Knowledge and experience of physicians during the COVID-19 Pandemic: A global cross-sectional study

Physicians are on the frontline of the COVID-19 pandemic with responsibility to manage the disease. The aim of this study is to investigate physicians' knowledge, attitudes, perceptions and experiences, as well as preventative practices regarding the COVID-19 pandemic and COVID-19 vaccinations. Further, we explore physicians' recommendations for future pandemics. A mixed-methods online survey was disseminated to physicians globally. The survey was distributed via social media from August 9–30, 2021. Data collected included sociodemographic characteristics, knowledge, attitudes, and practices towards COVID-19, concerns regarding vaccinations, and perspectives on policies implemented. Descriptive statistics were reported, and qualitative data were analysed using inductive thematic analysis. A total of 399 physicians from 62 countries completed the survey, with similar participation from High Income Countries and Low- or Middle-Income Countries. Most physicians (87%) revealed a good level of knowledge while only half (54%) reported adhering to adequate preventative measures. More than half of participants (56%) indicated that the policies implemented to handle COVID-19 by their public health agencies were insufficient or disorganised. While most physicians reported increased mental stress (61%) and described their experience with COVID-19 using negative terminology (63%), most physicians (87%) indicated they are willing to continue working in healthcare. Physicians globally possessed good knowledge of COVID-19 and COVID-19 vaccinations;yet improvements in ensuring compliance with preventative measures is warranted. Findings from this study have important implications. As recommended by physicians, efforts to manage pandemics should involve (1) strengthening health systems, (2) minimising adverse effects of infodemics, (3) delegating decision-making roles appropriately, and (4) acknowledging global responsibility.

Prevalence and correlates of burnout among Lebanese health care workers during the COVID-19 pandemic: a national cross-sectional survey.

BACKGROUND: The COVID-19 pandemic has harshly burdened the healthcare systems. Health care workers (HCWs) are at substantial risk of infection and confronted several stressors as well leading them to experience burnout. This study aimed to assess the prevalence of burnout among Lebanese health HCWs and to identify its associated factors. METHODS: A cross-sectional online survey was conducted between the first of November and the end of December 2020 among Lebanese HCWs working in all active hospitals operating across the country. Data were collected using an Arabic, anonymous, self-reported questionnaire comprising four sections: (a) basic sociodemographic characteristics, (b) exposure to COVID-19 covariates, (c) occupational factors, and (d) the measurements including the Copenhagen Burnout Inventory (CBI). CBI subscale cut-off score of 50 was used to assess the prevalence of burnout among HCWs. Multinomial logistic regression analyses were performed to examine the factors associated with the different aspects of burnout. RESULTS: Out of the 1751 respondents, personal burnout (PB) was detected in its moderate and high-level aspects among 86.3% of Lebanese HCWs. Moderate and high levels of work-related burnout (WB), and client-related burnout (CB) hit 79.2% and 83.3% of HCWs, respectively. HCWs who were females, married, physicians, having a poor health status and specific living conditions (dependent child, elderly at home, family member with comorbidities, and a low income) were more likely to exhibit a high level of PB compared to no/low burnout level. Moreover, frontline HCWs, those infected by COVID-19 or those having a colleague infected by COVID-19, and those exhibiting a high perception of threat were more prone to experience a high-level PB rather than a low/no burnout. Working in a public hospital, extensive working hours, and insufficient sleeping hours were also found positively associated with high PB. However, older age and altruism were negatively associated with high PB compared to no/low PB among HCWs. As for WB, similar factors were found either positively or negatively associated with a high level of WB except health status and living conditions factors (dependent child or family member). As for CB, older age of HCWs (> 30 years) and altruism were negatively associated with high CB compared to no/low burnout level. However, working in the frontline, high threat perception, extensive working hours, insufficient sleeping hours, and low income were positively associated with high CB among HCWs compared to no/low burnout. CONCLUSION: The prevalence of burnout among Lebanese HCWs during the pandemic was significant and alarming. Enacting and implementing preventive policies and effective interventions are urgently needed to cultivate wellness among HCWs.

Lebanese University Students and COVID-19: A Survey on their Related-Knowledge, Practice, and Behaviors.

