop appropriate comparison approaches. In particular, we focus on merge trees for the daily cases, normalized positivity rates, and baseline transmission rates of the models.

Results

We observe noticeable differences among different Hawaiian counties and interesting similarities between some Hawaiian counties and other geographic locations. The results suggest that mitigation measures should be more localized, that is, targeting the county level rather than the state level if the counties are reasonably insulated from one another. We also notice that the spread of the disease is very sensitive to unexpected events and certain changes in mitigation measures.

Conclusions

Despite being a part of the same archipelago and having similar protocols for mitigation measures, different Hawaiian counties exhibit quantifiably different dynamics of the spread of the disease. One potential explanation is that not sufficiently targeted mitigation measures are incapable of handling unexpected, localized outbreak events. At a larger-scale view of the general spread of the disease on the Hawaiian island counties, we find very interesting similarities between individual Hawaiian islands and other archipelago and islands.

An Effective Mechanism for the Early Detection and Containment of Healthcare Worker Infections in the Setting of the COVID-19 Pandemic: A Systematic Review and Meta-Synthesis

The COVID-19 pandemic has exposed healthcare workers (HCWs) to serious infection risks. In this context, the proactive monitoring of HCWs is the first step toward reducing intrahospital transmissions and safeguarding the HCW population, as well as reflecting the preparedness and response of the healthcare system. As such, this study systematically reviewed the literature on evidence-based effective monitoring measures for HCWs during the COVID-19 pandemic. This was followed by a meta-synthesis to compile the key findings, thus, providing a clearer overall understanding of the subject. Effective monitoring measures of syndromic surveillance, testing, contact tracing, and exposure management are distilled and further integrated to create a whole-process monitoring workflow framework. Taken together, a mechanism for the early detection and containment of HCW infections is, thus, constituted, providing a composite set of practical recommendations to healthcare facility leadership and policy makers to reduce nosocomial transmission rates while maintaining adequate staff for medical services. In this regard, our study paves the way for future studies aimed at strengthening surveillance capacities and upgrading public health system resilience, in order to respond more efficiently to future pandemic threats.

The impact and public health response of chiropractors to the COVID-19 pandemic: a survey across four continents

BACKGROUND

The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of COVID-19 on chiropractors internationally, and examines the public health response of chiropractors to the COVID-19 pandemic practising under a musculoskeletal spine-care versus subluxation-based care paradigm.

METHODS

A survey was distributed to chiropractors in Australia, Canada, Denmark, Hong Kong, United Kingdom and United States (Oct. 2nd-Dec. 22nd, 2020) via professional bodies/publications, and social media. Questions were categorised into three domains: socio-demographic, public health response and business/financial impact. Multivariable logistic regression explored survey items associated with chiropractors practising under different self-reported paradigms.

RESULTS

A total of 2061 chiropractors representing four global regions completed the survey. Our recruitment method did not allow the calculation of an accurate response rate. The vast majority initiated COVID-19 infection control changes within their practice setting, including increased disinfecting of treatment equipment (95%), frequent contact areas (94%) and increased hand hygiene (94%). While findings varied by region, most chiropractors (85%) indicated that they had implemented regulator advice on the use of personal protective equipment (PPE). Suspension of face-to-face patient care during the peak of the pandemic was reported by 49% of the participants with 26% implementing telehealth since the pandemic began. Chiropractors practising under a musculoskeletal spine-care paradigm were more likely to implement some/all regulator advice on patient PPE use (odds ratio [OR] = 3.25; 95% confidence interval [CI]: 1.57, 6.74) and practitioner PPE use (OR = 2.59; 95% CI 1.32, 5.08); trust COVID-19 public health information provided by government/World Health Organisation/chiropractic bodies (OR = 2.47; 95% CI 1.49, 4.10), and initiate patient telehealth in response to COVID-19 (OR = 1.46; 95% CI 1.02, 2.08) compared to those practising under a subluxation-based paradigm.

CONCLUSIONS

Chiropractors who responded to our survey made substantial infectious control changes in response to COVID-19. However, there was regional variation in the implementation of the advised practitioner and patient use of PPE and limited overall use of telehealth consultations by chiropractors during COVID-19. Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.

Shadow of cyber ostracism over remote environment: Implication on remote work challenges, virtual work environment and employee mental well-being during a Covid-19 pandemic

This study aimed to identify the influence of workplace cyber ostracism on employee online work engagement and employee mental well-being with the mediating roles of remote work challenges such as loneliness, procrastination, work-home interference, and ineffective communication. As amidst lockdown due to COVID-19, the data was collected from 303 respondents through an online questionnaire that was distributed in virtual groups among friends, relatives, and other fellows who were working in the private sector organizations of Pakistan. The hypotheses were tested using the partial least square structural equation modeling PLS-SEM technique. The findings of this study showed that workplace cyber ostracism has a positive and significant impact on employee online work engagement and employee mental well-being. Moreover, results also demonstrated that loneliness, ineffective communication, procrastination, and work-home interference positively and significantly mediate the relationship between workplace cyber ostracism, employee online work engagement, and employee mental well-being. Furthermore, discussion, implications, and limitations were also discussed in this research article.

