Common Prognostic Biomarkers and Outcomes in Patients with COVID-19 Infection (preprint)

Abstract: Background: COVID-19 is a respiratory disease that eventually became pandemic with 300 million people infected around the world. Alongside the improvement in COVID-19 management and vaccine development, identifying biomarkers for COVID-19 has recently reported to help in early prediction and managing severe cases which might improve outcome. The Aim of our study was to find out if there is any correlation between clinical severity and elevated hematological and biochemical markers in Covid-19 patients and its effect on the outcome Methods: We have collected data retrospectively of socio-demographic, medical history, biomarkers, and diseases outcome from five hospitals and health institutions in the Kingdom of Saudi Arabia. Results: Pneumonia was the most common presentation of COVID 19 in our cohort. All biomarkers (D-Dimer, CRP, troponin, LDH and ferritin) except for the mean lowest white blood cells were found to have significant correlation (p<0.05) with worse COVID-19 disease outcomes. There was a sig-nificant association between the inflammatory biomarkers and the disease severity of COVID 19 patients (p<0.001). Patients with evidence of severe respiratory disease particularly who required mechanical ventilation (MV) had higher biomarkers, when compared to those with stable respiratory condition (p<0.001). Conclusion: Identifying biomarkers predicts outcome for COVID-19 patients and may significantly help in the management.

Comparison of Monkeypox disease knowledge and perception among the healthcare workers versus the general population during the first month of the WHO emerging infectious disease alert (preprint)

Background Monkeypox disease (MPD) recently re-emerged in May 2022 and caused international outbreaks in multiple non-endemic countries. This study aimed to assess the Saudi Arabian public and healthcare workers (HCWs) knowledge about MPD and their information-seeking attitudes before any cases were yet reported in Saudi Arabia. Methods This online survey of HCWs and the public in the Kingdom of Saudi Arabia (KSA) was conducted from May 27 to June 5, 2022. The survey tool was adopted from our published research on COVID-19 with modifications related to the new MPD outbreak, which was validated for content, language, and consistency. Participants were invited by convenience sampling techniques through various social media platforms (i.e., Twitter and WhatsApp groups) and email lists. Variables surveyed included participants’ sociodemographic and job-related characteristics, COVID-19 infection status, and advocacy for MPD vaccination. Multiple questions assessing the participants’ knowledge related to MPD and (MPV) in terms of transmission, vaccination information by HCWs, and required isolation precautions. Finally, a Generalized Anxiety Disorder (GAD7) score was calculated. We then assessed the independent variables associated with participants’ attitudes to seek more information about MPD, and those associated with knowledge scores. Results A total of 1546 participants completed the public survey, and 61.3% showed interest in seeking more information about MPD. Of the participants, 48.7% knew that MPD could be transmitted before skin blisters appear, and 62.7% inferred that skin lesions are infectious. Only 38.1% inferred that touching contaminated surfaces, and 46.5% knew that sexual contact is a mode of transmission. 56.6% falsely believed the old smallpox vaccine is not effective against MPD. Public participants’ overall mean knowledge score of MPD was 4.88 of 9 points. In contrast, the mean score of the knowledge of the 1130 HCWs was 14.4 of 28. Among HCWs, 28.3% correctly answered that the Jynneos vaccine has activity against MPD and 79.7% incorrectly answered that VARIVAX, a chickenpox vaccine, is effective against MPD. In addition, 74.2% of HCWs perceived the need to seek more information about MPD. Male HCWs had significantly lower mean knowledge scores compared to females. Physicians and HCWs’ self-rated high awareness of MPD correlated positively and significantly with their knowledge score. Conclusion In this study, the general public and HCWs had a moderate level of knowledge about MPD. The knowledge gaps among HCWs were evident in the clinical presentation of patients and vaccinations. Both groups reported a desire to seek more information about MPD, but this did not correlate with knowledge scores. It is important to have further education and intensification of campaigns to enhance awareness of MPD. It is also crucial to have further studies evaluate the knowledge of both groups over time.

