1
|
Cooper DK, Sobolik JS, Kovacevic J, Rock CM, Sajewski ET, Guest JL, Lopman BA, Jaykus LA, Leon JS. Combined Infection Control Interventions Protect Essential Food Workers from Occupational Exposures to SARS-CoV-2 in the Agricultural Environment. Appl Environ Microbiol 2023; 89:e0012823. [PMID: 37310232 PMCID: PMC10370312 DOI: 10.1128/aem.00128-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
Essential food workers experience elevated risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to prolonged occupational exposures in food production and processing areas, shared transportation (car or bus), and employer-provided shared housing. Our goal was to quantify the daily cumulative risk of SARS-CoV-2 infection for healthy susceptible produce workers and to evaluate the relative reduction in risk attributable to food industry interventions and vaccination. We simulated daily SARS-CoV-2 exposures of indoor and outdoor produce workers through six linked quantitative microbial risk assessment (QMRA) model scenarios. For each scenario, the infectious viral dose emitted by a symptomatic worker was calculated across aerosol, droplet, and fomite-mediated transmission pathways. Standard industry interventions (2-m physical distancing, handwashing, surface disinfection, universal masking, ventilation) were simulated to assess relative risk reductions from baseline risk (no interventions, 1-m distance). Implementation of industry interventions reduced an indoor worker's relative infection risk by 98.0% (0.020; 95% uncertainty interval [UI], 0.005 to 0.104) from baseline risk (1.00; 95% UI, 0.995 to 1.00) and an outdoor worker's relative infection risk by 94.5% (0.027; 95% UI, 0.013 to 0.055) from baseline risk (0.487; 95% UI, 0.257 to 0.825). Integrating these interventions with two-dose mRNA vaccinations (86 to 99% efficacy), representing a worker's protective immunity to infection, reduced the relative infection risk from baseline for indoor workers by 99.9% (0.001; 95% UI, 0.0002 to 0.005) and outdoor workers by 99.6% (0.002; 95% UI, 0.0003 to 0.005). Consistent implementation of combined industry interventions, paired with vaccination, effectively mitigates the elevated risks from occupationally acquired SARS-CoV-2 infection faced by produce workers. IMPORTANCE This is the first study to estimate the daily risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across a variety of indoor and outdoor environmental settings relevant to food workers (e.g., shared transportation [car or bus], enclosed produce processing facility and accompanying breakroom, outdoor produce harvesting field, shared housing facility) through a linked quantitative microbial risk assessment framework. Our model has demonstrated that the elevated daily SARS-CoV-2 infection risk experienced by indoor and outdoor produce workers can be reduced below 1% when vaccinations (optimal vaccine efficacy, 86 to 99%) are implemented with recommended infection control strategies (e.g., handwashing, surface disinfection, universal masking, physical distancing, and increased ventilation). Our novel findings provide scenario-specific infection risk estimates that can be utilized by food industry managers to target high-risk scenarios with effective infection mitigation strategies, which was informed through more realistic and context-driven modeling estimates of the infection risk faced by essential food workers daily. Bundled interventions, particularly if they include vaccination, yield significant reductions (>99%) in daily SARS-CoV-2 infection risk for essential food workers in enclosed and open-air environments.