Introduction: Young adults are at the epicenter for preventing the progression of COVID-19 pandemic and must be targeted for education to impede any potential transmission of the disease. This study aimed to assess the knowledge, practice and behaviors of Lebanese university students regarding COVID-19. Methods: A cross-sectional study was carried out among university students at the Lebanese University between March 30, 2020, and April 4, 2020. Information on socio-demographic data, knowledge, practice, and additional information concerning COVID-19 were collected. Results: Our survey showed that the majority of the students had good knowledge 90.8%, and more than two third of the respondents 78.6% reported good practice regarding COVID-19. Graduate students were more knowledgeable compared to undergraduate students (unstandardized beta 0.349 with a 95% confidence interval (CI) of 0.165 to 0.533; p-value < 0.0001). Moreover, male students had a negative impact on good practice compared to females (unstandardized beta -0.280 with a 95% confidence interval (CI) of -0.402 to -0.159; p-value < 0.0001). Nearly half of the students (55.2%) reported that their food intake has increased, and 82.5% of the students didn't practice sport during the quarantine. The most common information source of the students was the television (63.3%) followed by social media (53.9%). Conclusions: This study offers useful insights into the knowledge and practices of Lebanese university students towards COVID-19. Our findings support the importance to deliver health education campaign by the ministry of public health through television and social media to improve the knowledge on disease transmission and preventive measures.

Smoking status and SARS-CoV-2 infection severity among Lebanese adults: a cross-sectional study.

BACKGROUND: A paradoxical hypothesis about the effect of smoking on patients infected with severe acute respiratory syndrom 2 (SARS-CoV-2) infection still exists. Furthermore, gender-discrepancy in the impact of smoking on COVID-19 severity was given little attention. Thus, the aims of the present study were to evaluate the prevalence of smoking and the COVID-19 infection severity in a sample of adult patients diagnosed with COVID-19 and to explore the relationship between smoking status and SARS-CoV-2 infection severity in the overall sample and stratified by gender. METHODS: A retrospective analytical study was conducted on patients diagnosed with COVID-19 cases between December, 2020 and April, 2021 from three leading laboratories in Lebanon. Sociodemographic characteristics, smoking status and clinical symptoms were collected. Multinomial logistic regression analysis was used to explore the relationship between smoking status and SARS-CoV-2 infection severity. RESULTS: A total of 901 confirmed COVID-19 cases participated in the study, 50.8% were females. The mean age of patients was 38.4 years (SD = 15.3). Of the total sample, 521(57.8%) were current smokers. Regarding infection severity, 14.8% were asymptomatic, 69.9% had mild symptoms, while 15.3% had severe infection. In the overall sample, smoking status, smoking types and dose-response were not significantly associated with infection severity. Upon stratifying the entire sample by gender, no association was found between all the considered variables with infection severity among females. However, a significant association was found among male with mild infection compared to their asymptomatic counterparts (OR = 1.78 95% CI (1.01-3.13)). Waterpipe smoking was found to be associated with infection severity among male with mild infection (OR 2.64 (95% CI 1.32-5.27)) and severe infection 2.79, 95% CI (1.19-6.53) compared to their asymptomatic counterparts. CONCLUSION: Our fundings highlight sex differences in the association between tobacco smoking and COVID-19 severity. Current tobacco smoking was not associated with SARS-CoV-2 infection severity among female patients, however, tobacco smoking, particularly waterpipe, was found to be associated with infection severity among male. Thus, the battle against smoking should continue by assisting smokers to successfully and permanently quit.

Practice of non-pharmaceutical interventions against COVID-19 and reduction of the risk of influenza-like illness: a cross-sectional population-based study.

