Evaluation of Confidence Level of Primary Healthcare Workers to Manage Patients with COVID-19 Infection

The COVID-19 epidemic has significantly impacted frontline healthcare workers (HCWs) and challenged an existing fragile healthcare system of South Africa (SA). Evaluation of the confidence levels of Primary Healthcare (PHC) workers in managing COVID-19 cases was conducted. A cross-sectional survey was used to investigate the level of training and confidence to manage COVID-19 cases. Descriptive statistics, univariate and multivariate analysis were undertaken. The majority of HCWs were female (82.8%), unmarried (56.6%), and nurses (65.4%). The study identified that only 30.1% of the respondents received training on the COVID-19 treatment guidelines and 30.6% of staff were trained on reporting of COVID-19 cases to the authorities. Significantly, higher proportions of HCWs learned about COVID-19 case management by self-reading as opposed to formal training (88% vs 64.7%, P<0.05). The overall confidence level in handling and managing COVID-19 cases of the HCW translated to a 58% level of confidence. Medical practitioners had a significantly higher level of confidence (88.9%) than nursing practitioners (75.5%) and allied HCWs (52.5%, p<0.05). HCWs who received training on 5 or more items of COVID-19 case management had a significantly higher ( 83.1%) level of confidence (p<0.05) than those who had training on 4 or less items (61.7%). This study revealed that training on aspects of COVID-19 case management significantly increased their confidence levels. Timely interventions are needed to improve the confidence levels of HCWs and perceived barriers in the training of COVID-19 need to be urgently addressed.

Healing in Health Care: Mental Health Promotion, Advocacy, and Voluntarism in Response to COVID-19.

The COVID-19 pandemic increased many known risk factors for mental health problems. In the context of overwhelmed health systems and resource and staffing shortages, the mental health needs of frontline health care workers (HCWs) gained attention as a major public health concern and a threat to high-quality care delivery. In response, mental health promotion initiatives were quickly developed to meet the demands of the public health crisis. Two years later, the context for psychotherapy has changed, especially as it pertains to the health care workforce. Particularly salient experiences-grief, burnout, moral injury, compassion fatigue, and racial trauma-have become routinely discussed as part of everyday clinical practice. Service programs have become more responsive to the needs, schedules, and identities of HCWs. In addition, mental health and other HCWs have contributed to advocacy and volunteer initiatives promoting health equity, culturally responsive care, and access to care across a range of settings. In this article, the authors review the benefits of these activities to individuals, organizations, and communities and summarize example programs. Many of these initiatives began in response to the acute public health crisis; however, engaging in these ways and spaces holds promise for increasing connection and prioritizing equity and structural change over the long term.

MADM for Assessment the Nurses Knowledge and their Attitudes During Covid-19 Spread in Mosul City in the Perspective of Neutrosophic Environment

Coronavirus remains an important public health issue both nationally and globally, so all healthcare professionals including nurses should have a good knowledge and attitudes for educating their patients about Coronavirus and provide appropriate referral and support mechanisms to minimize the complication of disease [1]. COVID-19 is an emerging, rapidly changing global health challenge affecting all sectors [2, 3]. The Health Care Workers (i.e. HCWs) are not only at the forefront of the fight against this highly infectious disease but are also directly or indirectly affected by it and the likelihood of acquiring this disease is higher among HCWs compared to the general population [4]. Therefore, it is importance that HCWs across the world have adequate knowledge and good attitudes about all aspects of the disease from clinical manifestation, diagnosis, proposed treatment and established prevention strategies. In this manuscript, a descriptive design study was conducted from 1st April to June 2021. The study samples consisting of 90 nurses were purposively selected in three hospitals (Al-Khansa Teaching Hospital, Ibn Sina Teaching Hospital, and Telafer General Hospital) in Mosul city The objectives of this study are to assess the knowledge and attitudes of nurses about the Covid19 using the multi attribute decision making technique where the data have been adapted and reconstructed to be as triangular single-valued neutrosophic numbers (TSVNN) and tackled these (TSVNN) into the neutrosophic structured element (NSE). It is well known that the neutrosophic theory has flexible tools to analyze data utilized in dozens of fields of science such as but not limited to medicine, engineering, economics, healthcare, physics…etc. In this manuscript, the authors were very felicitous to choose an uncertain mathematical environment named neutrosophic theory to use it as a strong method in decision making technique to measure the performance of the nurses and their attitude in three Iraqi hospitals during a specific period of time where Covid19 has spread and was in its peak. The decision-making with multi-attribute criteria containing truth membership, indeterminate membership, and falsity membership is regarded as the core of the neutrosophic decisions. The neutrosophic theory used to handle uncertain, vague, incomplete, and inconsistent data or information which already exist in our daily life © 2023,Neutrosophic Sets and Systems. All Rights Reserved.

FACTORS ASSOCIATED WITH COVID-19 SIGNS AND SYMPTOMS IN HEALTHCARE PROFESSIONALS AT A SPANISH UNIVERSITY HOSPITAL DURING THE PANDEMIC.

