The potential impact of the next influenza pandemic on a national primary care medical workforce

Stress-induced cognition among radiologic technologists in COVID-19 quarantine centres in Palestine

BACKGROUND

The outbreak of COVID-19 brought high mortality rate from the viral infection and caused a huge psychological stress for healthcare staff who work under great pressure during the pandemic.

AIMS

The purpose of this study is to assess the level of stress-induced cognition among radiologic technologists (RTs) in COVID-19 quarantine centres in Palestine after the outbreak of COVID-19.

METHODS

Stress-induced cognition was assessed using Stress-induced Cognition Scale (SCS) questionnaire. The validity and stability of the measuring tool was verified. The sample consisted of 61 RTs who are working currently at various quarantine centres in Palestine.

RESULTS

Cognition-induced stress was higher than average. There was a statistically significant difference between RTs working directly with COVID-19 patient compared with RTs working indirectly. Additionally, results show an increased level of stress for RTs having children compared with single or non-parent RTs. Also, RTs who dealt with COVID-19 patients for prolonged periods over a month had higher level of stress-induced cognition. Other variables did not show significant differences among RTs.

CONCLUSION

It is recommended to provide psychological support for RTs who dealt and are currently involved in COVID-19 quarantine centres to alleviate stress-induced cognition.

COVI-Prim survey: Challenges for Austrian and German general practitioners during initial phase of COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response.

METHODS

2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April).

RESULTS

The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly.

CONCLUSION

Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met.

REGISTRATION

Trial registration at the German Clinical Trials Register: DRKS00021231.

Immediate psychological outcomes associated with COVID-19 pandemic in frontline physicians: a cross-sectional study in Egypt

BACKGROUND

The mental health of frontline healthcare workers is influenced by the crisis of the COVID-19 pandemic. This adversely affects their clinical performance and productivity. Therefore, it is important to recognize levels of anxiety, depression and identify the contributing factors.

METHODS

A cross-sectional study recruited physicians working at frontline positions in university teaching and isolation hospitals in the Mid Delta Region of Egypt from April to May 2020. Data was collected through an electronic online survey. Anxiety and depression levels were assessed using General Anxiety Disorder-7 and Patient Health Questionnaire - 9 respectively.

RESULTS

The study included 237 physicians, their mean age was 38.2 ± 6.2 years and 58% of them were males. Overall, 78.9% and 43.8% of all participated physicians reported symptoms of anxiety and depression. 85% of respondents had children with a significant increase in the risk of anxiety (OR = 20.2). This study revealed that poor sleep quality, being a resident physician, disrupted social life, and stigma exposure due to COVID-19, were significant mediating factors for the observed anxiety (OR = 0.53,3.28,0.18,1.56 respectively) and depressive symptoms (OR = 0.51,1.39,0.56,1.9 respectively). However, working in isolation hospitals wasn't a significant contributing factor.

CONCLUSION

The frontline physicians experienced a high rate of mental symptoms during the COVID-19 pandemic. That requires prompt intervention, taking into consideration the underlying determinants.

Stressor Combat Strategies and Motivating Factors Among Health Care Service Providers During COVID-19 Pandemic

Context Since its inception in December 2019 in Wuhan, China, the severe acute respiratory syndrome coronavirus-2, the etiological agent for coronavirus disease 2019 (COVID-19), is spreading rapidly both locally and internationally, and became certified as a pandemic by the World Health Organization (WHO) in March 2020. Working in an environment of high risk, coupled with adherence to quarantine and stressors related to the job, has been found to exacerbate the psychological health of frontline healthcare workers. Aims To assess the perceived stressors, combat strategies, and motivating factors among health care service providers during the COVID-19 pandemic. Setting and design A cross-sectional study was conducted among healthcare workers at a tertiary care hospital in the north-central region of India from May to September 2020. Methods and materials A convenience sample of 150 health care workers was taken. A self-reported pretested structured "COVID 19 staff questionnaire" was used as a study tool. The health care workers (HCWs) included nurses, physicians, laboratory technicians, and radiology technicians who worked in high-risk areas (isolation ward, COVID intensive care unit, emergency department, and outpatient cough outdoor walk-in clinics) during the outbreak constituted our study population.  Statistical analysis used The varying levels of stress or effectiveness of measures were reported as mean and standard deviation, as appropriate. Descriptive statistics were used for data presentation. A Mann-Whitney U test was used to analyse differences between two groups of non-normally distributed data. A p-value of less than 0.05 was considered statistically significant. Results As compared to doctors, paramedical staffs were more stressed with frequent protocol changes (88%), emotional exhaustion (68%), and conflicts with duties (62.7%). The factors like seeing colleague getting better (78.7%) and hoping for financial compensation (49.3%) were reported as stress busters; family compensation in case of death at the workplace and disability benefits in case of disease-related disability development were more effective motivational factors for paramedical staff in case of future outbreaks (p-value <0.05). Conclusions It is needful that secondarily traumatized team members should be always observed, educated, and properly handled. Certain personal coping strategies adopted by health workers should be well addressed and motivated if scientifically sustainable. We have to include psychiatric preparedness and stress monitoring also for health care teams along with emphasizing hygiene, temperature monitoring, and fever management, in planning to fight the pandemic.

