Clinical review: influenza pandemic - physicians and their obligations

COVID-19 pandemic preparedness period through healthcare workers' eyes: A qualitative study from a Romanian healthcare facility

Introduction

Healthcare providers represent a limited resource, and their mental health is crucial for patient care and for ensuring containment of the pandemics. We aimed to explore how healthcare workers experienced the preparedness period of COVID-19 pandemic, in order to ascertain the perceived weaknesses and strengths.

Methods

Interviews were conducted with 17 participants encompassing senior physicians, residents, and nurses. They were audio-recorded, and the transcription was verbatim. We used thematic analysis.

Results

We identified four themes, with subsequent subthemes: dealing with the unknown, human versus doctors, sense of helplessness, and a bridge to heaven, which explore how healthcare workers experienced the lack of knowledge, their feeling of losing control, and how they managed their internal fights. The disappointment provoked by the authorities and their colleagues was further evaluated. We identified factors involved in their well-being.

Conclusions

COVID-19 pandemic represented and will still pose a challenge for healthcare workers (HCWs) from all over the world. They felt unprepared for such a crisis. Further measures should be implemented in every hospital to maintain HCWs awareness and to prevent physical imbalance. Appropriate standards of care should be further stated by the authorities so that the healthcare providers may find easier a balance between their safety and their patients’ needs. Conducting qualitative research involving HCWs during pandemic times may help in informing more significant policy decisions.

Cross-Cultural Comparison of Mental Health Between German and South African Employees: Shame, Self-Compassion, Work Engagement, and Work Motivation

The negative impact of the coronavirus disease outbreak 2019 (COVID-19) on work mental health is reported in many countries including Germany and South Africa: two culturally distinct countries. This study aims to compare mental health between the two workforces to appraise how cultural characteristics may impact their mental health status. A cross-sectional study was used with self-report measures regarding (i) mental health problems, (ii) mental health shame, (iii) self-compassion, (iv) work engagement and (v) work motivation. 257 German employees and 225 South African employees have completed those scales. This study reports results following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. T-tests, correlation and regression analyses were performed. German employees had lower mental health problems and mental health shame, and higher self-compassion than South Africans. Mental health problems were positively associated with mental health shame and amotivation, and negatively associated with work engagement and intrinsic motivation in both groups. Lastly, self-compassion, a PP 2.0 construct, was the strongest predictor for mental health problems in both countries. Our results suggest (i) that German culture's long-term orientation, uncertainty avoidance and restraint may help explain these differences, and (ii) that self-compassion was important to mental health in both countries. While the levels of mental health differed between the two countries, cultivating self-compassion may be an effective way to protect mental health of employees in those countries. Findings can help inform managers and HR staff to refine their wellbeing strategies to reduce the negative impact of the pandemic, especially in German-South African organizations.

Unravelling the Role of Socioeconomic Forces in the Early Stage of COVID-19 Pandemic: A Global Analysis

The COVID-19 pandemic has rapidly evolved into an acute health crisis with extensive socioeconomic and demographic consequences. The severity of the COVID-19 pandemic requires a refined (and more comprehensive) understanding of virus dissemination over space, transmission mechanisms, clinical features, and risk factors. In line with this assumption, the present study illustrates a comparative, empirical analysis of the role of socioeconomic and demographic dimensions in the early stages of the COVID-19 pandemic grounded on a large set of indicators comparing the background context across a global sample of countries. Results indicate that-in addition to epidemiological factors-basic socioeconomic forces significantly shaped contagions as well as hospitalization and death rates across countries. As a response to the global crisis driven by the COVID-19 pandemic, all-embracing access to healthcare services should be strengthened along with the development of sustainable health systems supported by appropriate resources and skills. The empirical findings of this study have direct implications for the coordination of on-going, global efforts aimed at containing COVID-19 (and other, future) pandemics.

Anxiety amongst physicians during COVID-19: cross-sectional study in Pakistan

BACKGROUND

Ensuring safety and wellbeing of healthcare providers is crucial, particularly during times of a pandemic. In this study, we aim to identify the determinants of anxiety in physicians on duty in coronavirus wards or quarantine centers.

METHODS

We conducted a cross-sectional quantitative survey with an additional qualitative item. Five constructs of workload, exhaustion, family strain, feeling of protection, and anxiety were measured using items from two validated tools. Modifications were made for regional relevance. Factor analysis was performed showing satisfactory Cronbach alpha results. Overall, 103 physicians completed the questionnaire.