INTRODUCTION: While the widespread implementation of the non-pharmaceutical interventions was intended to contain the COVID-19 pandemic, such measures could be also effective in limiting the spread of other respiratory infections. This study aimed to examine the association between the implementation of personal protective measures and the occurrence of influenza-like illnesses (ILI) in the general population. METHODS: An online retrospective cross-sectional observational study was conducted in April 2021 to assess cases of ILI among Lebanese adults aged 18 years and above, from all Lebanese governorates during the 2020-2021 flu season. Data were collected using a convenience sampling method. In addition to their socio-demographic information, participants were asked about their frequency of implementing personal protective measures and if they have experienced symptoms of ILI in the previous 6 months. The overall score of the personal protective measures was computed. Multivariable logistic regression was performed to examine the association between participants' level of adoption of personal protective measures against COVID-19 and the occurrence of ILI. RESULTS: Among the 1019 Lebanese adults participating in this study, 352 (34.54%) of them reported symptoms of ILI between October 2020 and March 2021. Lebanese adults who wore their facemasks frequently or always were less likely to suffer from symptoms of ILI than others who did not wear the mask (aOR = 0.452, 95% CI = 0.349-0.693, p < 0.001). Similarly, adults who adopt the following protective measures washing hands (aOR = 0.608, 95% CI = 0.524-0.922, p < 0.001), respecting cough etiquette (aOR = 0.763, 95% CI = 0.598-0.918, p < 0.001), disinfecting surface (aOR = 0.892, 95% CI = 0.632-0.911, p = 0.012), avoiding crowded places (aOR = 0.739, 95% CI = 0.688-0.903, p = 0.049), respecting physical distancing (aOR = 0.646, 95% CI = 0.482-0.833, p = 0.031) on a regular basis (frequently/always) were less likely to report symptoms of influenza-like illnesses when compared with those who did not adhere at all to these measures. CONCLUSION: Our study highlighted the potential of personal protective measures against COVID-19 in reducing the transmission of respiratory infections such as ILI. Such findings might be invested during influenza season, particularly among groups at high risk of developing severe complications. Exploring trends detected by the national severe acute respiratory infection surveillance system is recommended to confirm the utility of these measures.

COVID-19 mortality surveillance in Lebanon.

Since the beginning of the COVID-19 pandemic, the Epidemiological surveillance program of the Lebanese Ministry of Public Health has launched a rapid surveillance system for collecting COVID-19-related mortality data. In this study, we document the Lebanese experience of COVID-19 mortality surveillance and provide an analysis of the epidemiological characteristics of confirmed deaths. The implementation of the rapid COVID-19 mortality surveillance system, data sources, and data collection were described. A retrospective descriptive analysis of the epidemiological characteristics of confirmed cases occurring in Lebanon between February 20, 2020, and September 15, 2021, was performed. Epidemiological curves of Covid-19 confirmed cases and deaths as well as the geographic distribution map of mortality rates were generated. Between February 21, 2020, and September 15, 2021, a total of 8163 COVID-19-related deaths were reported with a predominance of males (60.4%). More than 60% were aged 70 years or above. Of all deaths, 84% occurred at hospitals and 16% at home. The overall cumulative mortality rate was 119.6 per 100,000. The overall case fatality ratio (CRF) was 1.3%. Of the total deaths, 82.2% had at least one underlying medical condition. The top reported COVID-19 comorbidities associated with COVID-19-related deaths are cardiovascular diseases including hypertension (59.1%), diabetes (37.2%), kidney diseases including dialysis (11%), cancer (6.7%), and lung diseases (6.3%). The CFR was 30.9% for kidney diseases, 20.2% for cancer, 20.2% for lung diseases, 18.1% for liver diseases, 14% for diabetes, and 12.2% for cardiovascular diseases. Considering the limited human and financial resources in Lebanon due to the economic and political crisis, the rapid mortality surveillance system can be considered successful. Improving this system is important and would contribute to better detection of deaths from emerging and re-emerging diseases during health crises.

Fear and death anxiety in the shadow of COVID-19 among the Lebanese population: A cross-sectional study.

BACKGROUND: The COVID-19 pandemic was one of the most devastating health crises the world has seen. One of its mental health consequences includes fear of being infected, which could lead to anxiety. This study aimed to assess the fear related to the COVID-19 pandemic and its associated factors among the adult population in Lebanon. METHODS: A cross-sectional study was conducted in Lebanon between February 26th and April 29th, 2021. Data was collected through an online survey among adults aged 18 years and older. Information on sociodemographic and clinical characteristics of the participants, fear and death anxiety related to the COVID-19 pandemic, depression, and anxiety were collected. Multivariable linear regression analyses were carried out to identify the predictors of fear related to the COVID-19 pandemic. RESULTS: A total of 1840 participants were included in the analysis of which 62.9% were females and 62.2% were single. The age of the participants ranged from 18 to 70 years with a mean of 26.6 ±8.8 years. Of the total participants, 41.9% felt uncomfortable thinking about the novel Coronavirus and 35.4% of candidates became nervous/anxious when watching the news about COVID-19 on social media. About one-third of the participants (33.7%) were afraid of COVID-19 and 23.8% were afraid of losing their life because of the disease. Concerning somatic symptoms of fear, 7.9% reported increased heart races or palpitations whenever they thought about getting infected with COVID-19, 3.7% complained about sleep disturbances while 2.5% developed tremors or sweating in their hands when they thought about Coronavirus. In addition, Death anxiety related to the COVID-19 pandemic was one of the most fear-related factors (B = 0.191, 95% CI (0.172 to 0.211), P-value < 0.0001). CONCLUSION: This study provides insights on the impact of COVID-19 on individuals at the level of fear in Lebanon. Death anxiety was identified as the most significant predictor of fear related to the COVID-19 pandemic. Considering the negative psychological effects of fear, it is necessary to educate the adults on how to deal with death anxiety and implement psychological interventions and counseling programs to relieve fear and improve the mental health of Lebanese adults.