Healthcare workers' worries and Monkeypox vaccine advocacy during the first month of the WHO Monkeypox alert: Cross-sectional survey in Saudi Arabia (preprint)

Background: Monkeypox virus re-surged in May 2022 as a new potential global health threat with outbreaks bursting in multiple countries across different continents. This study was conducted during the first month of the WHO announcement to assess the healthcare workers (HCWs) within Saudi Arabia, exploring their perception, worries, and vaccine acceptance for Monkeypox in-line with the resolving COVID-19 pandemic. Methods: A national cross-sectional survey was conducted between May 27 and June 10, 2022, in Saudi Arabia. Data were collected on the sociodemographic and job-related characteristics, COVID-19 infection status, HCWs' worry levels of Monkeypox compared to COVID-19 and its sources, their perceptions, awareness, and HCWs' Monkeypox vaccination advocacy. Results: Among the 1130 HCWs who completed survey, 41.6% already developed COVID-19. Still, 56.5% were more worried from COVID-19 compared to Monkeypox, while the rest were more worried of Monkeypox disease. The main reason for their worry among 68.8% of the participants was development of another worldwide pandemic post COVID-19, followed by their worry of acquiring the infection themselves or their families (49.6%). Most HCWs (60%) rated their self-awareness of Monkeypox disease as moderate to high. Males and those who previously developed COVID-19 were significantly less likely to worry about Monkeypox. The worry about Monkeypox developing into a pandemic and the perception of Monkeypox being a severe disease correlated significantly positively with the odds of high worry from the disease. Regarding participants' advocacy for HCWs' vaccination against Monkeypox disease, those who developed COVID-19 previously and those who supported application of tighter infection control measures compared to the current ones to combat the disease were significantly predicted to agree for vaccination. 74.2% of the surveyed HCWs perceived that they need to read more about the Monkeypox disease after the survey. Conclusion: During the first month of the WHO's Monkeypox international alert, about half of HCWs in this study were more worried about Monkeypox disease as compared to COVID-19, and its possible progression into another pandemic. In addition, the majority were in favor of applying tighter infection prevention measures to combat the disease. The current study highlights areas needed for healthcare administrative about the HCWs' perceptions and readiness for Monkeypox especially in the event of any occurrence of local or international pandemic.

Monkeypox caused less worry than COVID-19 among the general population during the first month of the WHO Monkeypox alert (preprint)

BackgroundMonkeypox re-emerged in May 2022 as another global health threat. This study assessed the publics perception, worries, and vaccine acceptance for Monkeypox and COVID-19 during the first month of WHO announcement. MethodsA national cross-sectional survey was conducted between May 27 and June 5, 2022, in Saudi Arabia. Data were collected on sociodemographic characteristics, previous infection with COVID-19, worry levels regarding Monkeypox compared to COVID-19, awareness, and perceptions of Monkeypox, and vaccine acceptance. ResultsAmong the 1546 participants, most respondents (62%) were more worried about COVID-19 than Monkeypox. Respondents aged 45 years and above and those with a university degree or higher had lower odds of agreement with Monkeypox vaccination (OR .871, p-value .006, OR .719, p-value <0.001), respectively. Respondents with moderate to a high level of self and family commitment to infection control precautionary measures and those who expressed self and family worry of Monkeypox infection had significantly higher odds of vaccination agreement (OR 1.089 p-value=0.047, OR1.395 p-value=0.003) respectively. On the other hand, respondents who previously developed COVID-19 were significantly more worried about the Monkeypox disease (1.30 times more, p-value=0.020). ConclusionWorry levels amongst the public are higher from COVID-19 than Monkeypox. Perception of Monkeypox as a dangerous and virulent disease, worry from contracting the disease, and high commitment to infection precautionary measures were predictors of agreement with Monkeypox vaccination. While advanced age and high education level are predictors of low agreement with vaccination.

SARS-CoV-2 Omicron variant: healthcare workers' perceptions and beliefs of vaccine effectiveness and advocacy: a national survey during the first week of the World Health Organization variant alert (preprint)