Mental Health Status of Healthcare Professionals and Students of Health Sciences Faculties in Kuwait during the COVID-19 Pandemic

Objectives: This study aimed to assess the impact of the COVID-19 pandemic on the mental health status of healthcare professionals (HCPs) and undergraduate students in the health sciences center (HSCUs). In addition, it explored the factors associated with the increased levels of mental health burden among the study population. Methods: A cross-sectional study was performed using two online-administered questionnaires: the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7), which were distributed in parallel to HCPs and HSCUs in Kuwait. These instruments are validated assessment scales to assess mental health status: depression (PHQ-9) and anxiety (GAD-7). Statistical analyses were carried out using SPSS- version 25. Results: A total of 857 individuals (559 HCPs and 298 HSCUs) participated in this study. The prevalence of moderately severe depression or severe depression (PHQ-9 total score of ≥15) among respondents was 66.6%. The median (interquartile range, IQR) PHQ-9 score was significantly higher among HSCUs (20 {11.5}) compared to HCPs (17 {8}). The prevalence of severe anxiety (GAD-7 total score of ≥15) among respondents was 36.7%. There were no significant differences between the median (IQR) GAD-7 scores among the HCPs (14 {7}) and HSCUs (13 {8}). Binary logistic regression analysis revealed that three variables were significantly and independently associated with severe depression among HCPs. The prevalence of severe depression was found to be greater among females compared to males. In addition, it was significantly lower among those who were aged ≥50 years, and those who reported that they were not in direct contact with COVID-19 patients. Among HSCUs, females showed greater depression than males. In contrast, those aged >29 years and who had no history of chronic disease showed lower depression compared to their counterparts in the 18–29 years age group and who had a chronic disease history. Conclusions: The COVID-19 pandemic had a significant negative impact on the mental health of HCPs and HSCUs in Kuwait. This highlights the need for proactive efforts to support their mental health and well-being through educational campaigns and psychological support programs.

Effect of COVID-19 stressors on healthcare workers’ performance and attitude at Suez Canal university hospitals

Background

Coronavirus disease 2019 is an emerging respiratory disease caused by a novel coronavirus effect on 10-20% of total healthcare workers and was first detected in December 2019 in Wuhan, China. This study was designed to assess effect of COVID-19 stressors on healthcare workers’ performance and attitude. A descriptive cross sectional research design was used. A convenient sample (all available healthcare workers) physicians “112,”, nurses “183,” pharmacists “31,” and laboratory technicians “38” was participated to conduct aim of the study. Utilize the study with two tools; online self-administrated questionnaire to assess level of knowledge, attitude, and infection control measures regarding coronavirus disease 2019 and COVID-19 stress scales to assess the varied stressors among healthcare workers.

Results

More than three quarter of the studied participants had satisfactory level of knowledge and infection control measures. Approximately all of the studied participants had positive attitude regarding COVID-19. A total of 57.4% of the studied medical participants had moderate COVID-19 psychological stress levels, while 49.1% of the studied paramedical participants had moderate COVID-19 psychological stress levels. But less than one quarter had severe COVID-19 psychological stress levels. There is a significant correlation between COVID-19 psychological stressor levels and satisfactory level of knowledge among medical participants.

Conclusion/implications for practice

Most of healthcare workers had satisfactory level of knowledge, infection control measures, and positive attitude regarding COVID-19. Most of them had moderate COVID-19 psychological stress levels.