Prevalence and correlates of burnout among physicians in a developing country facing multi-layered crises: a cross-sectional study.

Burnout among physicians is a serious concern that cultivates its seeds during their education. This study assessed the prevalence of burnout among Lebanese physicians and explored its correlates and the combined effects of the pandemic and the economic crisis on burnout. A web-based cross-sectional study was conducted in December 2020 using a snowball sampling technique. Moderate and high levels of burnout hit 90.7% of the physicians where personal, work-related, and client-related burnout were detected among 80.4%, 75.63%, and 69.6% of them respectively. A strong association was found between the higher level of burnout and female gender, younger age, being single, having a dependent child, living with an elderly or a family member with comorbidities, and insufficient sleeping hours. Physicians' specialties, working in a public health facility, limited years of professional experience, lack of previous experience in a pandemic, and extensive working hours were also associated with increased burnout. Furthermore, low income, working in the frontline, higher threat perception, and fear of COVID-19 were contributing to higher burnout. The combined effect of threat perception and financial hardship significantly increased burnout levels. The alarming burnout level detected among physicians urges health authorities to take prompt actions to enhance the physicians' well-being.

Utility of hematological and inflammatory biomarkers in predicting recovery in critical Covid-19 patients: Our experience in the largest Covid-19 treating center in Lebanon.

BACKGROUND: COVID-19 pandemic has led to a catastrophic shortage of ICU beds. This has resulted in the need to identify patients that can be discharged early before full clinical recovery. We designed this study to determine if in changes routine tests like CBCD and CRP can be a useful complement to clinical status when deciding to discharge patients from ICU. METHODS: This retrospective study was conducted in Rafic Hariri University Hospital. Levels of biomarkers measured at admission (T1) and within 3 days of outcome (T2) were collected and ratios (T2/T1) were calculated. The Odds Ratios of association between the changes in these biomarkers and outcome were estimated. Multivariate analysis and AUC for the performance of these biomarkers were also conducted. RESULTS: We found on multivariate analysis that reduction in counts of lymphocyte and platelets and elevation in counts of neutrophils and level of CRP (T2/T1 ratio > 1) are strongly associated with mortality with respective ORs estimated at 6.74, 3.26, 5.65 and 4.34 [p-values < 0.001]. AUCs were found to lie in a range of 0.68 to 0.81 indicating fair to good performance. Other factors found to impact survival were AKI, AF and ACS [p-values < 0.01]. In contrast to other studies, risk factors didn't show an association with survival when adjusted for effects of complications and changes in biomarker levels. CONCLUSIONS: Our results confirm that inexpensive tests like lymphocyte count and CRP can be reliably used to follow COVID-19 patients in ICU and to support the decision to discharge patients.

Feeling the burn in the era of COVID-19: cross-cultural adaptation and validation of the Arabic version of the Copenhagen Burnout Inventory among community pharmacists.

