Following the COVID19 playbook and battling another infodemic: Conspiracy beliefs around human Monkeypox among the Lebanese population (preprint)

Introduction: The non-endemic multicountry outbreak of monkeypox (MPX) has emphasized the issue of conspiracy theories that go viral in times of societal crisis. Now, it is the turn of MPX to join COVID19 in the conspiracy theory realm. Social media outlets were flooded by a scourge of misinformation as soon as MPX cases began to appear with an evident cross-pollination between diverse conspiracy theories. Given the adverse consequences of conspiracy beliefs, this study aimed to assess the extent of endorsement of MPX conspiracy beliefs among the Lebanese population and to identify its associated factors. Methods Using a convenience sampling technique, a web-based cross-sectional was conducted among Lebanese adults. Data was collected using an Arabic self-reported questionnaire. Multivariable logistic regression was performed to identify the factors associated with the MPX conspiracy beliefs scale. Results Conspiracy beliefs regarding emerging viruses including MPX were detected among 59.1% of Lebanese adults. Participants endorsed particularly the conspiracy theories linking the virus to a deliberate attempt to reduce the size of the global population (59.6%), gain political control (56.6%) or pharmaceutical companies' financial gain (39.3%), in addition to the manmade origin of MPX (47.5%). Remarkably, the majority of surveyed adults exhibited a negative attitude toward the government's preparedness for a potential MPX outbreak. However, a positive attitude was revealed toward the effectiveness of precautionary measures (69.6%). Female participants and those having a good health status were less likely to exhibit a higher level of conspiracy beliefs. On the contrary, divorced or widowed adults, those having a low economic situation, poor knowledge level, and negative attitude either toward the government or precautionary measures were more prone to disclose a higher level of conspiracy beliefs. Notably, participants relying on social media to get information about MPX were also more likely to have a higher level of conspiracy beliefs compared to their counterparts. Conclusion The widespread extent of conspiracy beliefs endorsement regarding MPX among the Lebanese population urged the policymakers to find ways to reduce people’s reliance on these theories. Future studies exploring the harmful impacts of conspiracy beliefs on health behaviors are recommended.

Practice of non-pharmaceutical interventions against COVID-19 and reduction of the risk of influenza-like illness: A retrospective cross- sectional population-based study (preprint)

Introduction: While this 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 was collected using a convenient sampling method. In addition to their sociodemographic information, participants were asked about their frequency of implementing personal protective measures and if they have experienced symptoms of ILI in the previous six 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 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.

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.

Prevalence and Correlates of burnout among Lebanese Health Care Workers during the COVID-19 pandemic: A national cross-sectional survey (preprint)

Background: Since the COVID-19 pandemic has harshly burdened the healthcare systems, health care workers (HCWs) are at high risk of infection and confronted several stressors 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 distributed across the country. Using a snowball sampling technique, data was collected using an Arabic, anonymous, self-reported questionnaire comprising three sections: socio-demographic characteristics, COVID-19 exposure variables, the Copenhagen Burnout Inventory (CBI), and the threat perception scale. 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. Work-related burnout (WB), and client-related burnout (CB) in their moderate and high levels hit 79.2% and 83.3% of HCWs respectively. HCWs who were females, married, physicians, those who have a poor health status, and those who had 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. Additionally, frontline HCWs, those infected or having a colleague infected by COVID-19, and those who had a high perception of COVID-19 threat were more prone to experience a high-level PB compared to no/low burnout as well. Working in a public hospital, extensive working hours, and insufficient sleeping hours were positively associated with high PB. However, older age and altruism were negatively associated with high PB compared to no/low PB. Similar factors were found either positively or negatively associated with a high level of WB excepting health status and living conditions factors (dependent child or family member). As for CB, older age of HCW (>30 years) and altruism were negatively associated with high CB compared to no/low burnout. However, working in the frontline, high threat perception, extensive working hours, insufficient sleeping hours, and low income were positively associated with high CB compared to no/low burnout. Conclusion The prevalence of burnout among Lebanese HCWs was high and alarming. Enacting and implementing preventive policies and effective interventions are highly required to cultivate wellness among HCWs.