RESULTS

T-test results revealed significant associations between gender and anxiety. Structural equation modeling identified that high workload contributed to greater exhaustion (β = 0.41, R² = 0.17, p < 0.001) and greater family strain (β = 0.47, R² = 0.22, p < 0.001). Exhaustion (β = 0.17, p < 0.005), family strain (β = 0.34, p < 0.001), and feelings of protection (β = - 0.30, p < 0.001) significantly explained anxiety (R² = 0.28). Qualitative findings further identified specific needs of physicians with regard to protective equipment, compensation, quarantine management, resource allocation, security and public support, governance improvement, and health sector development.

CONCLUSIONS

It is imperative to improve governmental and social support for physicians and other healthcare providers during the corona pandemic. Immediate attention is needed to reduce anxiety, workload, and family strain in frontline practitioners treating coronavirus patients, and to improve their (perceptions of) protection. This is a precondition for patient safety.

Doctors during the COVID-19 pandemic: what are their duties and what is owed to them?

Doctors form an essential part of an effective response to the COVID-19 pandemic. We argue they have a duty to participate in pandemic response due to their special skills, but these skills vary between different doctors, and their duties are constrained by other competing rights. We conclude that while doctors should be encouraged to meet the demand for medical aid in the pandemic, those who make the sacrifices and increased efforts are owed reciprocal obligations in return. When reciprocal obligations are not met, doctors are further justified in opting out of specific tasks, as long as this is proportionate to the unmet obligation.

Medical Education, Pre- and Post-Pandemic Era: A Review Article

A pandemic is the worldwide outbreak and spread of a disease. Although pandemics of influenza have occurred rarely, approximately once every few decades in more than three centuries, the outbreaks of H1N1 and H5N1 influenza, the severe acute respiratory syndrome (SARS), and most recently, the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have necessitated the institution of protective and preventive measures such as school closure and mandatory quarantine of infected people, as social distancing is considered to be the most effective preventative strategy until the development of a vaccine, treatment, or both. The current pandemic has also resulted in a transformation in medical education for both undergraduate and postgraduate medical students. Clinical rotations for undergraduates have been suspended all over the world; inter-hospital residency rotations and combined teaching sessions have also been curtailed until further notice. During this most recent pandemic, a number of medical schools have immediately converted their whole clinical curriculum into online formats. Similarly, educational and clinical assessments have been converted into online assessments. However, as the pandemic eras tend to recur over time and epidemics will continue to break out, medical students and healthcare workers will remain susceptible to contagion. Hence, we need to adopt a new educational system that would be safe and sustainable in the long run.

Support for mobilising medical students to join the COVID-19 pandemic emergency healthcare workforce: a cross-sectional questionnaire survey

OBJECTIVE

To identify what motivates medical students to join a pandemic emergency healthcare workforce.

DESIGN

Cross-sectional study.

SETTING

Aalborg University, Denmark.

PARTICIPANTS

All medical students.

MAIN OUTCOME MEASURES

Motivational points as perceived by the students to be important. Demographic characteristics and 11 motivational domains scored on a Visual Analog Scale from 0 (low) to 100 (high) responding to the question: 'To what degree are the following statements important for you to join a national emergency preparedness workforce?' The questionnaire was developed by an expert panel in a process of four iterations.

RESULTS

A total of 486 students of 688 (70.6%) completed the survey within 7 days in March 2020. 80% had decided to join the pandemic emergency healthcare workforce. Ranked median scores for motivational statements in each domain were: care, 100; learn, 90; pride, 83; team, 77; needed, 75; safety, 75; supervision, 75; job, 73; duty, 66; salary, 62; historic, 50. Supervision (p<0.001), salary (p<0.001) and duty (p=0.001) were given increasing priority with advancing study years. Interestingly, students added that support by the university and clarification of study plans were priorities.

CONCLUSIONS

Results guide decision-makers and colleagues on how to motivate or reinforce medical students in joining the pandemic emergency healthcare workforce. Importantly, students emphasised protection for themselves.

Attending to the Emotional Well-Being of the Health Care Workforce in a New York City Health System During the COVID-19 Pandemic

The COVID-19 pandemic has placed an enormous strain on health care workers, and its potential impact has implications for the physical and emotional well-being of the workforce. As hospital systems run well over capacity, facing possible shortages of critical care medical resources and personal protective equipment as well as clinician deaths, the psychological stressors necessitate a strong well-being support model for staff. At the Mount Sinai Health System (MSHS) in New York City, health care workers have been heroically providing frontline care to COVID-19 patients while facing their own appropriate fears for their personal safety in the setting of contagion. This moral obligation cannot be burdened by unacceptable risks; the health system's full support is required to address the needs of its workforce.In this Invited Commentary, the authors describe how an MSHS Employee, Faculty, and Trainee Crisis Support Task Force-created in early March 2020 and composed of behavioral health, human resources, and well-being leaders from across the health system-used a rapid needs assessment model to capture the concerns of the workforce related to the COVID-19 pandemic. The task force identified 3 priority areas central to promoting and maintaining the well-being of the entire MSHS workforce during the pandemic: meeting basic daily needs; enhancing communications for delivery of current, reliable, and reassuring messages; and developing robust psychosocial and mental health support options. Using a work group strategy, the task force operationalized the rollout of support initiatives for each priority area. Attending to the emotional well-being of health care workers has emerged as a central element in the MSHS COVID-19 response, which continues to be committed to the physical and emotional needs of a workforce that courageously faces this crisis.

