DNA amplification tests at universal pre-admission screening with enhanced precaution strategies for asymptomatic patients with COVID-19.

Objective: To analyse the effect of hospital pre-admission screening and enhanced precaution strategies on the transmission of severe acute respiratory syndrome coronavirus-2. Methods: This retrospective cohort study was conducted over 17 months from 11 May 2020 to 30 September 2021 at a large hospital in Tokyo. Universal DNA amplification tests were conducted during pre-admission screening, and enhanced precaution strategies were implemented for all patients with negative admission tests. The primary outcome was the occurrence of symptomatic coronavirus disease 2019 (COVID-19) in patients after admission. The secondary outcomes were time-series analyses of monthly positive admission test numbers, positive rates, clinical features in positive cases, and clinically confirmed nosocomial transmission. Results: In total, 32,081 patients were screened pre-admission (29,556 asymptomatic patients and 2525 symptomatic patients). Of the asymptomatic patients, 0.11% (n=32) tested positive and were admitted to a designated COVID-19 ward or were not admitted. Among the five inpatients who developed symptomatic COVID-19 during hospitalization, only two cases were related to a single nosocomial transmission. Conclusion: Pre-admission test screening was effective in identifying asymptomatic cases of COVID-19. This allowed administrators to quarantine patients or delay hospital admission. The combination of testing and enhanced precaution strategies for asymptomatic cases of COVID-19 may minimize nosocomial transmission.

Comparison of methylprednisolone pulse vs conventional dexamethasone for adult cases of COVID-19 requiring oxygen; a Japanese retrospective cohort study.

BACKGROUND: Although dexamethasone is an effective treatment in cases of coronavirus disease 2019 (COVID-19) requiring oxygen, the efficacy of methylprednisolone pulse is unclear. We compared the characteristics and outcomes of methylprednisolone pulse to those of dexamethasone. METHODS: We conducted a retrospective cohort study on adult COVID-19 cases requiring oxygen and no invasive mechanical ventilation treated with methylprednisolone pulse (1 g/day for 3 days) or dexamethasone (6 mg/day orally or 6.6 mg/day intravenously for ≥5 days). The primary outcome was intensive care unit (ICU) admission. The secondary outcomes were hospital mortality, length of hospital stay (LoS), duration of oxygen requirement, and requirement for hospital transfer, vasopressor(s), intubation, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). RESULTS: Twenty two cases of methylprednisolone pulse and 77 cases of dexamethasone were included. Mask ventilation was more common in the methylprednisolone pulse group (P < 0.001). The proportion of ICU admissions was similar between both groups (P = 0.635). The secondary outcomes of hospital mortality and the requirement for hospital transfer, vasopressor(s), intubation, and CRRT were similar between groups. No cases received ECMO. Median LoS (P = 0.006) and duration of oxygen requirement (P = 0.004) were longer in the methylprednisolone pulse group. CONCLUSIONS: The proportion of ICU admissions was similar between the methylprednisolone pulse and the dexamethasone group. However, more cases in the methylprednisolone pulse group required mask ventilation than in the dexamethasone group, suggesting that some cases benefited from methylprednisolone pulse.

Persistence of Mental Health Deterioration Among People Living Alone During the COVID-19 Pandemic: A Periodically-repeated Longitudinal Study.

BACKGROUND: This longitudinal study aimed to investigate how psychological distress levels changed from early to middle phases of the new coronavirus (COVID-19) pandemic depending on the living arrangements of individuals. METHODS: An internet-based, longitudinal survey of 2,400 Japanese people was conducted every 5-6 weeks between February 2020 and January 2021. The presence of severe psychological distress (SPD) was measured using the Kessler's psychological distress scale. Living arrangements were classified into two groups (ie, living alone or living with others). Mixed-effects logistic regression analysis was performed to assess whether changes in SPD status were different depending on living arrangements. RESULTS: Of 2,400 respondents, 446 (18.5%) lived alone. Although the proportion of SPD in both individuals living alone and those living with others increased to the same extent in the early phase of the pandemic, the distress levels decreased after the early phase of the pandemic in the group living with others, compared with the group living alone, for which SPD remained high. The odds ratio (OR) of developing SPD in interaction term with survey phases tended to be higher among those who lived alone than those who lived with others in Phase 6 (OR 1.89; 95% confidence interval [CI], 0.99-3.64) and Phase 7 (OR 1.88; 95% CI, 0.97-3.63). CONCLUSION: During the COVID-19 pandemic, those living alone are persistently at a higher risk of SPD compared to those living with others. Effective countermeasures targeting those living alone, such as enhancing online communication or providing psychological therapies, are essential.