A cross-sectional study assessing the alarming prevalence of burnout among physicians in a developing country facing a combination of a COVID-19 Pandemic and an economic collapse (preprint)

Background: Burnout among physicians is a serious concern that cultivates its seeds during their education and matures in their daily practicing life. Lebanese physicians were particularly at high risk of burnout since they confronted a mixture of overlapping crises. Objectives: This study aimed to assess the prevalence of burnout among Lebanese physicians and to investigate its associated factors. It targeted also to explore the combined effects of the pandemic and the economic crisis on burnout. Methods: A web-based cross-sectional study was conducted among Lebanese physicians over December 2020 using a snowball sampling technique. Self-reported data were collected electronically through an anonymous questionnaire that included information on socio-demographic characteristics, work-related variables, and 4 scales: fear of COVID-19, threat perception, InCharge Financial Distress/Financial Well-Being, and the Copenhagen burnout inventory (CBI). CBI scale cut-off score of 50 was used to evaluate the prevalence of burnout. Multivariable linear regression analyses were carried out to identify the factors associated with burnout. Results: A total of 398 physicians participated in the study. The majority of them were male (52.8%), married (60.1%), and aged between 40 and 49 years (43.2%).Moderate and High level of burnout hits 90.7% of the Lebanese 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 having 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 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. However, financial wellbeing, altruism, having good health, and previous history of COVID-19 were significantly associated to lower burnout. The combined effect of threat perception and financial hardship significantly increased the level of burnout. Conclusion: The huge burnout level detected among Lebanese physicians raises alarm about the seriousness of the current situation and urges the health authorities to take prompt action to enhance the physicians’ wellbeing.

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 (preprint)

Background: Community pharmacists (CPs) are one of the frontline healthcare workers (HCWs) working diligently to provide much-needed services during the COVID-19 pandemic. They are suffering from the detrimental impact of this pandemic which affected negatively their mental health and fueled their burnout. Objectives This study aimed to validate the Arabic version of Copenhagen Burnout Inventory (CBI-A) for use in the assessment of burnout among Lebanese CPs. Methods Using a snowball sampling technique, 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 flooring 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 revealed by the goodness of fit indices. Based on the modification indices, the three-factor model was adapted 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 criterion validity. CBI subscales were found also positively associated with mental health outcomes such as depression and anxiety indicating 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.

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 (preprint)

Background: The increasing occupational challenges inflicted on community pharmacists (CPs) in the wake of COVID-19 lays this valuable human resource at increased risk of burnout. Objectives: This study aimed to assess the prevalence of burnout among Lebanese CPs in the era of COVID-19 and to identify its associated factors. Methods: A web-based cross-sectional study was conducted among Lebanese CPs between the 1 st of February and the end of March 2021 using a snowball sampling technique. Data was collected using an anonymous Arabic self-administered questionnaire that includes information on socio-demographic characteristics, exposure and work-related variables, and two scales: the Copenhagen burnout inventory (CBI) which includes personal, work-related, and patient-related dimensions of burnout, and the COVID-19 threat perception scale. To evaluate the prevalence of burnout, CBI scale cut-off score of 50 was used. Bivariate and multivariable logistic regression analyses were used to identify the factors associated with burnout among CPs. Results: Burnout was detected among 81.9% of surveyed CPs, where 61% had a moderate burnout and 20.9% had a high level of burnout. Client burnout (CB) ranked first among other burnout aspects (89.7%) followed by personal burnout (77.8%) and work-related burnout (76.8%). Younger age, female gender, being staff pharmacist, working in pharmacy operating around the clock and working more than 40 hours per week were associated with higher level of burnout. Similarly, suffering from comorbidity, having a dependent child or living a family member with comorbidities, experiencing sleep disturbance and high perception of COVID-19 threat were also associated with higher burnout. However, being married, having large professional experience, having high socioeconomic situation, accepting the risk of dealing with COVID-19 cases and having previous history of COVID-19 were negatively associated to burnout. Conclusion: Burnout hits 81.9% of the Lebanese CPs. This alarming prevalence called health authorities to take prompt and warranted measures based on the factors associated with this syndrome unearthed in this study, to prevent burnout and mitigate among CPs in order to support resiliency in the profession.

