Home Care for COVID-19 positive cases: Suitability of the Residential Setting and ability of cases to adhere to the required preventive measures (preprint)

Introduction: With the upsurge of COVID-19 cases, Lebanese hospitals are overburdened and hospital care was prioritized for COVID-19 patients with the highest probability of poor outcomes. This paper aimed to assess the suitability of residential settings for home isolation and to explore the patient’s ability to adhere to the required precautions measures.Methods: All COVID-19 cases reported between February, 21 and the end of June 2020 and who had mild or moderate symptoms, were contacted via phone calls by a healthcare professional to fill out a standardized questionnaire developed to assess the suitability of the residential setting for home care. Inpatient cases were required, before their discharge from the hospitals, to sign consent related to their adherence to the mandatory precautionary measures. They were also asked to complete, on daily basis, the symptoms monitoring log form. A referral system to health facilities was established to manage cases with worsening health status. A collaborative framework to address violations of home isolation rules was also put in place.Results: Of the 600 cases assessed, 44.7% of them were isolated in a living building apartment (67.2%) with one entrance (85.5%) including four to eight rooms (71%). Around one-quarter of patients have children (< 5 years) and 75% of them were living with elderly people. Most of the patients confirmed the availability of a well-ventilated single room (96.2%) and a separate bathroom (80.17%). As for infrastructure, more than 90% of patients confirmed the availability of drinking and tank water, heating facilities, electricity, and safe trash elimination. Similarly, more than 90% of them had access to personal hygiene items, disinfectants, and personal protective equipment. The bulk of homes care were rated as easily reachable. As for awareness and ability to self-serving, 94.5% of patients were knowledgeable about the required preventive measures, able to serve themselves and to adhere to the isolation requirements as well. Only 51.8% of them had access to psychological support.Conclusion: Proper assessment of the residential setting for home care of COVID-19 cases combined with close monitoring of the adherence of patients to the required precaution measures are highly needed for limiting the spread of infection within the household and the community.

Determinants of Acceptance of Coronavirus Disease-2019 (COVID-19) Vaccine Among Lebanese Health Care Workers Using Health Belief Model (preprint)

Background: Since Health care workers (HCWs) are at high occupational risk for COVID-19, they are prioritized for immunization. This study aims to assess the acceptance rate of COVID-19 vaccine among HCWs and to identify its determinants. Method: ology: A web-based cross-sectional study was conducted over the period extending from 10 to 31 December 2020 among Lebanese HCWs. The Health Belief Model (HBM) was used as theoretical framework. Descriptive statistics were reported using frequency with percentages for categorical variables. Bivariate and multivariable logistic regression were carried out to identify the factors associated with the acceptance of COVID-19 vaccine. Adjusted odds ratio and their 95% confidence intervals were reported. The level of statistical significance was set at a p-value < 0.05. Results: : A total of 1800 HCWs have completed the survey. Around half of them were frontliners aged between (30-49) years old. About two third (67.33%) have received their influenza vaccine this year. The acceptance rate of COVID-19 vaccine among surveyed HCWs was 58%. Being a male (aOR=1.988, 95% CI (1.411-2.801)), working in the frontline (aOR=1.610, 95% CI (1.173-2.209), and having received influenza vaccination this year (aOR=1.378, 95% CI(0.990-1.916))were significantly associated with higher COVID-19 vaccine acceptance. However, living in rural area (aOR=0.606, 95%CI (0.440-0.836)), personal history of COVID-19 (aOR=0.695, 95%CI (0.470-1.029), novelty of vaccine (aOR=0.424, 95% CI (0.255-0.706)), side effects (aOR=0.413, 95%CI (0.234-0.731), reliability of manufacturer (aOR=0.434, 95% CI (0.297-0.633) and vaccine frequency (aOR=0.580, 95% CI (0.403-0.836) were negatively associated with the willingness to take it. Remarkably, limited availability (aOR=2.161, 95% CI(1.461-3.197) and accessibility (aOR=1.680, 95% CI (1.141-2.474) to the vaccine were also positively associated to its uptake. Similarly, HCWs who perceived vaccine benefits were more likely to get vaccinated (aOR=11.048, 95% CI (7.993-15.269)). With regards to cues of action, having reliable and adequate information regarding the vaccine (aOR=1.979, 95% CI (1.361-2.878)), recommendation by health authorities (aOR=1.976, 95% CI(1.343-2.908)) or health facilities (aOR=2.684, 95% CI(1.804-3.994)) were positively linked to vaccine acceptance, whilst recommendation by family members (aOR=0.479, 95% CI(0.283-0.811)) was negatively related to it. Conclusion: Pointing out the factors driving moderate vaccine acceptance among HCWs via targeting messages addressing key concerns would be required to reach higher vaccination rate.

