ABSTRACT
INTRODUCTION: The unprecedented nature of the COVID-19 pandemic has led to contentious discourse around issues related to vaccines and unproven COVID-19 therapies (UCTs), such as ivermectin. Despite recommendations against its use, ivermectin remains heavily used, and in some areas, highly demanded. We explored perceptions of patients living in the rural South about UCTs and healthcare distrust. METHOD(S): This mixed methods study was conducted from 2021-2022 in Moultrie, Georgia. Adult patients with a history of COVID-19 were recruited from inpatient and outpatient settings of a healthcare system. Validated phone questionnaires assessing healthcare distrust and a 30-minute qualitative interview exploring healthcare trust, perceptions of UCTs, and evidence-based therapies (eg monoclonal antibodies and vaccines) were conducted. Thematic analysis was applied to transcripts. Nonparametric independent samples Mann-Whitney U tests used conducted to compare survey means (95% CI). RESULT(S): We recruited 26 patients (62% female, 85% white). Eight themes emerged: 1) Anecdotal stories and personal experiences influence decision-making about COVID-19;2) Use of a haphazard approach to ;research';3) Strong distrust of national government and healthcare organizations;4) Strong trust in local doctors and the local health system;5) Decision-making is viewed as weighing pros and cons;6) Lack of consistency in COVID-19 related medication decisions (eg ivermectin, monoclonal antibodies, remdesivir);and 7) Patients value autonomous decisions about their healthcare and feel they have a right to try medications (knowing possible risks). High survey means indicated high distrust;healthcare distrust mean scores of those who requested/used ivermectin versus those who did not had a mean difference of 7.1 points (p=0.027). CONCLUSION(S): Although trust of healthcare and government was low, trust in local physicians was high. Patients value the right to try ivermectin, this desire was fueled by distrust of government. If clinicians are perceived as aligned with the government, such alignment may void trust of clinicians. Health messages should invoke patient autonomy and be framed as presenting options (including pros/cons) and should balance patient autonomy with clinicians' ethical parameters around unproven medical treatments.
ABSTRACT
INTRODUCTION: Ivermectin has been widely requested or prescribed as treatment for COVID-19 despite NIH and WHO recommendations against its use. Even so, clinicians commonly receive requests for unproven COVID-19 therapies (UCTs) and face substantial disruption to the therapeutic alliance when clinicians deny these requests from patients. METHOD(S): This study was conducted from 2021-2022 in Moultrie, Georgia. Physicians or advanced practice clinicians who treated a COVID-19-positive patient in the health system were eligible. Purposive, convenience sampling was used to recruit clinicians to participate in a 30-minute qualitative interview exploring experiences and thoughts related to UCT requests, patient trust in the healthcare system, and personal impact of distrust and UCT requests. Thematic analysis was applied to transcripts. RESULT(S): Participants were 8 clinicians (7 physicians, 1 advanced practice nurse) from several fields (outpatient setting=2, inpatient or mixed setting=6): pulmonary/critical care (n=3), internal medicine/hospitalists (n=2), nephrology (n=1), and family medicine (n=2). Five themes emerged: 1) Clinicians do not understand why people trust social media and not their clinical expertise;such distrust is hurtful and frustrating;2) Clinicians feel ambivalence about discussions about UCTs and are generally accepting of community beliefs;3) Clinicians perceived that distrust in healthcare originates outside of the healthcare system yet patients exhibit trust within the local healthcare system;4) Clinicians are torn about whether to use UCTs to build trust and rapport;5) Counseling strategies are variable yet clinicians spend significant time focusing on education. CONCLUSION(S): Clinicians experience distress related to perceived patient distrust in their recommendations about COVID-19 vaccination and UCT requests. Some clinicians perceive that acquiescing to UCT requests may help repair therapeutic relationships with minimal harm. Clinician perspectives are aligned with themes from a related study of patient trust and UCT request from the same healthcare system. Taken together, these studies provide insight for clinicians looking to craft savvy and ethical messages that are responsive to patient needs while upholding professional standards in prescribing medications.