BACKGROUND: Community pharmacists (CPs) are one of the frontline healthcare workers (HCWs) working diligently to provide much-needed services during the COVID-19 pandemic. Burnout was one of the detrimental outcomes of the pandemic on the mental health of Lebanese CPs. To assess the extent of this syndrome among Lebanese CPs, a psychometrically reliable and valid tool is needed. OBJECTIVES: This study aimed to validate the Arabic version of the Copenhagen Burnout Inventory (CBI-A) for use in the assessment of burnout among CPs. METHODS: A web-based cross-sectional study was conducted among Lebanese CPs over February 2021. Data were collected using an anonymous Arabic self-administered questionnaire that includes information on socio-demographic characteristics, work-related variables, in addition to the measurements: the CBI which includes personal, work-related, and patient-related dimensions of burnout, and the hospital anxiety and depression scale. Data were analyzed using SPSS and Amos software. Exploratory factor analysis and confirmatory factor analysis were performed to explore the factorial structure and to measure model fit. Cronbach's alpha was used to assess internal consistency. The criterion validity of the CBI was assessed. Multivariable linear regression analyses were used to explore the association between different aspects of burnout and mental health outcomes such as depression and anxiety. RESULTS: The CBI-A showed high internal consistency with Cronbach's alphas varied from 0.774 to 0.902 and a low floor and ceiling effect (1-9%). As for the CBI-A construct validity, the exploratory factor analysis showed three factors with good factor loadings and explained 72.17% of the variance. The confirmatory analysis supported the three-factorial structure of the CBI that presented a good overall fit based on the goodness-of-fit indices. Ad hoc modifications to the model were introduced based on the modification indices to achieve a satisfactory fit by allowing one covariate error between one pair of items within the personal burnout domain. All of the 19 items were kept in the construct since they showed a good factorial weight. The CBI-A is associated with burnout-related factors in expected directions, including extensive working hours, sleeping hours, and job satisfaction, indicating, therefore, the criterion validity of the tool. CBI subscales were also found positively associated with mental health outcomes such as depression and anxiety demonstrating, in turn, a predictive validity. CONCLUSION: This study provides evidence for the validity and reliability of the Arabic version of CBI as an adequate tool for assessing burnout among CPs. Such an instrument could be useful for assessing such syndrome among other healthcare workers.

Determinants of acceptance of Coronavirus disease-2019 (COVID-19) vaccine among Lebanese health care workers using health belief model.

Since Health care workers (HCWs) are at high occupational risk for COVID-19, they are prioritized for immunization. This study aimed to assess the acceptance rate of the COVID-19 vaccine among HCWs and to identify its determinants. A web-based cross-sectional study was conducted between10 and 31 December 2020 among Lebanese HCWs. The Health Belief Model (HBM) was used as a theoretical framework. Multivariable logistic analyses were carried out to identify the factors associated with the acceptance of the COVID-19 vaccine among HCWs. A total of 1800 HCWs have completed the survey. Around half (58.10%) of them were frontline HCWs and aged between (30-49) years old. Over two-thirds (67.33%) of the participants have received the seasonal influenza vaccine. The acceptance rate of the COVID-19 vaccine among surveyed HCWs was 58%. HCWs who were male (aOR = 1.99, 95% CI (1.41-2.80)), working in the frontlines (aOR = 1.61, 95% CI (1.17-2.21), and those who have received influenza vaccination for the current year (aOR = 1.38, 95% CI(0.99-1.92)) were more willing to get the COVID-19 vaccine. However, factors such as living in rural areas (aOR = 0.61, 95% CI (0.44-0.84)), and being previously diagnosed with COVID-19 (aOR = 0.66, 95%CI (0.45-0.96) were found negatively associated with vaccine acceptance. In terms of health beliefs items, concerns related to the novelty of vaccine (aOR = 0.42, 95% CI (0.25-0.71)), side effects/vaccine safety (aOR = 0.41, 95% CI (0.23-0.73), reliability of manufacturer (aOR = 0.43, 95% CI (0.30-0.63)), and the number of required doses (aOR = 0.58, 95% CI (0.40-0.84)) were also negatively associated with the willingness to get vaccinated against COVID-19. Remarkably, concerns such as the limited accessibility (aOR = 1.68, 95% CI (1.14-2.47)), and availability of vaccines (aOR = 2.16, 95% CI (1.46-3.20)) were associated with an increased likelihood of willingness to receive the COVID-19 vaccine. With regards to cues of action, receiving reliable and adequate information about the vaccine (aOR = 1.98, 95% CI (1.36-2.88)), recommendation by health authorities (aOR = 1.93, 95% CI(1.33-2.81)), and recommendations from health facilities (aOR = 2.68, 95% CI(1.80-3.99)) were also positively associated with vaccine acceptance. Lastly, perception of COVID-19 vaccine benefits by HCWs in terms of protecting them and their close contacts (patients, family members, and friends) from COVID-19 infection (aOR = 4.21, 95% CI (2.78-7.11)) was associated with an increased likelihood of vaccine uptake. The moderate acceptance rate of the COVID-19 vaccine among HCWs found in our study could have broader extents. Understanding and pointing out factors impairing vaccine acceptance such as concerns about the novelty of vaccine and manufacturers' reliability are required to reach a higher vaccination rate.

Prevalence and risk factors of burnout among Lebanese community pharmacists in the era of COVID-19 pandemic: results from the first national cross-sectional survey.