Background: As COVID-19 Omicron variant spread in several countries, healthcare workers' (HCWs) perceptions of vaccine effectiveness, booster and worries warrant reassessment. Methods: Online questionnaire among HCWs in Saudi Arabia (KSA) was collected between Dec 1-6, 2021, aiming to assess their Omicron variant's perceptions, worries, and booster-vaccine advocacy. Results: Among the 1285 HCWs participants in the study, two-thirds were females, 41% were nurses,46.4% were physicians, and 50% worked in tertiary care hospitals. Vaccination was perceived to be the most effective way to prevent the spread of Omicron variant and future variants by 66.9%. The respondents perceived social distancing (78%), universal masking (77.8%), and avoiding unnecessary travel (71.4%), slightly superior to vaccination to prevent COVID-19 variants spread. Of the respondents, 99.5% received two doses of COVID-19 vaccine. Regarding the booster dose, 96% either received it or planned to receive it once they are eligible. 57.7% of the respondents agreed that Omicron could cause a new COVID-19 wave worldwide, 45.9% agreed it may cause another COVID-19 wave in Saudi Arabia and 46.1% indicated the possibility of another lockdown. Overall, the HCWs worry level of the Omicron variant correlated significantly and strongly with their perception of the effectiveness of vaccination and preventive measures. Male HCWs had a significant agreement with mandatory vaccination of all eligible adult populations while HCWs who are unwilling to receive the vaccine had a strong disagreement with mandatory vaccination. Conclusions: The current study was conducted in the first week of Omicron variant discovery in KSA and only two-thirds of HCWs felt that vaccination is the best option to prevent the variant spread, indicating the need to further motivation campaigns for vaccination and booster doses education among HCWs. HCWs had a strong belief in non-pharmacologic interventions that should be encouraged and augmented. It is important to further study and enhance coping strategies for HCWs as we move through the third year of the pandemic with more potential variants, to protect HCWs from fatigue and burnout.

Healthcare workers’ COVID-19 Omicron variant uncertainty-related stress, resilience, and coping strategies during the first week of World Health Organization alert (preprint)

Background As the COVID-19 Omicron variant emerged and spread globally at an alarming speed, healthcare workers’ (HCWs) uncertainties, worries, resilience, and coping strategies warrant assessment. The COVID-19 pandemic had a severe psychological impact on HCWs, including the development of Post-Traumatic Stress symptoms. Specific subgroups of HCWs, such as front-line and female workers, were more prone to poor mental health outcomes and difficulties facing stress. Methods The responses to an online questionnaire among HCWs in Saudi Arabia (KSA) were collected December 1-5, 2021, aiming to assess their Omicron variant’s uncertainties, worries, resilience, and coping strategies. Three validated instruments were used to achieve the study’s goals: the Brief Resilient Coping Scale, the Standard Stress Scale (SSS), and the Intolerance of Uncertainty Scale (IUS) - Short Form. Results The online survey was completed by 1285 HCWs. Females made up the majority (64%). The BRCS score of resilient coping was negatively and substantially linked with the SSS score of stress (r=-0.313, p = 0.010). Furthermore, the IUS had a positive and significant relationship with stress (r=0.326, p= 0.010). Increased stress levels were linked to a considerable drop in resilient coping scores. Furthermore, being a Saudi HCW or a nurse was linked to a significant reduction in resilient coping ratings. Coping by following healthcare authorities’ preventative instructions and using the WHO website as a source of information was linked to a considerable rise in resilient coping. Conclusions Following the emergence of the Omicron variant of SARS-CoV-2 in late 2021, a rapid investigation into the correlates of stress and resilient coping among the HCWs in KSA was conducted. The negative association between resilient coping and stress was clearly shown, as well as how underlying intolerance of uncertainty is linked to higher stress among HCWs quickly following the development of a new infectious threat. The study provides early insights to develop and promote coping strategies for emerging SARS-CoV-2 variants.

Faculty Members’ Perspective on Virtual Interviews for Medical Residency Matching during the COVID-19 Crisis: A National Survey (preprint)

During the COVID-19 pandemic, conducting face-to-face medical residency interviews was challenging due to infection prevention precautions, social distancing and travel restrictions. Virtual interviews were implemented by the Saudi Commission for Health Specialties (SCFHS) as an alternative process for residency matching while striving to maintain the same quality standards. This national survey was conducted to assess the satisfaction and perceptions of faculty members’ virtual interviews performance in the assessment for the medical training residency programs. Among the participating 173 faculty members (34.1%) did not have previous experience with video-conferencing. Zoom application was the most commonly used platform (65.9%). Most (89.6%) of the faculty perceived virtual interviews as “adequate” for the candidates to express themselves, while almost half of the faculty (53.8%) agreed that virtual interviews allowed them to accurately reach an impression about the candidates. Overall, 73.4% of faculty felt comfortable ranking the virtually interviewed candidates. We conclude that the acceptance of participating faculty members in the first Saudi medical residency training matching cycle virtual interviewing event was well perceived. This study provides evidence for future application and research of virtual interviews in residency candidates' assessment, especially after the pandemic crisis resolves.

