Clinical accuracy and agreement between tympanic and forehead body temperature measurements for screening of patients with COVID-19.

AIM: To investigate the accuracy, reliability and agreement between infrared forehead thermometers versus infrared tympanic thermometers temperature, a cross-sectional study was conducted in April 2020. METHODS: The forehead and tympanic temperatures of 615 subjects were measured simultaneously in three exposed SARS-COV-2 groups at one hospital in Iran, during April 2020. These comparisons were evaluated by Bland-Altman Plot, repeatability, Passing-Bablok regression and Lin's concordance correlation coefficient. The receiver operating characteristic (ROC) analysis was done to describe the discrimination accuracy of a diagnostic test. The study adhered to STROBE checklist for cross-sectional studies. RESULTS: A Bland-Altman plot indicated that the limits of agreement between the forehead and tympanic temperature were -0.259 to +0.19°C. Passing-Bablok regression analysis illustrated that the infrared forehead was not linearly related to tympanic temperatures (reference method), with a slope estimate that was significantly different from 1.00. The infrared forehead thermometer showed poor precision and lower accuracy than the tympanic. The forehead temperature readings had 60.0% sensitivity and 44.4% specificity (p > .05) to predict disease. CONCLUSION: According to the results of study, there is no evidence that the assessment of temperature by infrared forehead thermometer could discriminate between the two groups (positive and negative).

COVID-19 Vaccine Acceptance and Hesitancy among Singaporean Primary Healthcare Workers (preprint)

Background: Factors affecting COVID-19 vaccine acceptance and hesitancy among primary healthcare workers (HCW) remain poorly understood. This study aims to identify factors associated with vaccine acceptance and hesitancy among HCW.MethodsA multi-centre online cross-sectional survey was performed across 6 primary care clinics from May to June 2021, after completion of vaccination exercise. Demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19 and previous influenza vaccination were collected. HCW who accepted vaccine were then asked to rank their top 5 reasons for vaccine acceptance; HCW who were vaccine hesitant had to complete the 5C scale on psychological antecedents of vaccination.Results557 out of 1182 eligible HCW responded (47.1%). 29 were excluded due to existing contraindications. Among 557 respondents, vaccine acceptance rate was 94.9% (n=501) and 5.1% were hesitant (n=27). COVID-19 vaccine acceptance was not associated with sex, age, ethnicity, profession, number of years in healthcare, living status, presence of chronic diseases, self-perceived risk or previous influenza vaccination. The top 3 reasons for COVID-19 vaccine acceptance ranked by 501 HCW were to protect their family and friends, protect themselves from COVID-19 and due to high risk of acquiring COVID-19 because of their jobs. The 15-item questionnaire from the 5C psychological antecedents of vaccination was completed by 27 vaccine hesitant HCW. The mean scores for the components of the 5Cs were: ‘Confidence’ (3.96), ‘Complacency’ (3.23), ‘Constraint’ (2.85), ‘Calculation’ (5.79) and ‘Collective responsibility’ (4.12).ConclusionCOVID-19 vaccine hesitancy is a minute issue among Singapore primary HCW, having achieved close to 95% acceptance rate with 5% hesitancy rate. Future studies can focus on other settings with higher hesitancy rates, and acceptance of booster vaccinations with the emergence of the delta COVID-19 variant.Trial RegistrationThis study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on 26th April 2021 (Reg No. 2021/00213).

Efficacy of COVID-19 vaccines in immunocompromised patients: A systematic review and meta-analysis (preprint)

