ABSTRACT
SUMMARY: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. RECOMMENDATIONS: Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of 'zero harm', aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections;the use of respirators that meet national and international manufacturing standards;evaluation of all respirators, at the least, by qualitative fit testing; andthe use of respirators as part of a 'package of care' in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential.
ABSTRACT
Objectives: The objective of this presentation is to implement and evaluate a yoga-based psychoeducation program in a school setting. Methods: The program consisted of a 35-minute session once weekly for 8 weeks. Each session introduced a psychosocial theme, breathing exercises, yoga poses, and relaxation techniques. Both sites had the same instructor and program, and ran from January to March 2020. Multiple measures of mental health were completed before and after the program. Results: A total of 33 students from 2 high schools participated. Of those, 29 students (88%) participated in at least 6 sessions, and all (100%) participated in at least 5 of 8 sessions. The mean age was 14.8 ± 0.8 years. Nineteen (57.6%) were female, and 14 (42.4%) were male. Seventeen (51.5%) were Asian, 5 (15.2%) were White, 3 (9.1%) were Hispanic/Latinx, 4 (12.1%) identified as other, and 4 (12.1%) were unknown. Of the 29 survey respondents, 28 (96.6%) responded that the program helped their psychosocial problems. The Outcomes Rating Score (ORS) showed no significant differences before the program (M = 29.0, SD = 7.8) compared to after the program (M = 28.9, SD = 5.6 [t = 0.03;p = 0.49]). The Child and Youth Resilience Measure (CYRM) also showed no difference before the program (M = 72.6, SD = 9.8) compared to after the program (M = 72.9, SD = 9.9 [t = –0.097;p = 0.46]). In addition, the Strength and Difficulties Questionnaire (SDQ) showed no differences from pre- (M = 9.2, SD = 4.6) to postprogram (M = 10.1, SD = 6.2 [t = –0.49;p = 0.32]). Controlling for sex and ethnicity did not change the results for all 3 measures. Conclusions: This study demonstrated the feasibility of implementing a yoga-based psychoeducation program in schools with positive student feedback. However, there were no significant differences in outcome measures before and after the program. The discrepancy between the participants’ feedback and the lack of significant changes in outcome measures may be attributable to a couple factors, including the possible impact of COVID-19 and the participant group being a healthy population. For future studies, we recommend a larger sample size with a control group. We also recommend considering repeating the program with a clinical population with a screening process or using measures more specific for healthy populations. CAM, SC, WL