Enhancing Parental Knowledge of Child Safety: An Interventional Educational Campaign (preprint)

Background Safeguarding children from unintentional injuries is a significant concern for parents and caregivers. With children staying more at home during the COVID-19 pandemic, more educational tools and valid educational programs are warranted to improve parental knowledge and awareness about children’s safety. This study aims to explore the effectiveness of child safety campaigns on parents’ knowledge and attitude towards preventable childhood injuries. Methods This was a pre-post experimental study, in which the pre-designed assessments were used as an evaluation tool before and after attending a Child Safety Campaign. The Pre – Post assessment question included questions to evaluate the socio-demographic status, followed by knowledge questions in line with the current child safety campaign. The outcomes of interest were assessed before and after attending the campaign’s stations. Results Three hundred and eight parents volunteered to participate in this study. Their knowledge score improved from 36.2 (SD 17.7) to 79.3 (SD 15.6) after attending the Child Safety Campaign (t-value= 34.6, p<0.001). Both, perceptions on the preventability of accidents and the parents’ perceived usefulness of educational campaigns showed improvements, with (t-value =6.3, p<0.001) and (t-value= 3.097, p<0.001), respectively. Conclusion The educational child safety campaign for caregivers in Saudi Arabia resulted in a significant increase in the overall knowledge and attitudes towards children’s safety. As children are currently staying at home more, additional educational tools and programs are warranted to promote childhood safe practices among parents and caregivers.

Pediatric intensive care hybrid-style clinical round during COVID-19 pandemic: A pilot study (preprint)

BackgroundWith the evolving COVID-19 pandemic and the emphasis on social distancing to decrease the spread of SARS-CoV-2 among healthcare workers (HCWs), our pediatric intensive care unit (PICU) piloted utilization of Zoom online into the clinical rounds to enhance communication among the treating team. We aimed to explore the feasibility of these hybrid virtual and physical clinical rounds for PICU patients from the HCWs perspective. MethodsA mixed quantitative and qualitative deductive thematic content analysis of narrative responses from pediatric intensive care HCWs were analyzed, descriptive statistics were used ResultsA total of 31 HCW were included in the analysis; the mean time of the virtual round was 72.45 minutes vs. 34.68 for physical rounds, the most shared component in the virtual round was CXR (93.5%). Some of the HCWs perceived advantages of the hybrid rounds were enabling the multidisciplinary discussions, lesser round interruptions, and practicality of the virtual discussions. The perceived challenges were the difficulty of the bedside nurse to attend the virtual round, decreased teaching opportunities for the trainees, and decreased interactions among the team members, especially if the video streaming was not utilized. ConclusionHybrid virtual and physical clinical rounds in PICU were perceived as feasible by HCWs. The virtual rounds decreased the physical contact between the HCWs, which could decrease the possibility of SARS-CoV-2 spread among the treating team. Still, several components of the hybrid round could be optimized to facilitate the virtual team-members interactions and enhance the teaching experience.

Remote Interviews for Medical Residency Selection During the Initial COVID-19 Crisis: a National Survey (preprint)

Background: During the coronavirus disease 2019 (COVID-19) pandemic, structured medical training is challenging because the necessary travel for on-site interviews could increase the spread of the disease.Aim: This study was conducted to describe an urgently implemented, web-based interview process for selecting medical residents for the National Residency Matching in Saudi Arabia.Method: A cross-sectional, nationwide survey (appendix 1) was sent to 4,153 residency-nominated applicants in Saudi Arabia to the matching interview for 2020.Results: Among the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had video conferences. Besides, most respondents (80.2%) had used Zoom to conduct E-interviews, whereas only 15.9% used FaceTime. Among the respondents, 75.7% agreed that their questions regarding the residency programs were adequately answered during the virtual interviews. The top perceived factors that enhanced the experience were the free application, the clarification emails they received from the organizers, and the organizers’ effective communication. Conversely, what negatively impacted the interviews were the slow and interrupted Internet, the absence of clear instructions, and the lack of previous experience with teleconferencing.Conclusion: Videoconferencing was successfully implemented on an urgent basis during the COVID-19 pandemic in the medical residency application process in Saudi Arabia. The residency applicants preferred video interviews, along with the cost savings and easier logistics to conduct the interviews from various locations. Future studies to enhance this experience are warranted.