Individual-level social capital and COVID-19 vaccine hesitancy in Japan: a cross-sectional study.

To reduce vaccine hesitancy, it is important to identify factors that can intervene at the individual or community level. Social capital is a possible factor because it is associated with various vaccine hesitancy, such as for measles and influenza. However, limited studies have explored the association between social capital and vaccination for COVID-19, which is an unprecedented pandemic and infodemic. Therefore, this study aimed to clarify the association between social capital and COVID-19 vaccination during the pandemic. This cross-sectional study used quota sampling for an online-based survey. Participants were asked whether they had previously been vaccinated for COVID-19 and their intention to receive a COVID-19 vaccine booster. Social capital was evaluated using three measures (individual-level civic participation, social cohesion, and reciprocity). Multiple logistic regression analysis was performed to clarify the association between social capital and previous COVID-19 vaccination status as well as intention to receive a COVID-19 booster. Participants were 2,313 individuals, of whom 87.2% had received a COVID-19 vaccine; 72.3% intended to obtain a COVID-19 booster. Individuals with any social capital are more likely to receive a COVID-19 vaccination than those with none (OR: 1.73, 95%CI: 1.18-2.54; OR: 1.58, 95%CI: 1.22-2.05; OR: 3.05, 95%CI: 2.15-4.33). These indicators were also associated with the intention to receive a COVID-19 booster. Thus, our results suggest that among the general public, those with individual-level social capital are more likely to receive a COVID-19 vaccination than those with none. Social capital may be a factor that can reduce vaccine hesitancy during a pandemic.

Trends in COVID-19 vaccination intent from pre- to post-COVID-19 vaccine distribution and their associations with the 5C psychological antecedents of vaccination by sex and age in Japan.

Vaccine hesitancy regarding the coronavirus disease 2019 (COVID-19) vaccine is widespread during the COVID-19 pandemic. Many recent studies have reported that the confidence of the vaccination and perceived risk were associated with vaccination intent, yet few studies have focused on other psychological factors. This study aimed to clarify the trends in COVID-19 vaccination intent and to identify the association between the 5C psychological antecedents and COVID-19 vaccination intent by sex and age in Japan. This was a longitudinal study conducted through an Internet-based survey from January 2021 to April 2021 before and after vaccine distribution in Japan, including 2,655 participants recruited by quota sampling. Participants were asked to indicate how likely they were to get vaccinated against COVID-19. In the second survey, the participants responded to questions regarding the 5C psychological antecedents: confidence, complacency, constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and collective responsibility (willingness to protect others). Multiple logistic regression analysis was performed to clarify the association between the 5C psychological antecedents and COVID-19 vaccination intent in the second wave survey. COVID-19 vaccination intent improved from 62.1% to 72.4% after vaccine distribution, but no significant difference was found in young men. Confidence and collective responsibility were positively associated with vaccination intent, and calculation was negatively associated among all generations. COVID-19 vaccination intent may be affected not only by confidence and constraints but also by calculation and collective responsibility, and further research is needed.

How Frequently Do Ordinary Citizens Practice Hand Hygiene at Appropriate Moments during the COVID-19 Pandemic in Japan?