Integrating Health Belief model to determine factors associated with COVID-19 Vaccine Acceptance in Lebanon: Differences between health care workers and non-healthcare workers (preprint)

Background: Vaccine acceptance is critical to the success of immunization programs, especially for emerging infectious diseases. This study aims to assess the willingness to receive the COVID-19 vaccine, and the factors associated with this willingness among healthcare workers (HCWs) and non-healthcare workers in Lebanon. Methods: : A web-based cross-sectional survey was conducted among Lebanese adults aged 18 years and above during November 2020 among Lebanese adults from all Lebanese provinces using a snowball sampling technique. Data were collected using an anonymous Arabic questionnaire that included sociodemographic, health-related variables, intention to receive COVID-19 vaccine, and the Health Belief Model covariates. Multivariable logistic regression analyses were performed to identify the factors associated with the COVID-19 vaccine acceptance among the 2 groups. Results: : A total number of 2802 participants completed the survey. The overall intention to receive a COVID-19 vaccine among the Lebanese adult population was 51.5%. HCWs expressed a higher willingness of getting vaccinated against COVID-19 than non HCWs (65.8% vs. 47%, p< 0.001). The factors that are positively associated with the willingness to vaccinate among the general population, non HCWs and HCWs were: older age, being married, living in urban areas, receiving influenza vaccine for this season, higher perception of susceptibility and benefits, concerns related to availability and accessibility of vaccines and recommendation of vaccine from health authorities. However, the previous refusal of any vaccine, concerns about vaccine safety, and side effects impacted negatively this intention. Female gender, importance accounted to religiosity, and concerns about the reliability of the manufacturer were negatively associated with vaccine acceptance among non HCWs. Conversely, good knowledge, vaccine intake by the public, and self-motivation were positively associated with this willingness. Of note, these factors were not significantly associated with such willingness among HCWs. Conclusion: To control COVID-19 effectively, efforts targeting modifiable factors driving COVID-19 vaccine acceptance are required to increase the acceptance rate among the Lebanese population.

Pharmacists as Immunizers in Lebanon: A National Survey of Community Pharmacists’ Willingness and Readiness to Administer Adult Immunization (preprint)

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 st and 31 st December 2020. Data were collected from Lebanese pharmacists 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. Knowledge and attitude scores were computed. Participants’ overall knowledge and overall attitude were categorized using modified Bloom’s cut-off point as good if the score was equal or more than 60%, and poor if the score was less than 60%. Results: : A total of 412 community pharmacists participated in this survey. Of the total, 66.5% of the surveyed community pharmacists are willing to administer vaccines. The majority of surveyed pharmacists (96.1%) 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. Conclusion: Most of Lebanese community pharmacists are willing to offer immunizations. However, before any statutory reform targeting the expansion of pharmacists’ scope of practice to include provision of immunizations, it is important to consider education and training as a fundamental part of the process.

Knowledge, attitudes and practices of hospital cleaning services staff towards Coronavirus Disease-2019 (COVID-19) in a Middle Eastern country: A web-based cross-sectional study (preprint)

Background Hospital cleaners are the unsung heroes in the fight against the COVID-19 pandemic. This study aims to assess the knowledge, attitudes, and practices (KAP) of hospital cleaners towards COVID-19 and to determine factors associated with good practices. Methods A cross-sectional study was conducted in Lebanon between 1st and 14th November 2020. Data was collected through an online survey that was sent to governmental-run and private hospitals. The questionnaire consisted of socio-demographic characteristics, clinical information, and KAP of hospital cleaners towards Covid-19. The collected data was exported to SPSS for analysis. The relation between nominal variables was tested using the chi-squared test. The variables in bivariate analysis with p-value<0.2 were entered into multivariable logistic regression. 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 453 cleaners completed the survey of which 54.3% were females. Most of the participants had a good level of COVID-19 knowledge (98%) and good preventive practices (89.7%). Regarding attitude, 90.7% had a positive attitude toward health facilities, 78.8% towards cleaning and disinfection, and 73.5% towards health authorities. Sociodemographic characteristics including younger age, higher levels of education, working in private hospitals, and having more than 3 years of experience were positively associated with good preventive practices. Our results also showed that participants with good knowledge about COVID-19, COVID-19 prevention and treatment, cleaning and disinfection process, and COVID-19 risk factors had a higher likelihood of positive preventive practices. Finally, a positive attitude towards health facilities, health authorities, and cleaning and disinfection were positively associated with good practices. Conclusion Our results indicate that cleaners have a high level of knowledge, expressed positive attitudes towards health facilities and health authorities, and good preventive practices. Understanding the determinants of cleaning performance is critical in tailoring interventions to improve hospital cleaning.

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.