Virtual handover of patients in the pediatric intensive care unit during COVID-19 crisis (preprint)

Objectives: A key measure to mitigate coronavirus disease 2019 (COVID-19) has been social distancing. Incorporating video-conferencing applications in the patient handover process between healthcare workers can enhance social distancing while maintaining handover elements. This study describes pediatric intensive care unit (PICU) physicians' experience of using an online video-conferencing application for handover during the COVID-19 pandemic. Design: qualitative content analysis Setting: PICU at a university hospital in Riyadh, Saudi Arabia Subjects: PICU Physicians Interventions: Due to the pandemic, the hospital's PICU used Zoom as a remote conferencing application, instead of a face-to-face handover. Following institutional review board approval, data were collected over two weeks (July 1, 2020 to July 14, 2020). Measurements: Demographic data and narrative descriptions of the perceived efficacy of remote handover were collected using open-ended questions through a created online link. The analysis process included open coding, creating categories, and abstraction. Main Results: All 37 PICU physicians who participated in the handover completed the survey. The participants comprised six attendings, nine specialists, and 22 residents. They had variable previous teleconferencing experiences. Most physicians (78.4%) were comfortable conducting a remote endorsement. Most found that Situation-Background-Assessment-Recommendation handover elements were properly achieved through this remote handover process. The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing. The perceived disadvantages were the paucity of nonverbal communication and teaching during virtual meetings. Conclusions: Video-conferencing applications used for online handovers could supplement traditional face-to-face intensive care unit patient endorsement during outbreaks of infectious diseases. The use of video streaming and more emphasis on teaching should be encouraged to optimize the users' experience.

Changes in healthcare workers’ knowledge, attitudes, practices, and stress during the COVID-19 pandemic (preprint)

Introduction Coronavirus disease 2019 (COVID-19) has caused an unprecedented health crisis around the world, not least because of its heterogeneous clinical presentation and course. The new information on the pandemic emerging daily has made it challenging for healthcare workers (HCWs) to stay current with the latest knowledge, which could influence their attitudes and practices during patient care. Methods This study is a follow-up evaluation of changes in HCWs’ knowledge, attitudes, and practices as well as anxiety levels regarding COVID-19 since the beginning of the pandemic. Data were collected through an anonymous, predesigned, self-administered questionnaire that was sent online to HCWs in Saudi Arabia. Results The questionnaire was sent to 1500 HCWs, with a 63.8% response rate (N=957). The majority of respondents were female (83%), and the most common age group was 31–40 years (52.2%). Nurses constituted 86.3% of the respondents. HCWs reported higher anxiety during the COVID-19 pandemic which increased from 4.91±2.84 to 8.6±2.27 on an 11-point Likert scale compared to other viral outbreaks. HCWs believed that their own preparedness as well as that of their hospital’s intensive care unit (ICU) or emergency room (ER) was higher during the COVID-19 pandemic than during the Middle East respiratory syndrome coronavirus pandemic (2012–2015). About 58% of HCWs attended one or more simulations concerning the management of COVID-19 patients in their ICU/ER, and nearly all had undergone N95 mask fit testing. The mean score of HCWs’ knowledge of COVID-19 was 9.89/12. For most respondents (94.6%), the perception of being at increased risk of infection was the main cause of anxiety related to COVID-19; the mean score of anxiety over COVID-19 increased from 4.91±2.84 before to 8.6±2.27 during the pandemic in Saudi Arabia. Conclusions HCWs’ anxiety levels regarding COVID-19 have increased since a pandemic was declared. It is vital that healthcare facilities provide more emotional and psychological support for all HCWs.

SARS-CoV-2 B.1.1.7 lineage-related perceptions and travel worry among healthcare workers (preprint)

BackgroundHealthcare workers (HCWs) travel-related anxiety needs to be assessed in light of the emergence of SARS-CoV-2 mutations. MethodsAn online, cross-sectional questionnaire among HCWs between December 21, 2020 to January 7, 2021. The outcome variables were HCWs knowledge and awareness of the SARS-CoV-2 B.1.1.7 lineage, and its associated travel worry and Generalized Anxiety Disorder (GAD-7) score. ResultsA total of 1,058 HCWs completed the survey; 66.5% were female, 59.0% were nurses. 9.0% indicated they had been previously diagnosed with COVID-19. Regarding the B.1.1.7 lineage, almost all (97.3%) were aware of its emergence, 73.8% were aware that it is more infectious, 78.0% thought it causes more severe disease, and only 50.0% knew that current COVID-19 vaccines are effective in preventing it. Despite this, 66.7% of HCWs were not registered to receive the vaccine. HCWs most common source of information about the new variant was social media platforms (67%), and this subgroup was significantly more worried about traveling. Nurses were more worried than physicians (P=0.001). ConclusionsMost HCWs were aware of the emergence of SARS-CoV-2 B.1.1.7 variant and expressed substantial travel worries. Increased worry levels were found among HCWs who used social media as their main source of information, those with lower levels of COVID-19 vaccine uptake, and those with higher GAD-7 scores. The utilization of official social media platforms could improve accurate information dissemination among HCWs regarding the pandemics evolving mutations. Targeted vaccine campaigns are warranted to assure HCWs about the efficacy of COVID-19 vaccines toward SARS-CoV-2 variants.