Knowledge, Risk Perception, and Preventive Behaviors Related to COVID-19 Pandemic Among Undergraduate Medical Students in Egypt

With the deteriorating situation during the COVID-19 pandemic, healthcare workers and medical students posted in wards are also supposed to be at risk of getting infected. This study aimed to evaluate knowledge, risk perception, and preventive behaviors related to the COVID-19 pandemic among undergraduate medical students in Egypt. This is a cross-sectional observational study using an anonymous online questionnaire. The survey was conducted through a link shared on social networking sites. Data were collected from 19 June 2020 to 26 June 2020. The medical students of Suez Canal University fulfilled the inclusion criteria and agreed to participate in the study were included by using convenience and snowball sampling technique (283 students). The total related knowledge score was 80.9%. The majority (83%) feel that coronavirus infection is a life-threatening illness. About 86.9% of the students perceived a COVID-19-infected person as a serious threat to society. However, three-quarters of the students (76.3%) perceived risk of infection with COVID-19 during ward rotations. About 92% of the students are practicing preventive behaviors. Female senior students have higher percentages in regard to related knowledge and practicing preventive behaviors. Students who received education about Covid-19 and students perceived higher risk of infection were more adherent to preventive measures. There is a moderate correlation between related knowledge and practicing preventive behaviors. Medical students have good knowledge, practice preventive behaviors, and perceive risk of being infected. The direction to raise knowledge and awareness will enhance practicing preventive behaviors to control the disease.

The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country

Background

The global pandemic of coronavirus disease of 2019 (COVID-19) has led to unprecedented psychological stress on health workers (HCWs). We aimed to assess the psychological impact of COVID-19 on HCWs in comparison to the stress brought on by the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in Saudi Arabia.

Method

Between February 5th and 16th, 2020, 811 health-care workers (HCWs) of a tertiary care teaching hospital were invited to fill a questionnaire regarding concerns and worries about the novel coronavirus pandemic, along with Generalized Anxiety Disorder (GAD-7) Anxiety Severity screening tool.

Results

Out of 582 HCWs who completed the survey questionnaire (response rate of 71.8%), about 40% were exposed previously to MERS-CoV infected or suspected patients during a previous hospital outbreak. While there were no COVID-19 cases reported yet in Saudi Arabia at the time of data collection, still, the anxiety level from COVID-19 was significantly higher than that from MERS-CoV or seasonal influenza: 41.1% were more worried about COVID-19, 41.4% were similarly worried about both MERS-CoV and COVID-19, and 17.5% were more stressed by the previous MERS-CoV hospital outbreak. The most frequent concern was transmitting the infection to family and friends (2.71/5) than to themselves only (2.57/5).

Conclusion

Pandemic and epidemic infectious diseases such as COVID-19 or MERS-CoV impose a significant level of anxiety and stress on healthcare workers who are caring of infected patients, with their main concern being the risk of transmitting the infection to their families or to acquire it themselves. Therefore, optimizing the compliance of healthcare workers with the proper infection prevention and control measures is paramount during the infectious disease outbreak, to ensure their safety, to decrease the likelihood of getting infected or transmitting the infection to others, and consequently to alleviate their psychological stress and anxiety.

An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia

Background

Middle East Respiratory Syndrome (MERS) is caused by MERS coronavirus (MERS-CoV). More than 80% of reported cases have occurred in Saudi Arabia, with a mortality exceeding 50%. Health-care workers (HCWs) are at risk of acquiring and transmitting this virus, so the concerns of HCWs in Saudi Arabia regarding MERS were evaluated.

Methods

An anonymous, self-administered, previously validated questionnaire was given to 1031 HCWs at three tertiary hospitals in Saudi Arabia from October to December, 2014. Concerns regarding the disease, its severity and governmental efforts to contain it, as well as disease outcomes were assessed using 31 concern statements in five distinct domains. A total concern score was calculated for each HCW. Multiple regression analyses were used to identify predictors of high concern scores.