ObjectiveTo compare the efficacy of COVID 19 vaccines between those with immunocompromised medical conditions and those who are immunocompetent DesignSystematic review and meta-analysis Data sourcesPubMed, EMBASE, CENTRAL, CORD-19 and WHO COVID-19 research databases were searched for eligible comparative studies published between 1 December 2020 and 3 September 2021. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched in September 2021 to identify registered yet unpublished or ongoing studies. Study selectionProspective observational studies which compared the efficacy of COVID-19 vaccination between those with immunocompromising medical conditions and those who were immunocompetent were included. Two reviewers independently screened for potentially eligible studies. Data extractionThe primary outcomes of interest were cumulative incidence of seroconversion after first and second doses of COVID vaccination. Secondary outcomes included SARS-CoV-2 antibody titre level after first and second doses of COVID-19 vaccination. After duplicate data abstraction, a frequentist random effects meta-analysis was conducted. Risk of bias was assessed using the ROBINS-I tool. Certainty of evidence was assessed using the GRADE approach. ResultsAfter screening 3283 studies, 42 studies that met our inclusion criteria were identified. 18 immunocompromised cohorts from 17 studies reported seroconversion in immunocompromised patients compared to healthy controls after the first dose and 30 immunocompromised cohorts in 28 studies reporting data after the second dose. Among immunocompromised groups, in incremental order, transplant recipients had the lowest pooled risk ratio of 0.06 (95%CI: 0.04 to 0.09, I^2=0%, p=0.81) (GRADE=Moderate) followed by haematological cancer patients at 0.36 (95%CI: 0.21 to 0.62, I^2 = 89%, p<0.01) (GRADE=Moderate), solid cancer patients at 0.40 (95%CI: 0.31 to 0.52, I^2 = 63%, p=0.03) (GRADE=Moderate) and IMID patients at 0.66 (95%CI: 0.48 to 0.91, I^2=81%, p<0.01) (GRADE=Moderate). After the second dose, the lowest pooled risk ratio was again seen in transplant recipients at 0.29 (95%CI: 0.21 to 0.40, I^2=91%, p<0.01) (GRADE=Moderate), haematological cancer patients at 0.68 (95%CI: 0.57 to 0.80, I^2=68%, p=0.02) (GRADE=Low), IMID patients at 0.79 (95%CI: 0.72 to 0.86, I^2=87%, p<0.01) (GRADE=Low) and solid cancer at 0.92 (95%CI: 0.89 to 0.95, I^2=26%, p=0.25) (GRADE=Low). ConclusionSeroconversion rates and serological titres are significantly lower in immunocompromised patients with transplant recipients having the poorest outcomes. Additional strategies on top of the conventional 2-dose regimen will likely be warranted, such as a booster dose of the vaccine. Systematic review registrationPROSPERO CRD42021272088

The Accuracy of Healthcare Worker versus Self Collected (2-in-1) Oropharyngeal and Bilateral Mid-Turbinate (OPMT) Swabs and Saliva Samples for SARS-CoV-2 (preprint)

Background Self-sampling for SARS-CoV-2 would significantly raise testing capacity and reduce healthcare worker (HCW) exposure to infectious droplets personal, and protective equipment (PPE) use. Methods We conducted a diagnostic accuracy study where subjects with a confirmed diagnosis of COVID-19 (n=401) and healthy volunteers (n=100) were asked to self-swab from their oropharynx and mid-turbinate (OPMT), and self-collect saliva. The results of these samples were compared to an OPMT performed by a HCW in the same patient at the same session. Results In subjects confirmed to have COVID-19, the detection rates of the HCW-swab, self-swab, saliva, and combined self-swab plus saliva samples were 82.8%, 75.1%, 74.3% and 86.5% respectively. All samples obtained from healthy volunteers were tested negative. Compared to HCW-swab, the detection rates of a self-swab sample and saliva sample were inferior by 8.7% (95%CI: 2.4% to 15.0%, p=0.006) and 9.5% (95%CI: 3.1% to 15.8%, p=0.003) respectively. The combined detection rate of self-swab and saliva had a higher detection rate of 2.7% (95%CI: -2.6% to 8.0%, p=0.321). The sensitivity of both the self-collection methods are higher when the Ct value of the HCW swab is less than 30. The negative correctness of both the self-swab and saliva testing was 100% (95% CI 96.4% to 100%). Conclusion Our study provides evidence that detection rates of self-collected OPMT swab and saliva samples were inferior to a HCW swab, but they could still be useful testing tools in the appropriate clinical settings.

DETERMINANTS OF BURNOUT AND OTHER ASPECTS OF PSYCHOLOGICAL WELL-BEING IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC: A MULTINATIONAL CROSS-SECTIONAL STUDY (preprint)

BackgroundThe Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. MethodsFrom 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. ResultsOf 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and other clinical (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Factors significantly protective for burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. ConclusionOur findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.