Protecting healthcare workers from SARS-CoV-2 and other infections

Occult Serologically Confirmed Cases of SARS-CoV-2 Coronavirus among the General Population in the Era of the Fourth Vaccination

Background: Asymptomatic SARS-CoV-2 infection can significantly increase the spread of the COVID-19 pandemic. We aimed to investigate the epidemiological and clinical predictors of occult serologically confirmed SARS-CoV-2 cases among the general population during the fourth vaccination era in Israel. Methods: We conducted a cross-sectional study among individuals aged ≥18 years who had not been tested for COVID-19 in the preceding 5 months. Occult serologically confirmed cases were based on the presence of anti-N IgG antibodies. Potential risk factors were examined. Multivariable regression analysis identified independent predictors of subclinical SARS-CoV-2 infection. Results: This study included 504 participants. The prevalence of occult serologically confirmed SARS-CoV-2 was 12.5%. Chronic disease was found to be an independent predictor for the absence of occult disease (aOR) 0.4 [95% (CI): 0.18-0.87], p-value = 0.02). No significant differences were observed in age, sex, marital status, number of children, vaccination status, or exposure to COVID-19 infection between participants with and without SARS-CoV-2 sub-infection. Conclusions: We found a lower prevalence of occult serologically confirmed SARS-CoV-2 cases, compared to previous reports, and a negative correlation between chronic disease and occult SARS-CoV-2. Continued research, surveillance, and intervention strategies are needed to optimize long-term health outcomes and provide valuable insights for public health policymakers and clinicians.

Characterization and evolution of infection control practices among severe acute respiratory coronavirus virus 2 (SARS-CoV-2)-infected healthcare workers in acute-care hospitals and long-term care facilities in Québec, Canada, Spring 2020

OBJECTIVES

In this study, we aimed to (1) estimate the severe acute respiratory coronavirus 2 (SARS-CoV-2) infection rate and the secondary attack rate among healthcare workers (HCWs) in Québec, the most affected province of Canada during the first wave; (2) describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and (3) compare the exposures and practices between acute-care hospitals (ACHs) and long-term care facilities (LTCFs).

DESIGN

Survey of cases.

PARTICIPANTS

The study included Québec HCWs from private and public institutions with laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnosed between March 1 and June 14, 2020. HCWs aged ≥18 years who worked during the exposure period and survived their illness were eligible for the survey.

METHODS

After obtaining consent, 4,542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs.

RESULTS

HCWs represented 13,726 (25%) of 54,005 reported COVID-19 cases in Québec and had an 11-times greater rate of COVID-19 than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs in LTCFs had less training, higher staff mobility between working sites, similar PPE use, and better self-reported compliance with at-work physical distancing. Suboptimal IPC practices declined over time but were still present at the end of the first wave.

CONCLUSION

Québec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

Transmission of Infections during Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency lifesaving endeavor, performed in either the hospital or outpatient settings, that significantly improves outcomes and survival rates when performed in a timely fashion. As with any other medical procedure, CPR can bear potential risks not only for the patient but also for the rescuer. Among those risks, transmission of an infectious agent has been one of the most compelling triggers of reluctance to perform CPR among providers. The concern for transmission of an infection from the resuscitated subject may impede prompt initiation and implementation of CPR, compromising survival rates and neurological outcomes of the patients. Infections during CPR can be potentially acquired through airborne, droplet, contact, or hematogenous transmission. However, only a few cases of infection transmission have been actually reported globally. In this review, we present the available epidemiological findings on transmission of different pathogens during CPR and data on reluctance of health care workers to perform CPR. We also outline the levels of personal protective equipment and other protective measures according to potential infectious hazards that providers are potentially exposed to during CPR and summarize current guidelines on protection of CPR providers from international societies and stakeholders.

Risks of Occupational-Related Adverse Events (ORAEs) and Effect of Bundled Interventions Among Health Care Workers in Novel Coronavirus Pneumonia Wards

OBJECTIVE

The aims of the study were to investigate the burden for health care workers (HCWs) who suffer from occupational-related adverse events (ORAEs) while working in contaminated areas in a specialized hospital for novel coronavirus pneumonia, to explore related risk factors, to evaluate the effectiveness of bundled interventions, as well as to provide scientific evidence regarding the reduction of risks concerning ORAEs and occupational exposure events.