Infection control of COVID-19 in pediatric tertiary care hospitals: challenges and implications for future pandemics

Background

More than 2 years into the COVID-19 pandemic, SARS-CoV-2 still impacts children’s health and the management of pediatric hospitals. However, it is unclear which hygiene and infection control measures are effective and useful for pediatric hospitals. Here, we report infection control measures implemented at a tertiary care children’s hospital. We evaluated frequency of SARS-CoV-2 detection in admitted patients, in-hospital transmission and infection related findings. Furthermore, we aimed to capture perspectives of health-care workers and caregivers on effectiveness and burden of infection control measures. Knowledge gained can inform management of the ongoing and future pandemics.

Methods

We designed a retrospective observational study and survey at a pediatric tertiary care referral center. Local infection control measures and respective guidelines regarding COVID-19 were reviewed. Three thousand seven hundred sixteen children under 18 years were tested for SARS-CoV-2 at the University Children’s Hospital Tuebingen and data on SARS-CoV-2 transmission were retrieved from internal records. Two surveys were conducted among 219 staff members and 229 caregivers.

Results

Local infection control measures comprised the formation of a task force, triage, protective hygiene measures and an adaptable SARS-CoV-2 test strategy. Between January 2020 and March 2021, SARS-CoV-2 infection was detected in 37 children presenting to our hospital, 21 of these were admitted. One hospital-acquired infection occurred. About 90% of health-care staff perceived the majority of measures as effective and appropriate. However, visitor restrictions and cancellation of scheduled treatments were perceived least effective by hospital staff and as a particular burden for patients and their caregivers. Visits at the pediatric emergency department significantly decreased during the pandemic. We drafted a pandemic action plan by ranking infection control measures according to local transmission stages.

Conclusions

SARS-CoV-2 infection control measures implemented in our tertiary care children’s hospital were evaluated by health-care workers as mostly effective and appropriate. In particular, good communication, transparency of decision-making as well as universal masking and infection screening were assessed as successful measures of infection control management. Visitor restrictions and cancellation of routine appointments, in contrast, were perceived as a particular burden on patient care and should be avoided. An established pandemic action plan may guide children’s hospitals in the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03299-x.

The Impact of the First Wave of the COVID-19 Pandemic on Healthcare Workers: An Italian Retrospective Study

Healthcare workers (HCWs) played an essential role in managing the COVID-19 pandemic. The Italian Workers’ Compensation Authority (INAIL) and the Italian National Institute of Health (ISS) developed a retrospective study to analyze and understand trends and characteristics of infections among HCWs during the first wave of the pandemic. Between May and September 2020, Italian Regions retrospectively collected anonymous data regarding HCWs infected from the beginning of the pandemic until 30 April 2020 from their administrative sources through a questionnaire asking for socio-demographic and occupational information about the characteristics of contagion and disease outcome. Almost 16,000 valid questionnaires were received. Logistic regression was performed to ascertain the effect of age, gender, geographical macro area, profession, and pre-existing health conditions on the likelihood of HCWs developing more severe forms of COVID-19 (at least hospitalization with mild symptoms). All predictor variables were statistically significant. HCWs at higher risk of developing a more severe disease were males (OR: 1.90; 95% CI: 1.44–2.51), older than 60 years of age (OR: 6.00; 95% CI: 3.30–10.91), doctors (OR: 4.22; 95% CI: 2.22–9.02), working in Lombardy (OR: 55.24; 95% CI: 34.96–87.29) and with pre-existing health conditions (OR: 1.90; 95% CI: 1.43–2.51). This study analyses the main reasons for the overload put on the National Health Service by the first wave of the pandemic and the risk of infection for HCWs by age, gender, occupational profile and pre-existing health conditions. Improved knowledge, availability of personal protective equipment (PPE) and a tight vaccination campaign for HCWs strongly changed the trend of infections among HCWs, with substantial elimination of serious and fatal cases.