Objectives: The aim of the study was to identify factors associated with the development of COVID-19 in healthcare professionals at a university hospital at the onset of the pandemic. Material(s) and Method(s): Cross-sectional study using an online survey validated in aspect and content, cognitive pre-test and piloting aimed at healthcare professionals. Absolute and relative frequencies were described for qualitative and quantitative variables, associations were analyzed using the chi-square test for qualitative variables and Student's t-test for quantitative variables. Logistic regression was performed to identify factors associated with COVID-19 in healthcare professionals. Result(s): 728 workers participated in the survey. Statistically significant differences were observed in type of work (p=0.041), exposure related to spaces and organisation (p=0.001), previous pathology (p=0.029) and asthma (p=0.034). Healthcare professionals working in care areas of the hospital were most likely to develop COVID-19 (OR: 2.02;p=0.027) and also in those with exposure related to space and organisation (OR: 2.13;p<=0.001). Conclusion(s): Healthcare professionals who worked in care areas of the hospital were twice as likely to develop COVID-19.The same was observed for those with space-related exposure.Copyright © 2023, Accion Medica S.A.. All rights reserved.

Occupational stress and its influencing factors of primary health care workers during COVID-19.

[Background] Since the outbreak of COVID-19, primary health care workers have been facing un-precedented work pressure, and their occupational stress should be taken seriously. [Objective] To analyze the occupational stress situation and its influencing factors of primary health care workers in Guangdong Province, and to propose targeted interventions. [Methods] Using a multi-stage stratified random sampling method, each prefecture-level city in Guangdong Province was classified into "good", "medium", or "poor" category based on its gross domestic product (GDP) in 2019 released by the Guangdong Provincial Bureau of Statistics. In September 2021, four primary health care institutions were randomly selected from each stra-tum, and a total of 1 327 staff members were selected for the study. The Core Occupational Stress Scale (COSS) and a basic information questionnaire designed by the authors were used. Mann-Whitney U test was used to compare the means between two groups, and Kruskal-Walis H test was used to compare the means among multiple groups. The comparison of categorical data was performed by trend chi2 test or Pearson chi2 test;the analysis of factors influencing occupational stress was performed by dichotomous multiple logistic regression analysis. [Results] There were 365 health care workers reporting occupational stress in this survey, and the positive rate of occupational stress was 27.5%. The total occupational stress score in M (P25, P75) and the scores of social support, organization and reward, demand and effort, and control were 45.0 (40.0, 50.0), 20.0 (17.0, 21.0), 14.0 (12.0, 17.0), 12.0 (10.0, 15.0), and 5.0 (4.0, 6.0), re-spectively. The results of dichotomous multiple logistic regression analysis showed that high education, low income, doctor positions, long working hours in a day, and shift work were associated with the occurrence of reporting occupational stress (P < 0.05). [Conclusion] Education, average monthly income, job category, daily working hours, and shifts are factors influencing the occurrence of reporting occupational stress in primary health care workers;targeted interventions should be implemented to reduce their occupational stress levels.Copyright © 2023, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review.

BACKGROUND: Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. OBJECTIVE: This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. METHODS: We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. RESULTS: In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. CONCLUSIONS: This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. TRIAL REGISTRATION: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44066.

Factors affecting compliance to quarantine and its psychological effects during the COVID-19 pandemic: A cross-sectional study from aspirational district of India

Background: COVID-19 has caused pandemic during 2019-2020 and has presented with illnesses ranging from the usual mild flu to serious respiratory problems/complications, even leading to considerable mortality. Recent literatures have suggested that the health (especially psychological) impacts of quarantine are substantial and can be long lasting. Aim: The purpose of this study was to assess the mental health status (psychological distress) of experienced quarantine and compliance to quarantine during the outbreak of COVID-19 in Nuh district. Methods: The study included 543 subjects (adults aged 18 years or more) who were sent for quarantine at home or state-run facilities and included "Flu corner " screened patient and health-care staff working in COVID-19 outpatient and wards. The psychological impact was assessed using the Kessler Psychological Distress Scale (K10). Categorical data were presented as percentages (%), and bivariable logistic regression was applied to find out the association, and it was considered significant if the P < 0.05. Results: The doctors and nursing staff were among two-fifth of the subjects (217/543, 40.1%), and only 11.6% of quarantined subjects (63/543) were compliant with all protective measures. The mean score obtained on Kessler Psychological Distress Scale (K10) subjects was 18.69 +/- 4.88, whereas out of 543 subjects, 152 (27.9%) had a score of 20 or more, and it has a significant association with the elderly age group, female gender, and workplace as exposure setting (P < 0.05). Conclusion: Given the developing situation with coronavirus pandemic, policymakers urgently need evidence synthesis to produce guidance for the public. Thus, the outcomes of this study will positively help authorities, administrators, and policymakers to apply quarantine measures in a better way.