BACKGROUND: Community pharmacists (CPs) are increasingly facing occupational challenges as a result of the COVID-19 pandemic, putting them at high risk of burnout. This study aimed to assess the prevalence of burnout among Lebanese CPs during the COVID-19 pandemic and to identify its associated factors. METHODS: An online survey was conducted among Lebanese CPs between February 1st and March 30, 2021. Collected data included information on sociodemographic characteristics, exposure and work-related variables, the Copenhagen burnout inventory (CBI), and the COVID-19 threat perception scale. Prevalence of burnout was calculated. Multiple logistic regressions were performed to identify the factors associated with the three burnout domains. RESULTS: A total of 387 CPs participated in the survey. Of the total, 53.7% were females; and 43.2% were aged less than 40 years old. The prevalence of moderate-to-high personal, work-related and client-related burnout was 77.8%, 76.8, and 89.7%, respectively. Younger age, staff pharmacist, working more than 40 h per week, high perceived COVID-19 threat were associated with a moderate-to-high likelihood of burnout in all three domains. However, altruistically accepting the risks of caring for COVID-19 patients was the only variable that was associated with a lower likelihood of burnout in all three domains. CONCLUSION: An alarming prevalence of personal, work-related and client-related burnout was revealed among Lebanese CPs. This study has many implications for practice and provides a framework for establishing policy interventions to reduce burnout levels among Lebanese CPs. Preventive strategies and interventions on individual and organizational basis are recommended.

Vaccination against influenza among Lebanese health care workers in the era of coronavirus disease 2019.

BACKGROUND: Health-care workers (HCWs) are at a higher occupational risk of contracting and transmitting influenza. Annual vaccination is an essential tool to prevent seasonal influenza infection. However, HCWs vaccine hesitancy remains a leading global health threat. This study aims to evaluate the flu vaccination coverage rates among Lebanese HCWs and to assess their knowledge, attitudes, practices, perceived barriers, and benefits toward the flu vaccine during the COVID-19 pandemic. In addition, we sought to identify the factors associated with flu vaccine uptake. METHODS: A cross-sectional study using an online survey was conducted in Lebanon among HCWs between 14 and 28 October 2020. Multivariable logistic regression was carried out to identify the factors associated with influenza vaccine uptake. RESULTS: A total of 560 HCWs participated in the survey of whom 72.9% were females, and 53.9% were aged between 30-49 years. Regarding Flu vaccination uptake, the rate has risen from 32.1% in 2019-2020 to 80.2% in 2020-2021 flu season. The majority of HCWs had a good knowledge level and a positive attitude toward flu vaccination. Regarding their practices, less than 50% of HCW were currently promoting the importance of getting the flu vaccine. The majority (83.3%) ranked the availability of a sufficient quantity of vaccines as the most significant barrier to flu vaccination. The main perceived flu vaccination benefits were enhancing patient safety, minimizing the viral reservoir in the population, decreasing hospital admission, and avoiding influenza and COVID-19 co-infection. The odds of influenza vaccine uptake was lower in unmarried compared to married HCWs (OR = 0.527, CI (0.284-0.978). However, HCWs having received the influenza vaccine in the previous season (OR = 6.812, CI (3.045-15.239)), those with good knowledge level (OR = 3.305, CI (1.155-9.457)), low perceived barriers (OR = 4.130, CI (1.827-9.334)) and high perceived level of the benefits (OR = 6.264, CI (2.919-13.442)) of the flu vaccination were found more prone to get the flu vaccine. CONCLUSION: Flu vaccination uptake has increased among HCWs during the 2020-2021 flu season compared with the previous one. Continuing education as well as ensuring free, equitable, and convenient access to vaccination are still required to increase the annual flu vaccination uptake among HCWs.