Collapse
Affiliation(s)
- D. Kane Cooper
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Julia S. Sobolik
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jovana Kovacevic
- Food Innovation Center, Oregon State University, Portland, Oregon, USA
| | - Channah M. Rock
- Department of Soil, Water and Environmental Science, University of Arizona, Tucson, Arizona, USA
| | | | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ben A. Lopman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lee-Ann Jaykus
- Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Juan S. Leon
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Ahlers M, Aralis H, Tang W, Sussman JB, Fonarow GC, Ziaeian B. Non-pharmaceutical interventions and covid-19 burden in the United States: retrospective, observational cohort study. BMJ MEDICINE 2022; 1:e000030. [PMID: 36936598 PMCID: PMC9978758 DOI: 10.1136/bmjmed-2021-000030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/05/2022] [Indexed: 12/22/2022]
Abstract
Objective To evaluate the adoption and discontinuation of four broadly used non-pharmaceutical interventions on shifts in the covid-19 burden among US states. Design Retrospective, observational cohort study. Setting US state data on covid-19 between 19 January 2020 and 7 March 2021. Participants US population with a diagnosis of covid-19. Main outcome measures Empirically derived breakpoints in case and mortality velocities (ie, rate of change) were used to identify periods of stable, decreasing, or increasing covid-19 burden. Associations between adoption of non-pharmaceutical interventions and subsequent decreases in case or death rates were estimated by use of generalised linear models accounting for weekly variability across US states. State level case and mortality counts per day were obtained from the Covid-19 Tracking Project. State level policies on non-pharmaceutical interventions included stay-at-home orders, indoor public gathering bans (mild >10 or severe ≤10 people), indoor restaurant dining bans, and public mask mandates. National policies were not included in statistical models. Results 28 602 830 cases and 511 899 deaths were recorded during the study. Odds of a reduction in covid-19 case velocity increased for stay-at-home orders (odds ratio 2.02, 95% confidence interval 1.63 to 2.52), indoor dining bans (1.62, 1.25 to 2.10), public mask mandates (2.18, 1.47 to 3.23), and severe indoor public gathering bans (1.68, 1.31 to 2.16) in univariate analysis. In mutually adjusted models, odds remained elevated for orders to stay at home (adjusted odds ratio 1.47, 95% confidence interval 1.04 to 2.07) and public mask mandates (2.27, 1.51 to 3.41). Stay-at-home orders (odds ratio 2.00, 95% confidence interval 1.53 to 2.62; adjusted odds ratio 1.89, 95% confidence interval 1.25 to 2.87) was also associated with a greater likelihood of decrease in death velocity in unadjusted and adjusted models. Conclusions State level non-pharmaceutical interventions used in the US during the covid-19 pandemic, in particular stay-at-home orders, were associated with a decreased covid-19 burden.
Collapse
Affiliation(s)
- Michael Ahlers
- Internal Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Hilary Aralis
- Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
| | - Wilson Tang
- David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Gregg C Fonarow
- Internal Medicine, Division of Cardiology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Boback Ziaeian
- Internal Medicine, Division of Cardiology, David Geffen School of Medicine, Los Angeles, CA, USA
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
3
|
Salwa M, Haque MA, Islam SS, Islam MT, Sultana S, Khan MMH, Moniruzzaman S. 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. BMJ Open 2022; 12:e054837. [PMID: 35697439 PMCID: PMC9195156 DOI: 10.1136/bmjopen-2021-054837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mohammad Tanvir Islam
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sarmin Sultana
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Maruf Haque Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Syed Moniruzzaman
- Risk and Environmental Studies, Department of Social and Cultural Sciences, Karlstad University, Karlstad, Sweden
| |
Collapse
|
4
|
Abraham SAA, Doe PF, Osei Berchie G, Agyare E, Ayisi Addo S, Obiri-Yeboah D. Explorative-descriptive study on the effects of COVID-19 on access to antiretroviral therapy services: the case of a teaching hospital in Ghana. BMJ Open 2022; 12:e056386. [PMID: 35613780 PMCID: PMC9125379 DOI: 10.1136/bmjopen-2021-056386] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To explore how the COVID-19 pandemic affected access to antiretroviral therapy (ART) services from the perspective of the persons living with HIV (PLWH). DESIGN The study adopted an exploratory-descriptive qualitative design that used in-depth interviews as the technique for the data collection. Data analysis was done using conceptual content analysis, following the traditions of Elo and Kyngäs on deductive and Hsieh on inductive content analysis. SETTING ART clinic, Cape Coast Teaching Hospital, Ghana. PARTICIPANTS Twelve participants who had at least 1 year history of accessing ART care before the COVID-19 pandemic and at least one clinic visit during the pandemic were purposively sampled from the ART clinic. RESULTS Five concepts of accessing healthcare proposed by Penchansky and Thomas were explored: accessibility, availability, affordability, accommodation and acceptability. The ART unit in the study setting remained open for service delivery throughout the pandemic. However, fear of contracting the virus while patronising services affected the participants' decision to use the facility. Although all the participants in this study reportedly honoured their refill appointments, they indicated knowledge of other PLWH defaulting. With reference to the availability of resources, a shortage of antiretrovirals was reported, affecting the refill appointment intervals. In spite of the challenges, several strategies were implemented to accommodate the patients' needs while protecting them from contracting the virus by instituting the stipulated COVID-19 protocols. The study found that some of the strategies impacted the acceptability and affordability of the services as transportation costs increased. Varying levels of accessibility to health workers providing ART services in the study setting was also recorded. CONCLUSION Strategies were implemented to accommodate the effects of the pandemic on ART provision. However, these had deficiencies that must be addressed using appropriate Differentiated Service Delivery (DSD) interventions that will ensure continuous access to service delivery in the ongoing and any similar future occurrences.