We aimed to clarify the status of hand hygiene practices among ordinary citizens during the COVID-19 pandemic in Japan, as well as the frequency of daily hand hygiene as an indicator of education and evaluation. This cross-sectional study was based on an internet survey completed by 2,149 participants (age range: 20-79 years, men: 51.0%, response rate: 89.5%), selected from June 23 to 28, 2020. The participants responded regarding the frequency of implementing hand hygiene at 5 moments (after returning from a public place, after using the toilet, after touching something outside, before eating food, and after blowing the nose, coughing, or sneezing). Additionally, the participants responded to the number of daily hand hygiene events. The cutoff value of the total number of daily hand hygiene events to determine whether hand hygiene was performed at all 5 time points was determined using receiver operating characteristic analysis. The mean number of hand hygiene events was 10.2 times/day. The prevalence of implementing hand hygiene at each moment ranged from 30.2% to 76.4%; only 21.1% of respondents practiced hand hygiene at all times. Both Youden Index and specificity were high when the cut-off value was 11 times/day. Therefore, the criterion of hand hygiene (≥11 times/day) may be useful in education and evaluation.

Survey on usage and concerns of a COVID-19 contact tracing application in Japan.

OBJECTIVES: We aimed to identify the concerns, current implementation status and correct usage, and factors inhibiting implementation and correct use of a COVID-19 contact tracing application among the ordinary citizens in Japan. STUDY DESIGN: This was a cross-sectional study based on an internet survey completed by 2013 participants who were selected among registrants of an Internet research company between September 8 and 13, 2020. METHODS: Participants completed an online survey that included thoughts and concerns about the application, status of use, and questions about whether the application was being used correctly. We performed multiple logistic regression analysis to clarify the association between the use of the app and sociodemographic factors and user concerns. RESULTS: Of the 2013 respondents, 429 (21.3%) participants reported using this application, but only 60.8% of them used it correctly. The percentage of those having some concerns about the application ranged from 45.9% to 75.5%, with the highest percentage being 'doubts about effectiveness of apps for preventing spread of infection'. Multiple logistic regression analysis revealed, the main concerns inhibiting application use were insufficient knowledge of how to use it, privacy concerns, doubts about the effectiveness of the app, and concerns about battery consumption and communication costs. Additionally, the prevalence of the application was lower for lower-income individuals. CONCLUSIONS: The findings suggest that income may create inequalities in the efficacy and effectiveness of COVID-19 contact tracing applications. Awareness activity strategies to dispel such concerns and support low-income individuals may be needed.

Changes in the medical treatment status of Japanese outpatients during the coronavirus disease 2019 pandemic.

Background: The coronavirus disease 2019 (COVID-19) has a tremendous influence in general public's behaviors; however, changes in the status of regularly scheduled outpatient visits in Japan during COVID-19 pandemic are still unknown. Methods: This cross-sectional study was conducted in May 2020. Participants were recruited by an Internet-based survey company. A total of 659 patients (54% male, average age 60 ± 14 years) who had regularly scheduled outpatient visits prior to the onset of COVID-19 were enrolled. Participants answered four questions ("decrease in medical visit frequency," "inability to take regular medication," "deterioration of a chronic disease," and "utilization of telephone/online medical care") and stated whether they had a fear of acquiring infection at a medical facility. The associations between answers, fear of infection, and socio-demographic factors were examined. Results: Among the participants, 37.8% had decreased their medical visits, 6.8% were unable to take regular medications, 5.6% experienced a deterioration of chronic disease, and 9.1% utilized telephone/online medical care. Fear of being infected by COVID-19 at medical facilities was strongly associated with a reduced frequency of medical visits and lack of regular medications even after adjusting for socio-demographic factors and current medical histories. Conclusions: During the first wave of COVID-19, approximately 40% of participants reduced their frequency of medical visits. It is important to continue implementing thorough infection control measures at facilities and educating the public the importance of keeping chronic diseases in good condition, as well as promoting telephone/online medical care.

Acceptance of a COVID-19 Vaccine in Japan during the COVID-19 Pandemic.