ABSTRACT
Background: The 2019 novel coronavirus pandemic has had a significant impact on anesthesiology practice globally. Its high infectivity and severity of onset has led to numerous examples of healthcare systems being overwhelmed, especially at its incipience. Drawing on experiences from previous pandemics, we anticipated that our Anesthesiology Department would be faced with unique challenges due to our proximity to airway maneuvers. We set out to intentionally strategize a quality improvement framework with which to guide our departmental response. Methods: We employed a Key Drivers Diagram (KDD) model to strategically account for the numerous novel quality improvement measures implemented simultaneously in response to the pandemic. Having identified areas of interest, measurable indices were identified, and dynamic progress assessed using run charts. These were (I) protect patients and staff, (II) keep up-to-date with evolving evidence, (III) maintain communication with department, (IV) keep staff engaged, and (V) align departmental goals with institutional aims. Results: Positive trends in staff engagement were identified across participation in educational activities such as guideline development, grand round attendance, and interdepartmental meetings. Conclusions: The KDD provided a valuable framework for managing parallel quality improvement processes. It enabled leadership to identify needs, measure adequacy of response and implement changes in a rapidly evolving environment. © Journal of Hospital Management and Health Policy. All rights reserved.
ABSTRACT
Introduction: Racial disparities continue to exist during the COVID-19 pandemic. A systematic review found that Black and Hispanic patients experience disproportionate COVID-19 hospitalizations and higher morbidity and mortality. Low level evidence in that review suggested that Asians' outcomes are similar to those of non-Hispanic whites. As most practicing gastroenterologists are White, and as endoscopies are aerosolizing procedures risking viral transmission, this study evaluates differences in fear levels among gastroenterologists from different racial backgrounds. Methods: This IRB-approved multi-center cross-sectional study used a snowball sampling approach to disseminate a 42-question survey, pilot-tested for reliability and validity, to gastroenterologists across different geographic locations in the US. Fear levels during endoscopic procedures on suspected/confirmed COVID-19 patients were assessed using a 1-10 Likert scale, with 10 being the greatest fear. Fear was assessed at three points for upper and lower endoscopies: first procedure, subsequent before the COVID-19 vaccine, and subsequent after the vaccine. Data was analyzed using Pearson's chi-squared, Mann-Whitney U, and Wilcoxon rank tests and significance was determined at p<0.05 Results: We analyzed 69 responses from gastroenterologists at 30 sites. Of the respondents, 39 selfidentified as white, 3 as Black, 6 as Latinx, 4 as Middle Eastern, and 17 as Asian. Due to the small sample size, non-White racial groups were combined to evaluate the impact of race on reported fear level reported by gastroenterologists who performed endoscopies during the COVID-19 pandemic. Fear levels at the six assessed points were not significantly different when comparing Asians to Whites, and when comparing Blacks and Latinx to Whites. However, Asians, Blacks, and Latinx had a higher fear level post vaccine when performing lower endoscopies compared to Whites (mean (m) 53.59, standard deviation (SD)=2.83 vs m=1.94, SD=1.083, respectively;P=0.045). Conclusion: While results can be due to chance due to the small sample size and survey response bias, our study suggests that after receiving the COVID-19 vaccine, minority endoscopists experienced greater fear than White endoscopists while performing lower endoscopies. It is possible that the disproportionate COVID-19 disease burden in Black and Hispanic communities negates the decrease in fear levels that was experienced by White endoscopists even after receiving the COVID-19 vaccine..