Collapse
Affiliation(s)
| | | | - Gifty Osei Berchie
- Maternal and Child Health Department, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Dorcas Obiri-Yeboah
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Directorate of Research Innovation and Consultancy, University of Cape Coast, Cape Coast, Central, Ghana
| |
Collapse
|
5
|
Stone E, Irving L, Tonga KO, Thompson B. Sustaining the Australian respiratory workforce through the COVID-19 pandemic - a scoping literature review. Intern Med J 2022; 52:1115-1122. [PMID: 35195945 PMCID: PMC9111702 DOI: 10.1111/imj.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Health St Vincent's Clinical Campus
| | - Lou Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katrina O Tonga
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Health St Vincent's Clinical Campus; Northern Clinical School, University of Sydney, New South Wales, Australia
| | - Bruce Thompson
- Swinburne University of Technology, 3783, School of Health Sciences, Hawthorn, Victoria, Australia
| |
Collapse
|
6
|
Leonhardt JM, Ridinger G, Rong Y, Talaei-Khoe A. Invincibility threatens vaccination intentions during a pandemic. PLoS One 2021; 16:e0258432. [PMID: 34705834 PMCID: PMC8550387 DOI: 10.1371/journal.pone.0258432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/28/2021] [Indexed: 12/02/2022] Open
Abstract
Some people feel they are invincible to the novel coronavirus SARS-CoV-2 (COVID-19). They believe that being infected with COVID-19 would not be a serious threat to their health. While these people may or may not be correct in their personal risk assessment, we find that such perceived invincibility may undermine community efforts to achieve herd immunity. Multi-level analysis of survey respondents across 51 countries finds that perceived invincibility from COVID-19 is negatively associated with believing there is a need to prevent the spread of COVID-19 in one's community (n = 218,956) and one's willingness to inoculate against the disease (n = 71,148). These effects are most pronounced among individuals from countries lower in cultural collectivism (e.g., USA, UK, Canada) and highlight the need to consider the interplay of individual and cultural factors in our efforts to understand, predict, and promote preventative health behavior during a pandemic.
Collapse
Affiliation(s)
- James M. Leonhardt
- Department of Marketing, University of Nevada, Reno, Nevada, United States of America
| | - Garret Ridinger
- Department of Management, University of Nevada, Reno, Nevada, United States of America
| | - Yu Rong
- Department of Management, University of Nevada, Reno, Nevada, United States of America
| | - Amir Talaei-Khoe
- Department of Information Systems, University of Nevada, Reno, Nevada, United States of America
| |
Collapse
|
7
|
Park BM, Lee HJ. Healthcare Safety Nets during the COVID-19 Pandemic Based on Double Diamond Model: A Concept Analysis. Healthcare (Basel) 2021; 9:1014. [PMID: 34442151 PMCID: PMC8393212 DOI: 10.3390/healthcare9081014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to analyze the concept of the "healthcare safety net" during the COVID-19 pandemic. Walker and Avant's process of concept analysis was used in this systematic literature review. The attributes of the concept of a healthcare safety net during the COVID-19 pandemic were found to be: (a) capacity, (b) accessibility, (c) health equality, and (d) education. In consideration of these defining criteria, antecedents to the concept were identified as: (a) the COVID-19 pandemic, (b) health inequalities (internal factors and external factors), and (c) healthcare systems (health insurance, screening, protective equipment, medicine, and medical services). Consequences of the concept were: (a) meeting healthcare needs, (b) quality of life, and (c) a decrease in morbidity and mortality. A healthcare safety net is an important concept during the COVID-19 pandemic. In situations like COVID-19, healthcare safety nets are designed to meet safety needs, improve quality of life, and reduce patient turnover and mortality. Based on the results of this study, the development of standardized tools for measuring a healthcare safety net as well as that of policies and systems for resolving a healthcare safety net in the COVID-19 situation is recommended.
Collapse
Affiliation(s)
- Bom-Mi Park
- Department of Nursing, Konkuk University, Chungju-si 27478, Korea;
| | - Hyun-Jung Lee
- Department of Nursing, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 06591, Korea
| |
Collapse
|