Influenza vaccination policy-making processes in France and The Netherlands: Framework and determinants

OBJECTIVES

Target groups for seasonal influenza vaccination are nationally defined based on several factors. However, few studies have explored the policy-making processes at the country-level. We investigated key differences in the policy-making process for the development of vaccination recommendations between France (FR) and The Netherlands (NL). This paper presents preliminary results on the evidence used in the decision-making process and focuses on the interactions between the experts and stakeholders.

METHODS

A documentary analysis identified the stakeholders of this process as governmental authorities, research institutions, associations, and manufacturers. This qualitative study included at least one expert from each stakeholder group. Thirty-three semi-structured interviews were performed in 2013 (16 FR, 17 NL). We used NVivo10® to perform a thematic content analysis on the data.

RESULTS

National Immunization Technical Advisory Groups (NITAGs) were the key stakeholders in the development of recommendations. There was no systematic standard evaluation of evidence during the decision-making process in both countries. Likewise, voting was not systematic, although it did occur more often in FR. A declaration of interests was obligatory in both countries. Experts with no conflicts of interest were rare because many depend on private funding for their research on influenza vaccination.

CONCLUSIONS

The transparency of the NITAGs' procedures for the development of recommendations should be improved. We believe improvements might be achieved by the systematic standard evaluation of evidence, consistent voting, clear declarations of interest, and increased public funding for vaccination research.

Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza

BACKGROUND

Many commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI).

METHODS

We critically analyzed the Ghana NISPPI's sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks.

RESULTS

This paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI's text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them.

CONCLUSIONS

Our analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan's content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.

Willingness of the local health department workforce to respond to infectious disease events: empirical, ethical, and legal considerations

According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among local health department workers, a vital response cohort, regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. A summary of relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency is presented. Recommendations are proposed for future work to be done to bring the relevant empirical, ethical, and legal considerations together to develop practical guidance for the local response to infectious disease emergencies.

The duty to treat in the context of an influenza pandemic

The recent influenza pandemic proved that an influenza pandemic is no longer a future scenario. It may urge health care workers to undergo certain or even large risks. According to the WHO as well as commentators, a strong case can be made for adopting a duty to treat during a disease outbreak. Many current professional codes of ethics, however, fail to provide explicit guidance sufficient to set policy or assure the public in the event of an infectious disease outbreak. This paper aims to assess whether there is a duty to treat in the case of an influenza pandemic. As we conclude that there are valid reasons that support the duty to treat in this specific context, we will subsequently explore its scope and limits.

Role of the primary care safety net in pandemic influenza

An influenza pandemic would have a disproportionately adverse impact on minority populations, the poor, the uninsured, and those living in underserved communities. Primary care practices serving the underserved would face special challenges in an influenza pandemic. Although not a formalized system, components of the primary care safety net include federally qualified health centers, public hospital clinics, volunteer or free clinics, and some local public health units. In the event of an influenza pandemic, the primary care safety net is needed to treat vulnerable populations and to provide health care surge capacity to prevent the overwhelming of hospital emergency departments. We examined the strength, capacity, and preparedness of key components of the primary care safety net in responding to pandemic influenza.

The Challenges of “Continuing Medical Education” in a Pandemic Era

Closure of medical schools or the barring of “live patient” contact during an epidemic or pandemic is potentially disruptive to medical education. During the SARS epidemic, the use of web-based learning, role play, video vignettes and both live and mannequin-based simulated patients minimised disruptions to medical education. This article examines the pedagogical innovations that allow clinical teaching to continue without medical students examining actual patients, and proposes a contingency plan in the event of future outbreaks that may necessitate similar containment measures. Key words: Infection control, Medical education, Pandemic, Strategies

Pandemic influenza: are we prepared to face our obligations?

After decades of low personal risk for contracting lethal diseases, physicians are suddenly facing the possibility of a substantial increase in occupational risk during an influenza pandemic. If they are not confronted before the onset of an influenza pandemic, feelings of unease and fear or ignorance about physicians' professional obligations could profoundly hinder individual physicians in fulfilling their professional duties. Such feelings could therefore undermine institutional and societal preparations. In their review published in Critical Care, Anantham and coworkers outline the ethical framework that forms the basis of the professional obligations of physicians who respond to health care emergencies, such as an influenza pandemic.