Results

The average age of participants was 37.1 ± 9.0 years, 65.8% were married and 59.1% were nurses. The majority of respondents (70.4%) felt at risk of contracting a MERS-CoV infection at work, 69.1% felt threatened if a colleague contracted MERS-CoV, 60.9% felt obliged to care for patients infected with MERS-CoV and 87.8% did not feel safe at work using standard precautions. In addition, 87.7% believed that the government should isolate patients with MERS in specialized hospitals, 73.7% agreed with travel restriction to and from areas affected by MERS and 65.3% agreed with avoiding inviting expatriates from such areas. After adjustment for covariates, high concern scores were significantly associated with being a Saudi national (p < 0.001), a non-physician (p < 0.001) and working in the central region (p < 0.001).

Conclusions

The majority of respondents reported concern regarding MERS-CoV infection from exposure at work. The overall level of concern may be influenced by previous experience of MERS outbreaks and related cultural issues. The concerns of HCWs may affect their overall effectiveness in an outbreak and should be addressed by incorporating management strategies in outbreak planning.

The Ethics of Medical Practitioner Migration From Low-Resourced Countries to the Developed World: A Call for Action by Health Systems and Individual Doctors

Medical migration appears to be an increasing global phenomenon, with complex contributing factors. Although it is acknowledged that such movements are inevitable, given the current globalized economy, the movement of health professionals from their country of training raises questions about equity of access and quality of care. Concerns arise if migration occurs from low- and middle-income countries (LMICs) to high-income countries (HICs). The actions of HICs receiving medical practitioners from LMICs are examined through the global justice theories of John Rawls and Immanuel Kant. These theories were initially proposed by Pogge (1988) and Tan (1997) and, in this work, are extended to the issue of medical migration. Global justice theories propose that instead of looking at health needs and workforce issues within their national boundaries, HICs should be guided by principles of justice relevant to the needs of health systems on a global scale. Issues of individual justice are also considered within the framework of rights and social responsibilities of individual medical practitioners. Local and international policy changes are suggested based on both global justice theories and the ideals of individual justice.

Sensitivity Analysis of the Parameters of Korea's Pandemic Influenza Preparedness Plan

OBJECTIVES

Our aim was to evaluate Korea's Pandemic Influenza Preparedness Plan.

METHODS

We conducted a sensitivity analysis on the expected number of outpatients and hospital bed occupancy, with 1,000,000 parameter combinations, in a situation of pandemic influenza, using the mathematical simulation program InfluSim.

RESULTS

Given the available resources in Korea, antiviral treatment and social distancing must be combined to reduce the number of outpatients and hospitalizations sufficiently; any single intervention is not enough. The antiviral stockpile of 4-6% is sufficient for the expected eligible number of cases to be treated. However, the eligible number assumed (30% for severe cases and 26% for extremely severe cases) is very low compared to the corresponding number in European countries, where up to 90% of the population are assumed to be eligible for antiviral treatment.

CONCLUSIONS

A combination of antiviral treatment and social distancing can mitigate a pandemic, but will only bring it under control for the most optimistic parameter combinations.

Estimates of the impact of a future influenza pandemic in China

Background  The next influenza pandemic will create a surge in demand for health resources in China, with its current population of >1·3 billion persons and under‐developed medical care and public health system. However, few pandemic impact data are available for China.

Objectives  We estimated the effects of a future influenza pandemic in China by examining pandemic scenarios of varying severity and described the time distribution of cases during a first wave.

Methods  We used a Monte‐Carlo simulation model and death rates, hospitalizations and outpatient visits for 1918‐ and 1968‐like pandemic scenarios and data from the literature or experts’ opinion to estimate four health outcomes: deaths, hospitalizations, outpatient medical visits and clinical illness for which medical care was not sought. For each of the two scenarios we estimated outcomes by week using a normal distribution.

Results  We estimated that a 1968 scenario in China would result in 460 000–700 000 deaths, 1·94–2·27 million hospitalizations, 111–117 million outpatient visits and 192–197 million illnesses for which medical care was not sought. Fifty‐two percent of hospitalizations occurred during the two‐peak weeks of the first wave. We estimated that patients at high‐risk of influenza complications (10–17% of the population) would account for 61–75% of all deaths. For a 1918 scenario, we estimated that 4·95–6·95 million deaths, 20·8–22·7 million hospitalizations and 101–108 million outpatient visits could occur.

Conclusion  Even a 1968 pandemic scenario will pose substantial challenges for the medical and public health system in China, and planning to manage these challenges is essential.