Knowledge, attitudes and practices among Lebanese Obstetricians and gynecologists toward Coronavirus Disease-2019 (COVID-19) and pregnancy (preprint)

Introduction: The pandemic of Coronavirus Disease 2019 (COVID-19) has seriously disturbed the daily life of the general population particularly the life of the pregnant women. Since the obstetricians and gynecologists (OBGYN) are often the primary health care providers during pregnancy, hence the importance of their critical role in preventing and managing COVID-19 infection in their patients.Objectives: This study aims to assess the knowledge, attitudes and practices of OBGYN in order to identify existing gaps and to improve patient and occupational safety.Methods: A cross-sectional study, using an online survey, was conducted during the rapid rise of COVID-19 pandemic in Lebanon over the period extending between 20th October and 20th November 2020 among Lebanese OBGYNs. The analysis was performed using Statistical Package for Social Sciences (SPSS) software. Data collected is subjected to descriptive analysis. A good level of knowledge was defined when the percentage of correct answers reaches more than 80% of the respondents.Results: A total of 279 OBGYNs participated in the survey of which 57% were males. The majority of them (64.2%) were aged more than 45 years, married (79.9%) with large work experience (70.3%). Only 28.3% were reluctant to take care of COVID-19 patient. Most of them feared of contracting COVID-19 or transmitting COVID-19 to their family member due to occupational exposure and 42.3% felt overwhelmed. 62.7% of them considered that policies implemented by the ministry of public health are sufficient. The majority of OBGYNs had a good level of knowledge in different basic and specific domains related to COVID-19 and pregnancy. Furthermore, a good practice score in all relevant aspects (personal, clinic and patient) was revealed.Conclusion: The high knowledge and practice scores, among Lebanese OBGYNs disclose a strong commitment from the part of these physicians to fulfill their responsibilities during this pandemic towards themselves and their patients.

Phased Repatriation of Lebanese Expatriates Stranded Abroad During Coronavirus Disease 2019 (COVID-19) Pandemic (preprint)

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. Objectives: 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. Methodology: 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 hours. 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, 25783 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 14893 with an average percentage of around 1% positivity for COVID-19. On the other hand, more than 10687 repatriates underwent external PCR requisite in the third and fourth phases. 272 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.

Vaccination Against Influenza Among Lebanese Health Care Workers in the Era of Coronavirus Disease 2019 (preprint)

Background: Health care workers (HCWs) are at increased risk of influenza infection. Hence, the rationale for immunization to protect them and their patients particularly during the co-circulation of influenza and coronavirus disease 2019 (COVID-19). This study aims to assess knowledge, attitudes, and practices among HCWs towards the influenza vaccine and to identify the determinants of their willingness to vaccinate. Methods: Using an online survey, a cross-sectional study, was conducted in Lebanon between 14th and 28th October 2020 among HCWs. Descriptive statistics were reported using frequency and percentages for categorical variables. Multivariable logistic regression was carried out to identify the factors associated with influenza vaccine uptake. Adjusted odds ratio and their 95% confidence intervals were reported.   Results: A total of 560 HCWs participated in the survey of which 72.9% were females. The majority were nurses (63.2%), married (66.1%) and aged between 30-49 years (53.9%). Nearly half of them had a good level of knowledge (≥80%).  As perceived by HCWs, the availability of a sufficient quantity of vaccine will be the biggest challenge. Benefits of vaccination in enhancing patient safety, and avoiding co-infection by influenza and COVID-19 were well-acknowledged by HCWs. 32.1% of HCWs have received the influenza vaccine during the last year and 80.2% were willing to vaccinate for the current year. The influenza uptake was higher among HCWs who have received influenza vaccine in the past season (OR = 6.812, CI (3.045-15.239)), having a fair health status (OR = 3.117, CI (1.345-7.220)), good knowledge (OR=3.305, CI (1.155-9.457)), positive attitude (OR=2.305, CI (0.921-5.571)), low perception of barriers (OR= 4.130, CI (1.827-9.334)) and high perception of benefits (OR=6.264, CI (2.919-13.442) and was lower in single and divorced (OR=0.527, CI (0.284-0.978)). ConclusionAddressing misconceptions unveiled in this study through adapted training, along with economic interventions are needed to improve influenza vaccination coverage among HCWs.