Adenovirus and RNA-based COVID-19 vaccines: perceptions and acceptance among healthcare workers (preprint)

Objectives The aim of this study was to compare the perception, confidence, hesitancy, and acceptance rate of various COVID-19 vaccine types among healthcare workers (HCWs) in Saudi Arabia, a nation with MERS-CoV experience. Design National cross-sectional, pilot-validated questionnaire. Setting Online, self-administered questionnaire among HCWs. Participants A total of 2,007 HCWs working in the Kingdom of Saudi Arabia participated; 75.3% completed the survey and were included in the analysis. Intervention Data were collected through an online survey sent to HCWs during November 1-15, 2020. The main outcome measure was HCW acceptance of COVID-19 candidate vaccines. The associated factors of vaccination acceptance were identified through logistic regression analysis and via measurement of the level of anxiety, using the generalized anxiety disorder 7 (GAD7) scale. Results Among the 1512 HCWs who were included, 62.4% were women, 70.3% were between 21 and 40 years of age, and the majority (62.2%) were from tertiary hospitals. In addition, 59.5% reported knowing about at least one vaccine; 24.4% of the participants were sure about their willingness to receive the ChAdOx1 nCoV-19 vaccine, and 20.9% were willing to receive the RNA BNT162b2 vaccine. However, 18.3% reported that they would refuse to receive the Ad5-vectored vaccine, and 17.9% would refuse the Gam-COVID-Vac vaccine. Factors that influenced the differential readiness of HCWs included their perceptions of the vaccine's efficiency in preventing the infection (33%), their personal preferences (29%), and the vaccine's manufacturing country (28.6%). Conclusions Awareness by HCWs of the several COVID-19 candidate vaccines could improve their perceptions and acceptance of vaccination. Reliable sources on vaccine efficiency could improve vaccine uptake, so healthcare authorities should use reliable information to decrease vaccine hesitancy among frontline healthcare providers.

COVID-19 vaccine confidence and hesitancy among healthcare workers: a cross-sectional survey from a MERS-CoV experienced nation (preprint)

ObjectivesThis study aimed to identify COVID-19 vaccine perception, acceptance, confidence, hesitancy, and barriers among healthcare workers (HCW). MethodsAn online national cross-sectional pilot-validated questionnaire was self-administered by HCW in Saudi Arabia, a nation with MERS-CoV experience. The main outcome variable was HCWs acceptance of COVID-19 vaccine candidates. The associated factors of vaccination acceptance were identified through a logistic regression analysis and the level of anxiety using generalized anxiety disorder 7. ResultOut of 1512 HCWs who completed the study questionnaire--944 (62.4%) women and 568 (37.6%) men--1058 (70%) were willing to receive COVID-19 vaccines. Logistic regression analysis revealed that male HCWs (ORa=1.551, 95% CI: 1.122-2.144), HCWs who believe in vaccine safety (ORa=2.151; 95% CI:1.708-2.708), HCWs who believe that COVID vaccines are the most likely way to stop the pandemic (ORa=1.539; 95% CI: 1.259-1.881), and HCWs who rely on Centers for Disease Control and Prevention website for COVID 19 updates (ORa=1.505, 95% CI: 1.125-2.013) were significantly associated with reporting willingness to be vaccinated. However, HCWs who believed vaccines were rushed without evidence-informed testing were found to be 60% less inclined to accept COVID-19 vaccines (ORa=0.394, 95% CI: 0.298- 0.522). ConclusionMost HCWs are willing to receive COVID-19 vaccines once available; yet, satisfactoriness of COVID-19 vaccination among HCWs is crucial because health professionals knowledge and confidence toward vaccines are important determining factors for their own vaccine acceptance and recommendation to their patients.