Vaccination could be a key protective measure against coronavirus disease 2019 (COVID-19), and it is important to understand the acceptability of the COVID-19 vaccine among the general public. However, there is no study on the acceptance of a COVID-19 vaccine in Japan. Therefore, this study aimed to describe the COVID-19 vaccine acceptance and hesitancy situation in Japan and assess the factors associated with such issues. This was a cross-sectional study based on an internet survey completed by 2956 people. Participants were asked to indicate how likely they were to get vaccinated for COVID-19. In addition, the participants responded to questions regarding sociodemographic factors, attitudes, and beliefs regarding COVID-19 infection and vaccination. The proportion of participants with a high likelihood of getting a COVID-19 vaccine was 62.1%. Multiple logistic regression analysis showed that vaccine acceptance was lower among several sociodemographic groups, such as women, adults aged 20-49 years, and those with a low-income level. Several psychological factors, especially the perceived effectiveness of the COVID-19 vaccine, and willingness to protect others by getting oneself vaccinated, were associated with vaccine acceptance. Our results indicate that the perceived effectiveness of the vaccine and willingness to protect others may play an important role in the acceptance of the COVID-19 vaccine.

Development of severe psychological distress among low-income individuals during the COVID-19 pandemic: longitudinal study.

BACKGROUND: It has been indicated that the health impact of COVID-19 is potentially greater in individuals from lower socioeconomic status than in the overall population. AIMS: To examine how the spread of COVID-19 has altered the general public's mental health, and whether such changes differ in relation to individual income. METHOD: An online longitudinal survey was conducted at three different time periods during the pandemic. We recruited 1993 people aged 20-70 years, living in the Tokyo metropolitan area in Japan. Participants' mental health was measured with the six-item version of the Kessler Psychological Distress Scale; the existence of severe psychological distress was ascertained through the cut-off data. Multiple logistic and mixed-model ordinal logistic regression analyses were performed, with income as the independent variable. RESULTS: Of the participants, 985 were male, with a mean age of 50.5 (±15.8) years. Severe psychological distress percentages for each tested period were 9.3%, 11.2% and 10.7% for phases 1, 2 and 3, respectively. Between phases 1 and 2 or phases 2 and 3, the group that earned <£15 000 had significantly higher propensity to develop severe psychological distress than the group that earned ≥£45 000 (odds ratio 2.09, 95% CI 0.95-4.56 between phases 1 and 2; odds ratio 3.00, 95% CI 1.01-9.58 between phases 2 and 3). CONCLUSIONS: Although there has been significant deterioration in mental health among citizens during the COVID-19 pandemic, this was more significant among those with lower income. Therefore, mental health measures that focus on low socioeconomic groups may be necessary.

Changes in Psychological Distress During the COVID-19 Pandemic in Japan: A Longitudinal Study.

BACKGROUND: This longitudinal study aimed to examine the changes in psychological distress of the general public from the early to community-transmission phases of the COVID-19 pandemic and to investigate the factors related to these changes. METHODS: An internet-based survey of 2,400 Japanese people was conducted in two phases: early phase (baseline survey: February 25-27, 2020) and community-transmission phase (follow-up survey: April 1-6, 2020). The presence of severe psychological distress (SPD) was measured using the Kessler's Six-scale Psychological Distress Scale. The difference of SPD percentages between the two phases was examined. Mixed-effects ordinal logistic regression analysis was performed to assess the factors associated with the change of SPD status between the two phases. RESULTS: Surveys for both phases had 2,078 valid respondents (49.3% men; average age, 50.3 years). In the two surveys, individuals with SPD were 9.3% and 11.3%, respectively, demonstrating a significant increase between the two phases (P = 0.005). Significantly higher likelihood to develop SPD were observed among those in lower (ie, 18,600-37,200 United States dollars [USD], odds ratio [OR] 1.95; 95% confidence interval [CI], 1.10-3.46) and the lowest income category (ie, <18,600 USD, OR 2.12; 95% CI, 1.16-3.86). Furthermore, those with respiratory diseases were more likely to develop SPD (OR 2.56; 95% CI, 1.51-4.34). CONCLUSIONS: From the early to community-transmission phases of COVID-19, psychological distress increased among the Japanese. Recommendations include implementing mental health measures together with protective measures against COVID-19 infection, prioritizing low-income people and those with underlying diseases.

Incorrect Use of Face Masks during the Current COVID-19 Pandemic among the General Public in Japan.