Requirements and design of the PROSPER protocol for implementation of information infrastructures supporting pandemic response: a Nominal Group study

BACKGROUND

Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source.

METHODS

Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels.

RESULTS

The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production.

CONCLUSIONS

The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses of outbreak detection and progress, and response program effectiveness. Scientifically grounded reporting principles need to be established for interpretation of information derived from outbreak detection algorithms and predictive modeling.

The influenza A(H1N1) epidemic in Mexico. Lessons learned

Several influenza pandemics have taken place throughout history and it was assumed that the pandemic would emerge from a new human virus resulting from the adaptation of an avian virus strain. Mexico, since 2003 had developed a National Preparedness and Response Plan for an Influenza Pandemic focused in risk communication, health promotion, healthcare, epidemiological surveillance, strategic stockpile, research and development. This plan was challenged on April 2009, when a new influenza A(H1N1) strain of swine origen was detected in Mexico. The situation faced, the decisions and actions taken, allowed to control the first epidemic wave in the country. This document describes the critical moments faced and explicitly point out the lessons learned focused on the decided support by the government, the National Pandemic Influenza Plan, the coordination among all the government levels, the presence and solidarity of international organizations with timely and daily information, diagnosis and the positive effect on the population following the preventive hygienic measures recommended by the health authorities. The international community will be able to use the Mexican experience in the interest of global health.

Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care

Introduction: With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting. Materials and Methods: An anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness. Results: We obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%). Conclusions: HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning. Key words: Bird flu, Outbreak, Personnel, Singapore

General practice: professional preparation for a pandemic

General practice will play a key role in both prevention and management of an influenza pandemic. Australian pandemic plans acknowledge a role for general practice, but there are few published data addressing the issues that general practitioners and their practices will face in dealing with such a crisis. The outcome will revolve around preparation in three key areas: Definition of the role of general practice within a broad primary care pandemic response, and adequate preparation within general practices so they can play that role well. Planning exercises and forums must include GPs, and rehearsals must include practical experience for general practices and their staff. Local Divisions of General Practice and GP practices can advocate for this, can define their role, and can prepare by using pandemic preparedness checklists; Definition and enactment of communication strategies to facilitate transfer of useful clinical and administrative data from practices and rapid dissemination of information into the community via general practice; Resource provision, which should be centrally funded but locally distributed, with personal protective equipment, vaccines and antivirals readily available for distribution. Resources must include support for human resource management to ensure appropriate health care professionals reach areas of workforce demand. Administrative, clinical and financial resources must be available to train GPs and practices in pandemic awareness and response.

Influenza A virus infection of primary differentiated airway epithelial cell cultures derived from Syrian golden hamsters

The ability of several different influenza A virus strains to infect and replicate in primary, differentiated airway epithelial cell cultures from Syrian golden hamsters was investigated. All virus strains tested replicated equivalently in the cultures and displayed a preference for infecting nonciliated cells. This tropism correlated with the expression of both alpha2,3- and alpha2,6-linked sialic acid on the nonciliated cells. In contrast, the ciliated cells did not have detectable alpha2,6-linked sialic acid and expressed only low amounts of alpha2,3-linked sialic acid. In contrast to clinical isolates, laboratory strains of influenza A virus infected a limited number of ciliated cells at late times post-infection. The presence of alpha2,3- and alpha2,6-linked sialic acid residues on the same cell type suggests that Syrian golden hamsters and differentiated airway epithelial cell cultures derived from hamsters may provide a system for studying the reassortment of influenza A virus strains which utilize different forms of sialic acid as a primary virus receptor.

Potential impact of pandemic influenza on blood safety and availability

The spread of H5N1, an avian influenza A virus, to many countries and the direct infection of humans by this virus have increased awareness of the likelihood of a pandemic among humans. The potential impact of pandemic influenza on the safety of the blood supply should be small because of the limited viremia and the nature of respiratory tract infection of influenza viruses. However, the potential impact of pandemic influenza on the availability of the blood supply could be significant because of reduced donation from blood donors and reduced staff capacity at blood centers during a pandemic. On the other hand, there could be reduced hospital admissions and reduced transfusions, at least for certain blood products, which should result in reduced demand for blood products. Studies are needed to further assess the likely impact of a pandemic on the blood supply and also of the possible intervention options.