METHODS

The study was completed using a special team of 138 HCWs assembled for a specialized hospital for novel coronavirus pneumonia in Wuhan, dated from February 16 to March 26, 2020. The incidence of occupational exposure was determined by data reported from the hospital, while the prevalence of ORAEs was derived from questionnaire results. The relation coefficients of ORAEs and the variable potential risk factors are analyzed by logistic regression. After the risk factors were identified, targeted organized intervention was implemented and chi-square tests were performed to compare the incidence of occupational exposure and the prevalence of ORAEs in contaminated areas before and after the interventions.

RESULTS

Ninety one out of 138 (65.94%) had reported ORAEs with 300 (27.96%) cases of ORAEs being recorded in a total of 1073 entries into contaminated areas. The prevalence of different ORAEs include 205 tenderness (24.73%), 182 headache/dizziness (21.95%), 138 dyspnea (16.65%), 130 blurred vision (15.68%), and 95 nausea/vomiting (11.46%). Personal protective equipment (PPE) is significantly associated with ORAEs in contaminated areas (P < 0.05). Among non-PPE-related factors, insomnia is associated with the majority of ORAEs in contaminated areas. Significant differences were achieved after organized interventions in the incidence of occupational exposure of HCWs (χ2 = 39.07, P < 0.001) and the prevalence of ORAEs in contaminated areas (χ2 = 22.95, P < 0.001).

CONCLUSION

During the epidemic period of novel severe respiratory infectious disease, the burden of the ORAEs in contaminated areas and the risk of occupational exposure of HCWs were relatively high. In time, comprehensive and multi-level bundled interventions may help decrease the risk of both ORAEs and occupational exposure.

Follow-up of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

Purpose

The SARS-CoV‑2 pandemic has affected the health and practice of otorhinolaryngologists (ORLs) for over 1 year. Follow-up data of a national survey with German ORLs were evaluated regarding differences between the two waves of the pandemic.

Methods

As in the initial survey, German ORLs were addressed via e‑mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association. All ORLs afflicted with SARS-CoV‑2 were invited to participate in a web-based survey. General data on infections and concomitant parameters were evaluated.

Results

Since the start of the pandemic, 129 ORLs reported testing positive for SARS-CoV‑2 in Germany. The ORLs infected during the first wave had a relative risk (RR) of 4.07 (95% CI: 3.20; 5.19) of contracting SARS-CoV‑2. During the second wave, the RR decreased to 0.35 (95% CI: 0.28; 0.45). The availability of personal protective equipment (PPE) increased from the first to the second wave along with an increased perception of protection in the professional environment. The source of infection shifted from infections via medical staff during the first wave to patients and household exposure during the second wave. Regular medical practice was resumed by clinicians and general practitioners in the second wave. Nevertheless, a proportionally lower infection rate was observed compared with the German population as a whole.

Conclusion

The data reflect a unique long-term survey of ORLs during the pandemic. Differences in the source of infection were seen between the first and second wave, confirming the need for appropriate PPE for medical professionals working in high-risk environments. Further strategies to reduce the risk of infection include consistent testing for SARS-CoV‑2 in healthcare professionals, patients, and the general public as well as vaccination of high-risk medical groups.

Supplementary Information

The online version of this paper (10.1007/s00106-021-01075-4) contains the German version of the COVID-19 questionnaire. The article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field. The additional material can be found at the article under “Ergänzende Inhalte”.

Time when a physician turned out to be a patient: A Case Study on how an Ayurvedic physician cured himself from COVID-19

Medical literature continues to get enriched through various researches and observations related to SARS-CoV-2 infection leading to COVID-19. Case reports play crucially to understand a novel clinical condition where much is yet to be known. Current pandemic is unique for the reason that its impacts upon front line health care workers (HCWs) are much higher than general population. In this situation, how an Ayurvedic physician has handled his own case leading to a cure from COVID-19 may furnish important information regarding mitigation and cure from the disease. This is also an unprecedented writing in medical literature as a physician reporting his own case is a rare phenomenon in medical history. This case report puts strongly the prophylactic and disease modifying potential of Ayurvedic interventions in COVID-19.