Phased repatriation of Lebanese expatriates stranded abroad during coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND: The coronavirus disease (COVID-19) pandemic represents a serious worldwide threat. Stranded Lebanese citizens abroad appealed to the Lebanese government to embark on citizen repatriation missions. We aim to document the Lebanese experience in the repatriation of citizens during COVID-19 which allow us to disclose encountered challenges and lessons learned. METHODS: This is a retrospective description of processes involved in the phased repatriation of Lebanese citizens. The Mission consisted of 4 phases starting, April 5th until June 19th 2020. The prioritization of returnees was based on both medical and social risk assessment. The repatriation team was divided into four groups: the aircraft team, the airport team, the hotel team and the follow up team. On arrival, all returning citizens were tested using Polymerase chain Reaction (PCR) based technique, and were obliged to adhere to a mandatory facility quarantine for 24 to 48 h. Returning travelers who were tested positive for COVID-19 were transferred to the hospital. Those who were tested negative were urged to strictly comply with home-quarantine for a duration of 14 days. They were followed up on a daily basis by the repatriation team. RESULTS: Overall, 25,783 Lebanese citizens have returned home during the phased repatriation. The third phase ranked the uppermost in regard of the number of citizens repatriated. The total number of performed PCR tests at the airport upon arrival was 14,893 with an average percentage of around 1% positivity for COVID-19. On the other hand, more than 10,687 repatriates underwent external PCR requisite in the third and fourth phases. Two hundred seventy-two repatriates were tested positive for COVID-19 upon their arrival. CONCLUSION: Considering the limited human and financial resources besides the economic and political crisis, the overall repatriation mission could be considered as a successful experience. Such processes would not have been achieved without the professionalism of all involved stakeholders.

Pharmacists as immunizers in Lebanon: a national survey of community pharmacists' willingness and readiness to administer adult immunization.

BACKGROUND: Since the focus of healthcare has shifted toward prevention, pharmacists were highly encouraged to expand their practice to include immunization services. Our study aimed to assess the knowledge, attitudes and beliefs of community-based Lebanese pharmacists, in addition to their willingness to expand their practice scope to include vaccine administration. METHODS: A cross-sectional study was conducted during the phase preceding the arrival of the COVID-19 vaccine in Lebanon between 1 and 31st December 2020. Using a stratified random sampling method, data were collected from Lebanese community pharmacists (CPs) through an online survey that included information on socio-demographic characteristics, clinical experience, willingness to administer vaccines, knowledge about vaccination, attitudes towards immunization, reasons supporting utilizing pharmacists as immunizers and the requested elements to incorporate immunization in pharmacists' practice scope. Multivariable analyses were performed to identify the factors associated with knowledge. RESULTS: A total of 412 community pharmacists participated in this survey. Of the total, 66.5% of the surveyed CPs are willing to administer vaccines. The majority of them (89.8%) had an overall good level. Out of all, 92.7% showed a positive overall attitude score toward immunization, 95.4% agreed that community pharmacists can play an important role in advertising and promoting vaccination. The main needed elements for implementing immunization services in pharmacies listed by participants were: support of health authorities (99.3%), statutory allowance (82.8%), patient demand (95.4%), pharmacist's interest (96.1%) and continuous education and training workshops on immunization. Older CPs (50 years and above) [aOR = 0.703, CI 95% (0.598-0.812)] and those working in Bekaa and North have lower knowledge score than their counterparts. High educational level [aOR = 1.891, CI 95% (1.598-2.019)], previous experience in immunization [aOR = 3.123, CI 95% (2.652-4.161)] and working in urban areas [aOR = 3.640, CI 95% (2.544-4.717)] were positively associated with a good knowledge level. CONCLUSION: Most of Lebanese community pharmacists are willing to offer immunizations. The expansion of the pharmacists practice scope to include provision of immunizations required a national plan that encompasses strengthening knowledge, training, certification for eligibility to administer vaccines, enhancing pharmacovigilance and statutory reform.

Exploring determinants of community pharmacist-led influenza vaccination in a Middle Eastern country: a national web-based cross-sectional study.

