Community Health Workers in Time of Crisis: A COVID-19 Case Study

This article focuses on the lived experiences of those implementing community health worker (CHW) programs during the COVID-19 pandemic. Based in an upper mid-west state, this qualitative case study is bounded by the state-level context and two distinct local case sites—one rural and one urban—and includes the experiences of five CHWs, two program directors, and a state-level administrator. The acute crisis response galvanized the ongoing need for CHWs, not only because they are trusted health messengers, but because they advocate for—and organize with—communities to address inequalities and inform public health institutions. Author-practitioners described personal and community identity as intertwined, a perspective in solidarity with decolonized approaches to humanistic psychology. Highlights discussed include: (a) Personal relationships motivated author-practitioners to join the pandemic response;(b) All pandemic response efforts were interconnected with social determinants of health;(c) The pandemic was as an opportunity to do things differently with more flexibility, personally and organizationally;and (d) Privately funded opportunities enabled local areas to implement quick responses, which influenced eventual state-level responses. All authors described structural racism as a constant context of this work. This article fills gaps in the literature related to the implementation of crisis responses and CHW programs. [ FROM AUTHOR]

Direct Detection of SARS-CoV-2 Using Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP) Without RNA Purification (preprint)

Coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which has spread globally. Shortage of nucleic acid extraction kits may delay the speed of diagnosis. In order to address this need, we propose a simple method for direct RNA extraction from nasopharyngeal swab samples without RNA purification. Here, we describe a reverse transcription loop-mediated isothermal amplification technique with 95.4% sensitivity (95% CI: 84.2-99.4%) and 100% specificity (95% CI: 78-100%). Combined with a simple RNA extraction step, this optimized RT-LAMP method is able to amplify SARS-CoV-2 directly from clinical nasopharyngeal swab samples in viral transport media in 50 minutes. This method provides an opportunity to facilitate SARS-CoV-2 detection especially in resource limited settings where nucleic acid extraction kits are few.Funding: This study was supported by Prototype Research Grant Scheme (PRGS), PR001-2020B (PRGS/2/2020/SKK09/UM/02/1) from the Ministry of Education, Malaysia.Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript.Ethics Approval Statement: Ethical approvals for this study was obtained from UMMC 85 Medical Ethics Committee (202041-8418) and Medical Research Ethics Committee 86 (MREC) Ministry of Health Malaysia (NMRR-20-2344-56994).

Serology surveillance of anti-SARS-CoV-2 antibodies among asymptomatic healthcare workers in Malaysian healthcare facilities designated for COVID-19 care (preprint)

IntroductionHealthcare workers (HCW) are presumed to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection due to occupational exposure to infected patients. We aim to determine the prevalence of anti-SARS-CoV-2 antibodies among asymptomatic HCW.MethodsWe prospectively recruited HCW from the National Public Health Laboratory and two COVID-19 designated public hospitals in Klang Valley, Malaysia between April 13th and May 12th, 2020. Quota sampling was applied to ensure adequate representation of the HCW involved in provision of care for patients directly and indirectly. All participants had worked in the respective healthcare facility for at least 30 days prior study enrollment. HCW who were previously confirmed with COVID-19 infection or listed as “patient under investigation” were excluded. A self-administered questionnaire was used to capture sociodemographic information, history of contact with COVID-19 cases within the past month, clinical signs and symptoms and adherence to universal precautions. Blood samples were taken to test for anti-SARS-CoV-2 antibodies by surrogate virus neutralization test.ResultsA total of 400 HCW were recruited, comprising 154 (38.5%) nurses, 103 (25.8%) medical doctors, 47 (11.8%) laboratory technologists and others (23.9%). The mean age was 35±7.8 years, with females predominant (74%). A majority (68.9%) reported direct contact with COVID-19 patients, body fluids of COVID-19 patients and/or contaminated objects and surfaces in the past month within their respective workplaces. Nearly all claimed to adhere to personal protection equipment (PPE) guidelines (97%-100% adherence) and hand hygiene practice (91%-96% adherence). None (95% CI: 0, 0.0095) of the participants had anti-SARS-CoV-2 antibodies detected, despite 135 (33.8%) reporting respiratory symptoms one month prior to study recruitment. One hundred and fifteen (29%) participants claimed to have contact with known COVID-19 persons outside of the workplace.ConclusionOur finding of zero seroprevalence among asymptomatic HCW suggests a low risk of asymptomatic COVID-19 infection in our healthcare setting; which is at expected levels for a country with an incidence of 26 per 100,000. The adequacy of PPE equipment and strict adherence to infection prevention and control measures offers considerable protection during contact with COVID-19 cases and should be ensured to prevent future nosocomial transmission.