ABSTRACT
IntroductionPsychological effects of withholding treatment that could have benefited a patient during a pandemic remain largely unknown. It is also unclear to what extent their reasons for withholding treatment contributed to the subsequent impact on mental health outcomes. Paramedics may have withheld treatments either due to fear of exposure, being directed by their service, or both. As such, the present research aimed to characterize withholding treatment and investigate potential negative mental health outcomes.Materials and MethodsParamedics from five provinces (Alberta, British Columbia, Manitoba, Ontario, Saskatchewan) working during the COVID-19 pandemic completed online questionnaires assessing withholding treatment (i.e., due to fear of exposure, directed by their service, or both), and mental health outcomes including depression (PHQ-9) and post-traumatic stress (PTSD) symptoms (PC-PTSD-5) as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) study.ResultsOf the 1453 participants, 54.2% reported withholding treatment due to fear of exposure (4.3%), as directed by their service (76.5%) or both (19.2%). Participants who withheld treatment reported higher rates of PTSD (M=2.6, p < .01) and depression (M=8.2, p < .001) symptoms than those that did not withhold treatments (MPTSD=2.3;Mdepression=6.4). Reason for withholding treatment and PTSD symptom severity were associated (p<.01). Paramedics who withheld treatment due to fear of exposure were more likely to report probable PTSD symptoms (23.5%) than those who withheld treatments as directed by their service (8.7%) or both (12.2%). Depression symptom severity did not differ by reasons for withholding treatment.ConclusionsWithholding treatment is potentially traumatic and may influence the development of depression and PTSD symptoms. Withholding due to fear of exposure rather than being directed to increased PTSD symptoms. Further research will investigate the mental health impact of withholding treatment and reported reasons for withholding over time.
ABSTRACT
IntroductionDuring the first pandemic lockdown in Spain certain workers have been at increased risk of COVID-19. Results from published studies are heterogeneous, possibly due to differences in public health interventions, availability of personal protective equipment (PPE), virulence of variants of concern, population-wide immunity or methodological issues.MethodsThe COVICAT study (IEC approved) pooled ongoing population-based cohort studies from Catalonia. Occupational analyses of COVICAT were restricted to working age and included 8,422 participants, of which 3,563 were tested for SARS-CoV-2 antibodies during the first wave;study participants were re-contacted in mid-2021. Participants responded to a web-based or telephone survey including questions on socio-demographics, pre-pandemic health, behavioural and environmental risk factors. Occupational questions covered mode of work, job title, PPE, and mode of commuting. COVID-19 cases were defined by self-reported symptoms or hospitalisation and SARS CoV-2 seropositivity. Association of type of work, job titles and job-exposure matrix (JEM) with COVID-19 was assed using log-binomial models adjusted for potential confounders, such as age, sex, education, deprivation index, population density and survey type. Analyses for the extended follow-up were stratified by pandemic waves.ResultsThe relative risk (RR) for COVID-19 for working at the usual workplace compared to telework was 1.83 (95% CI: 1.41, 2.38), and 1.63 (95% CI: 1.05, 2.52) among the serology study participants. The RR by job title was increased for all health care workers and highest for personal health care workers in health services (6.19;3.71, 10.33);PPE was associated with a stronger protective effect by increasing protection level. Using public transport for commuting was associated with a 50% increase in COVID risk. Results for the extended follow-up will be presented.ConclusionsThe extended follow-up of the COVICAT cohort provides data to illuminate occupational risk factors for COVID-19 infection over time, which may contribute to explain heterogeneities across countries.
ABSTRACT
IntroductionDuring the first lockdown in Spain (March-June, 2020) essential workers may have been at increased risk of coronavirus disease 2019 (COVID-19) via occupational exposure. Results from published studies are heterogeneous.MethodsOngoing population-based cohort studies from Catalonia were pooled to form the COVICAT study. A random sub-population donated a blood sample (May-July, 2020) for validated multiplex serology testing. Occupational analyses were restricted to working age (18–65 years). Participants responded to a web-based or telephone survey including questions on socio-demographics, pre-pandemic health, behavioural and environmental risk factors. Occupational questions covered mode of work (e.g. telework), job title, availability of personal protective equipment (PPE), and mode of commuting. Job titles were coded by an occupational hygienist to the Spanish CNO-11 and cross-walked to ISCO-08. COVID-19 cases were defined by symptoms or hospitalisation and SARS CoV-2 seropositivity based on immune responses to 15 isotype-antigen combinations (serology sub-cohort). Logistic regression models were built for type of work, job titles and job-exposure matrix (JEM), covering several dimensions and levels of SARS-CoV-2 transmission probabilities , and adjusted for age, sex, education, deprivation index, population density and survey type.ResultsThis analysis included 8,582 participants, of which 3,599 were tested for SARS-CoV-2 antibodies, median (SD) age 53.7 (6.3) years, 59.9% were women. The relative risk for COVID-19 for work in the usual workplace compared to telework was 1.87 (95% CI: 1.44, 2.42), and 1.44 (95% CI: 1.09, 1.90) among the serology study. The relative risk for nurses who worked in their usual workplace was 4.57 (95% CI: 3.12, 6.7). Detailed results by job title, JEM, availability of PPE and commuting mode will be presented.ConclusionsThis study has several strengths, including random serology testing and individual-level exposure data. Detailed results may support extended legal definitions of COVID-19 as a recognized occupational disease.