BACKGROUND: Utilizing community pharmacists (CPs) as immunizers has being adopted in various countries as approach to boost influenza vaccination coverage. Our study aims to explore the Lebanese CPs' willingness to administer influenza vaccine, and to identify factors associated with this willingness. METHODS: This is a web-based, cross-sectional study, conducted over 2 months, from the 1st of November to the end of December 2020. Self-reported data were collected electronically from Lebanese CPs through an anonymous, questionnaire using google form. The collected data were analyzed using the statistical software SPSS (Statistical Package for Social Sciences). Bivariate and multivariable analyses were performed to examine factors associated with the willingness of CPs to administer influenza vaccine. RESULTS: A total of 412 CPs participated in this survey of which 76.9% are willing to administer influenza vaccines. More than 90% of them had a good overall knowledge score and 88.8% of CPs showed a positive overall attitude score, particularly towards involvement of CPs in influenza vaccine provision. Their willingness to administer vaccine was positively associated with the younger age (aOR = 3.12 with 95% CI (1.597-4.040)), higher education level (aOR = 2.02 with 95% CI (1.093-3.741)), previous experience in immunization (aOR = 2.72 with 95% CI (1.320-5.627)) and urbanicity of pharmacy (aOR = 1.542 with 95% CI (1.219-4.627)). Extensive working hours (aOR = 2.34 with 95% CI (1.131-4.845)), working in pharmacies that are operating round-the-clock, showing positive attitude towards immunization (aOR = 3.01 with 95% CI (1.872-6.422)) and towards provision of influenza vaccines (aOR = 13.72 with 95% CI (13.721-38.507)) were also positively associated to this willingness. Conversely, patient privacy (aOR = 0.55 with 95% CI (0.079-0.983)), time and cost for professional development (aOR = 0.55 with 95% CI (0.172-0.918)), limited patient's trust (aOR = 0.39 with 95% CI (0.203-0.784)), financial remuneration (aOR = 0.18 with 95% CI (0.088-0.377)), and requirement of formal certification in vaccine administration (aOR = 0.07 with 95% CI (0.020-0.279)) were negatively associated to this willingness. CONCLUSION: Addressing the unearthed concerns related to utilizing CPs as influenza immunizers through a concerted effort is a key to success in any future implementation of vaccination services in pharmacies.

Assessment of knowledge and practice of dentists towards Coronavirus Disease (COVID-19): a cross-sectional survey from Lebanon.

BACKGROUND: Coronavirus Disease (COVID-19) epidemic is a public health emergency of international concern. Dentists are exposed to the enormous risk of COVID-19 infection during this epidemic. This study aims to assess the knowledge and practice of dentists toward the COVID-19 epidemic in Lebanon. METHODS: We conducted an online survey using the snowball-sampling technique. Information on socio-demographic data, knowledge, practice, and additional information required concerning COVID-19 were collected. RESULTS: Our results showed that the majority of the Lebanese dentists had good knowledge (91.3%), and nearly half of the respondents had a good practice (58.7%) regarding COVID-19. The most common information source was the World Health Organization (73.7%). Multiple linear regression showed that specialist dentists who completed training on COVID-19 with a high level of knowledge had better practice. CONCLUSIONS: Lebanese dentists revealed good knowledge regarding COVID-19. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and patients from this virus. Our findings have important implications for the development of strategies suitable for improving the level of practice among dentists and enhance prevention programs.

Knowledge and practice of physicians during COVID-19 pandemic: a cross-sectional study in Lebanon.

BACKGROUND: As the Coronavirus disease 2019 (COVID-19) pandemic continues to evolve, physicians must be equipped with adequate knowledge, skills on the prevention measures, and confidence in diagnosing and treating COVID-19 patients. Therefore, it is of great interest to assess the knowledge and practices of Physicians to identify existing gaps and improve occupational safety and viral surveillance. METHODS: A cross-sectional study was conducted in Lebanon between 28th March and 11th April 2020. Data was collected through an online survey that included information on socio-demographic characteristics, knowledge, practice, physicians fear towards COVID-19 as well as their perceptions regarding actions/policies implemented by the Ministry of Public Health (MOPH) and their health care facilities. Multivariable logistic regression analyses were carried out to identify the factors associated with good knowledge of COVID-19 and good practice toward its prevention. Adjusted odds ratio and their 95% confidence intervals were reported. RESULTS: Our survey revealed that the majority of Lebanese physicians had good knowledge about the disease (89.5%) while approximately half of the respondents adopted good preventive practices (49.7%). The odds of having good knowledge was 2.16 times higher among physicians aged 40 and above (adjusted OR = 2.16 with a 95% confidence interval (CI) of 1.08 to 4.34) compared to their counterparts aged less than 40 years old. Our results also showed that the odds of good practice was 2 times higher among frontline compared to the second line workers (adjusted OR = 2.01 with 95% CI of 1.21 to 3.34). Physicians with an experience of 10 years and above were 3.35 times more likely to have good practice compared to their counterparts (adjusted OR = 3.35 with 95% CI of 1.60 to 7.02). Finally, participants with good knowledge of COVID-19 were 2.04 times more likely to have a good practice (OR = 2.04 with 95% CI of 1.01 to 4.12). CONCLUSION: Lebanese physicians revealed a good level of knowledge; however, they had limited comprehension of the precautionary measures that protect them from this virus. Our findings have important implications for the development of strategies suitable for improving the level of practice among physicians and enhance prevention programs.