COVID-19 Critical Care Simulations: An International Cross-sectional Survey (preprint)

Background: Many healthcare systems initiated rapid training with COVID-19 simulations for their healthcare workers (HCWs) to build surge capacity and optimize infection control measures. This study aimed to describe COVID-19 simulation drills in international healthcare centers. Methods: This is a cross-sectional survey among simulation team leaders and HCWs, based on each center's debriefing reports from simulation centers from 30 countries in all WHO regions where COVID-19 simulation drills were conducted. The primary outcome measures were the COVID-19 simulations' characteristics, outcomes, facilitators, obstacles, and challenges encountered during the simulation sessions. Results: Invitation was sent to 500 simulation team leaders and HCWs, and 343 responded. Those who completed the study comprised 121 participants: 62.8% females; 56.2% physicians; 41.3% from East Mediterranean (EMRO) countries; 25.6% from Southeast Asian countries (SERO); and 12.4% from Europe. The frequency of simulation sessions was monthly (27.1%), weekly (24.8%), twice weekly (19.8%), or daily (21.5%). Among participants, 55.6% reported the team's full engagement in the simulation sessions. The average session length was 30–60 minutes. The most commonly reported debriefing leaders were ICU staff, simulation lab staff, and E.R. facilitators, and the least common were infection control staff. A total of 80% reported "a lot" to "a great improvement" in terms of clinical preparedness after simulation sessions, and 70% were satisfied with the COVID-19 simulation sessions and thought they were better than expected. Most of the perceived issues reported were related to infection control measures, followed by team dynamics, logistics, and patient transport issues. Conclusion: Simulation centers team leaders and HCWs reported positive feedback on COVID-19 simulation sessions. The presence of multiprofessional personnel during drills is warranted. These drills are a valuable tool for rehearsing safe dynamics of HCWs on the frontline of COVID-19.Trial registration: Not applicable.

COVID-19 critical care simulations: An international cross-sectional survey (preprint)

IntroductionMany healthcare systems initiated rapid training with COVID-19 simulations for their healthcare workers (HCWs) to build surge capacity and optimize infection control measures. This study aimed to describe COVID-19 simulation drills in international healthcare centers. MethodsThis is cross-sectional, international survey among simulation team leaders and HCWs, based on each centers debriefing reports from simulation centers from 30 countries in all WHO regions where COVID-19 simulation drills were conducted. The main outcome measures were the COVID-19 simulations characteristics, outcomes, facilitators, obstacles and challenges encountered during the simulation sessions. ResultsInvitation was sent to 500 simulation team leaders and HCWs, 343 responded, and 121 completed the survey. Those who completed the study were from East Mediterranean (EMRO) countries (41.3%); Southeast Asian countries (SERO) (25.6%); and Europe (12.4%) and the remainder from other regions. The frequency of simulation sessions was monthly (27.1%), weekly (24.8%), twice weekly (19.8%), or daily (21.5%). Among participants, 55.6% reported teams full engagement in the simulation sessions. The average session length was 30-60 minutes. The most commonly reported debriefing leaders were ICU staff, simulation lab staff, and ER facilitators, and the least common were infection control staff. A total of 80% reported "a lot" to "a great improvement" in terms of clinical preparedness after simulation sessions, and 70% were satisfied with the COVID-19 simulation sessions and thought they were better than expected. Most of the perceived issues reported were related to infection control measures, followed by team dynamics, logistics, and patient transport issues. ConclusionSimulation centers team leaders and HCWs reported positive feedback on COVID- 19 simulation sessions. The presence of multiprofessional personnel during drills is warranted. These drills are a valuable tool for rehearsing safe dynamics of HCWs on the frontline of COVID-19. Summary boxexplaining the significance of their study by providing each of the following key questions: What is already known?O_LISimulation enhances healthcare systems safety. C_LIO_LIPreparedness to potential disasters includes training for personal protection techniques, environmental contamination, medical management, and training of HCWs. C_LI What are the new findings?O_LIMany hospitals conducted COVID-19 simulations in all WHO regions. C_LIO_LIMost of the team leaders and HCWs reported full engagement and significant clinical preparedness improvement after the COVID-19 simulation sessions. C_LI What do the new findings imply?O_LIThe presence of multiprofessional personnel, including infection control experts, during COVID-19 drills is warranted. C_LIO_LISimulation are a valuable tool for rehearsing safe dynamics of HCWs on the frontline of COVID-19. C_LI