Since the emergence of the COVID-19 pandemic, the use of face masks by healthy individuals for prevention has been attracting public attention. However, efficacy depends on proper usage. We set out to determine the prevalence of wearing masks to prevent COVID-19 and compliance with appropriate measures for the correct use of face masks among the general public in Japan where wearing medical masks is a "cultural" normality. This cross-sectional study was based on an internet-based survey completed by 2141 people (50.8% men, aged 20-79 years) who were selected among registrants of an Internet research company between 1 April and 6 April 2020. Participants were asked to indicate how often they wore masks for prevention and to what extent they practiced appropriate measures suggested by the World Health Organization. The prevalence of wearing masks was 80.9% and compliance rates with appropriate measures ranged from 38.3% to 83.5%. Only 23.1% complied with all recommendations. Compliance rates were overall low in men and persons with low household incomes. Our results, hence show that many citizens implement inaccurate measures when using face masks. Therefore, providing guidance on correct usage is essential when encouraging the use of face masks to prevent COVID-19.

The actual implementation status of self-isolation among Japanese workers during the COVID-19 outbreak.

BACKGROUND: Self-isolation is an important personal protective measure in inhibiting the transmission of coronavirus disease 2019 (COVID-19) as people carry out economic and social activities amid its spread. Yet few studies have clarified the actual implementation status of self-isolation during an outbreak. This study aimed to reveal the actual implementation of self-isolation among Japanese workers during the COVID-19 outbreak and the factors inhibiting this measure. METHODS: This was a cross-sectional study based on an internet survey completed by 1,226 workers (60.0% men) living in 7 prefectures (i.e., Tokyo, Kanagawa, Saitama, Chiba, Ibaraki, Tochigi, and Gunma) who were selected among registrants of an Internet research company, between May 12 and 17, 2020. Participants were asked whether they had experienced fever or other cold symptoms between February 17, 2020 and the date of the survey. Those who responded affirmatively were asked where they had visited (e.g., hospital, work, and shopping for groceries or necessities) to clarify whether they had left the house within 7 days after symptom onset. We performed multivariate logistic regression analysis to clarify the relationship between going to work within 7 days after symptom onset and both sociodemographic factors and employment-related constraints. RESULTS: Of the survey participants, 82 had experienced fever or other cold symptoms (6.7%). Among these participants, 51 (62.2%) went to work within 7 days after symptom onset. A mere 17.1% practiced strict self-isolation. Multivariate logistic regression analysis revealed that those living outside the metropolitan area (i.e., Ibaraki, Tochigi, and Gunma), working as a company employee, and being unable to work from home were associated with going to work within 7 days after symptom onset. CONCLUSIONS: The prevalence of strict self-isolation among participants who experienced cold-like symptoms during the COVID-19 outbreak was extremely low, and 62.2% of these participants went to work within 7 days after symptom onset. This study highlights the need for further public awareness regarding self-isolation and countermeasures against factors that obstruct it.

Adoption of personal protective measures by ordinary citizens during the COVID-19 outbreak in Japan.

OBJECTIVES: To clarify the implementation status of personal protective measures by ordinary citizens in Japan during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: This was a cross-sectional study based on internet-based survey. A total of 2400 people (50% male: 20-79 years) were selected between February 25 and 27, 2020, from registrants of an Internet research company, to complete a questionnaire. Participants were asked to indicate how often they implemented the following five personal protective measures recommended by the World Health Organization (hand hygiene, social distancing measures, avoiding touching the eyes, nose and mouth, respiratory etiquette, and self-isolation). In addition, the participants responded to questions regarding the daily frequency of hand hygiene events. RESULTS: The prevalence of the five personal protective measures ranged from 59.8% to 83.8%, with the lowest being avoiding touching the eyes, nose, and mouth. In total, 34.7% implemented all personal protective measures. The median daily hand hygiene events were 5 per day (25th percentile, 75th percentile: 3,8). CONCLUSIONS: The protective measures implemented by ordinary citizens are insufficient and further public awareness activities are required.