Efficacy and Safety of BCG Revaccination With M. bovis BCG Moscow to Prevent COVID-19 Infection in Health Care Workers: A Randomized Phase II Clinical Trial

The Bacillus Calmette-Guérin (BCG) vaccine, which is widely used to protect children against tuberculosis, can also improve immune response against viral infections. This unicentric, randomized-controlled clinical trial assessed the efficacy and safety of revaccination with BCG Moscow in reducing the positivity and symptoms of COVID-19 in health care workers (HCWs) during the COVID-19 pandemic. HCWs who had negative COVID-19 IgM and IgG and who dedicated at least eight hours per week in facilities that attended to individuals suspected of having COVID-19 were included in the study and were followed for 7, 15, 30, 60, and 180 days by telemedicine. The HCWs were randomly allocated to a revaccinated with BCG group, which received the BCG vaccine, or an unvaccinated group. Revaccination with BCG Moscow was found to be safe, and its efficacy ranged from 30.0% (95.0%CI -78.0 to 72.0%) to 31.0% (95.0%CI -74.0 to 74.0%). Mycobacterium bovis BCG Moscow did not induce NK cell activation at 15–20 days post-revaccination. As hypothesized, revaccination with BCG Moscow was associated with a lower incidence of COVID-19 positivity, though the results did not reach statistical significance. Further studies should be carried out to assess whether revaccination with BCG is able to protect HCWs against COVID-19. The protocol of this clinical trial was registered on August 5th, 2020, at REBEC (Registro Brasileiro de Ensaios Clínicos, RBR-4kjqtg - ensaiosclinicos.gov.br/rg/RBR-4kjqtg/1) and the WHO (# U1111-1256-3892). The clinical trial protocol was approved by the Comissão Nacional de ética de pesquisa- CONEP (CAAE 31783720.0.0000.5078).

Sustaining the Australian respiratory workforce through the COVID-19 pandemic - a scoping literature review

The outbreak of the COVID‐19 pandemic in late 2019 and in 2020 presented challenges to healthcare workers (HCW) around the world that were unexpected and dramatic. The relentless progress of infection, starting in China and rapidly spreading to Europe, North America and elsewhere gave more remote countries, like Australia, time to prepare but also time for unease. HCW everywhere had to readjust and change their work practices to cope. Further waves of infection and transmission with newer variants pose challenges to HCW and health systems, even after mass vaccination. Respiratory medicine HCW found themselves at the frontline, developing critical care services to support intensive care units and grappling with unanticipated concerns about safety, risk and the need to retrain. Several studies have addressed the need for rapid changes in the healthcare workforce for COVID‐19 and the impact of this preparation on HCW themselves. In this paper, we present a scoping review of the literature on preparing HCW for the pandemic, explore the Australian experience of building the respiratory workforce and propose evidence‐based recommendations to sustain this workforce in an unprecedented high‐risk environment.

Remote, Hybrid, and On-Site Work during the SARS-CoV-2 Pandemic and the Consequences for Stress and Work Engagement

With the COVID-19 pandemic having disrupted economies, businesses, and individual activities, it is important to examine how different forms of work affect employee behaviour. This study applies work engagement (the key construct in organisational psychology) as the dependent variable and considers its determinants in the form of stress factors and attitudes toward remote work. A cross-sectional study was conducted. A total of 544 (Female = 58.5%) workers were surveyed: remote (n = 144), hybrid (n = 142), and on-site (n = 258). The selection for the study was purposive. Standardised survey questionnaires were used in the study: UWES-9, Stress Management Standards, and Attitudes toward Remote Work. The obtained results indicate that there were no significant differences between groups in terms of the intensity of work engagement, but work engagement was explained by other variables that are different in each of the studied groups. Relationships and use of social media were the most important factors among remote workers. For on-site workers, the most important factors were control and role definition. For practitioners, the results indicate which aspects of work should be considered in order to maintain high levels of work engagement when employees are transferring to other forms of work.

Discrepant serological findings in SARS-CoV-2 PCR negative, hospitalised patients with fever and acute respiratory symptoms during the pandemic

BACKGROUND

COVID-19 serology has an evolving role in the diagnosis of SARS-CoV-2 infection. However, its use in hospitalised patients with acute respiratory symptoms remains unclear.

METHODS

Hospitalised patients with acute respiratory illness admitted to an isolation ward were recruited. All patients had negative nasopharyngeal swab polymerase chain reaction (PCR) for SARS-CoV-2. Serological studies using 4 separate assays (cPass: surrogate neutralising ELISA; Elecsys: N-antigen based chemiluminescent assay; SFB: S protein flow-based; epitope peptide-based ELISA;) were performed on stored plasma collected from patients during the initial hospital stay, and a convalescent visit 4-12 weeks later.

RESULTS

Of the 51 patients studied (aged 54, IQR 21-84; 62.7% male), no patients tested positive on the Elecsys or cPass assays. 5/51 patients had antibodies detected on B-cell Epitope Assay, and 3/51 had antibodies detected on SFB assay. These 8 patients with positive serological test to COVID-19 were more likely to have a high-risk occupation (p=0.039), bacterial infection (p=0.028) and neutrophilia (p=0.013) during their initial hospital admission.

CONCLUSION

Discrepant COVID-19 serological findings were observed amongst those with recent hospital admissions and bacterial infections. The positive serological findings within our cohort raise important questions about the interpretation of sero-epidemiology during the current pandemic. This article is protected by copyright. All rights reserved.