ABSTRACT
Background: Olfactory dysfunction is a typical symptom of COVID-19 infection. While COVID-associated anosmia is welldescribed, knowledge of parosmia (olfactory distortions) and phanthosmia (olfactory hallucinations) is relatively lacking. We undertook a clinical study of the parosmia/phanthosmia phenotype, aiming to support improved prediction and management of these symptoms. Subjects and methods: In a cross-sectional study between September 2020 and May 2021, we recruited 187 COVID-19 patients with parosmia/phanthosmia via social media and a matched healthy control group from neurologists. The patients received an online video-consultation with a neurologist trained in olfactory research and completed a questionnaire to assess the nature of their subjective olfactory disorder. Results: In the acute period of COVID-19 parosmia/phanthosmia, patients often experienced comorbid manifestations such as fatigue, fever, headache, myalgia, and "brain fog". Isolated phanthosmia was observed in 13.9% of acute COVID-19 patients, as compared to 34.2% in the long term. Parosmia was described in 89.8% of patients in the long-term course of the disease. COVIDassociated parosmia/phanthosmia was more common in women (81.3%) than men (18.7%). Almost all parosmia/phanthosmia patients had an acute history of anosmia, which often progressed to hyposmia. A third of the patients had a history of taste disturbance The long-term COVID-19 sequelae such as fatigue, brain fog, and dizziness are significantly more common among patients with parosmia/phanthosmia, as were autonomic symptoms such as awareness of heartbeat and rapid pulse. The incidence of migraine with aura was significantly higher in the parosmia/phanthosmia group than in the control group (8% versus 0.9%). The allergy was reported significantly more frequent in the study group compared to the control group. Conclusions: Qualitative olfactory disorders occur frequently in COVID-19 patients. Those with the parosmia/phanthosmia phenotype have a higher risk for other symptoms, notably headache (including migraine with aura), fatigue, brain fog, dizziness, and cardiovascular/autonomic manifestations, as well as allergy. We suppose that further investigation of this phenomenon will reveal phenotypic variants depending on particular symptoms cluster;improved nosology of qualitative olfactory disorders in COIVD-19 is a prerequisite for establishing appropriate treatments. © 2021 Medicinska Naklada Zagreb. All rights reserved.
ABSTRACT
Background and purpose: Early on in the COVID-19 pandemic, New York City (NYC) vowed to “keep the subways running” despite the lack of plans in place for protecting the health and well-being of transit workers. This study was designed to assess the impact of employment during the early phase of the pandemic on this essential frontline workforce. Methods, settings, and study participants: A convenience sample of members (stratified by job title) of the NYC Transport Workers Union, Local 100, was recruited in August 2020 to participate in an anonymous, cross-sectional, internet-based survey. Results: The demographics of the sample participants (N = 645) reflected union membership, ie, 82 percent male, 29 percent Black;27 percent Hispanic, and 59 percent ≥age 50 years. At the time of the “NYC Pause” (March 22, 2020) when mandatory stay-at-home orders were issued, transit workers had limited worksite protections. Many reported a lack of such basics as face masks (43 percent), hand sanitizer (40 percent), and disposable gloves (34 percent). A high proportion (87 percent) were concerned about getting infected at work. Lack of certain protections was significantly associated with both fear of contagion at work and mental health symptoms. Nearly 24 percent of participants reported a history of COVID-19 infection. Self-reported infection was significantly correlated with lack of certain protections, including respiratory masks (p < 0.001), disposable gloves (p < 0.001), and hand sanitizer (p < 0.001). Infection was also significantly associated with mental health symptoms (p < 0.001). By August 2020, despite participants reporting that many worksite protections were then in place, 72 percent of workers were still fearful for their safety at work, eg, because of potential exposure due to passengers not wearing masks, and risk of verbal abuse and physical assault by passengers angered when asked to wear face masks. Workers who were fearful for their safety at work were more than six times more likely to report mental health symptoms (p < 0.001). Conclusions: Lack of worksite protections before “NYC Pause” (March 22, 2020) was significantly associated with self-reported infection, fear, and mental health symptoms in TWU, Local 100 members. To reduce the risk of adverse impacts associated with bioevents in all essential work groups, and across all essential occupational settings, infection control preparedness, early recognition of risk, and implementation of tailored risk reduction strategies are imperative. Pandemic preparedness is fundamental to protecting the health and well-being of essential workers and crucial in controlling the spread of disease in the community. Bioevent preparedness for all essential frontline workgroups will also help reduce occupational health inequities. Workers at risk, regardless of setting, deserve and have the right to equal protections under federal and state law. © 2021 Weston Medical Publishing. All rights reserved.