Differences in the presentation of COVID-19-related psychosocial stress and general psychological distress and the relation between the number of care days and these symptoms among Japanese ward staff working exclusively with COVID-19 and support staff.

BACKGROUND: Psychological distress has been frequently observed in frontline healthcare workers under stress during the coronavirus disease 2019 (COVID-19) epidemic; however, it is unclear if there are differences in the stress and symptoms experienced by staff members who work exclusively in a COVID-19 ward and support staff temporarily deployed to a COVID-19 ward. The present study investigated psychosocial stress specific to the care for patients with COVID-19 and psychological distress among ward staff working exclusively with COVID-19 and temporary support staff. METHODS: The participants were full-time nurses and doctors working in COVID-19 wards or the ICU who provided face-to-face care to patients with COVID-19 during the COVID-19 outbreak in February of 2021. The data of 67 staff members (21 exclusively working with Covid-19 patients (group A) and 46 in the temporary support group (group B)) was available for study. Psychosocial stress specific to healthcare professionals during this COVID-19 outbreak (Tokyo Metropolitan Distress Scale for Pandemic [TMDP]) and general psychological distress (K6) were assessed. RESULTS: The K6 score was significantly lower in group B than in group A (p = .006), but no significant difference was found in the total score of TMDP or its subscales. Positive correlations were found between TMDP and K6 for group B (p = .011), as was the number of days of care on TMDP-social (rs = .456, p = .001). CONCLUSION: Even though support staff members experienced lower psychological distress than staff working exclusively with COVID-19, COVID-19-related psychosocial stress specific to HCWs was comparable. The support staff also presented psychological distress associated with psychosocial stress specific to healthcare professionals during this COVID-19 outbreak, and the COVID-19-related social stress was enhanced as the number of working days increased. Our results show that all staff, not only those working exclusively with COVID-19 patients but also other support staff should be provided with care focusing on COVID-19-related psychosocial occupational stress.

Study of correlates of depression among health care workers during COVID-19 epidemic

Aims: Study aimed to find out the prevalence and risk factors of depression among the health care workers during COVID-19 outbreak. Methods and Material: This was a four month, cross-sectional, observational, single center study of heath care workers of a notified COVID-19 hospital. Study objectives were explained to health care workers, and written consent was obtained. Patient health questionnaire-9 (PHQ-9), DSM-5 criterion of major depressive disorder and Structured Clinical Interview for DSM-5 were used to diagnose the depression. Descriptive statistics, chi-square test, and Binary logistic regression were used for analysis of variables. Results: Overall 18.78% health workers reported major depressive disorder. Nearly three fourth of the old age participants had moderate to severe depression. 20.69% of married subjects had major depression. Medical health workers reported more depression. One third of the front line workers had major depression. 51% of the participants with medical co-morbidities reported major depression as compared to only 12% in those without any medical co-morbidity.33% of subjects watching COVID-19 news very frequently in a day had major depression. Discussion: The prevalence of depression ranges from 9 to 35% in various studies. Among them living in joint family, married, elderly, presence of medical illness, frontline work, frequently watching COVID-19 news, excessive fear of COVID-19, and medical health worker emerged as statistically significant variables associated with major depression. Conclusions: The prevalence of depression is high among health care workers while performing duties during COVID-19 outbreak. Early diagnosis and treatment of depression would be crucial during this difficult time. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Practical approach to COVID-19: an Egyptian pediatric consensus

BackgroundOutbreak of a novel corona virus was reported in China on December 2019. Sooner, a global spread was reported and WHO announced a public health emergency of international concern and then declared it as a pandemic. Egypt announced the first case on February 14, 2020, and since that time, cases are increasing.Main bodyThere is increasing need to simplify the practical approach for pediatricians and other health care workers in a step wise manner;how to deal with COVID-19 cases, how to care for the newborn babies as regards to breastfeeding, and how to ensure safety of health care workers assess their risk of infection and management accordingly. A national practical approach guideline was prepared including case definition, diagnosis, and management of pediatric COVID-19 suspected and confirmed cases in an algorithmic pattern.ConclusionUp to the current knowledge, this is a simple and practical guidance for clinical management of children during the current pandemic.

Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi;Amid the COVID-19 Pandemic

ABSRACT Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting. Study Design: Cross sectional analytic study. Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22. Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26. Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p=0.28). Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity.

Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi;Amid the COVID-19 Pandemic

Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting. Study Design: Cross sectional analytic study. Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22. Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26. Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p=0.28). Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity. © 2022, Army Medical College. All rights reserved.

Switching to a Coronavirus Disease 2019 (COVID-19) Center: Lessons From Ariana Hospital Experience.

After the translating of the worldwide pandemic coronavirus disease 2019 (COVID-19) disease from South East Asia to Europe, North African countries accelerate their steps to follow WHO guidelines to prepare the outbreak response. In March 2020, the Tunisian Ministry of Health switched Abderrahmen Mami Hospital to a COVID-19 center. The main objectives were management of patients but also setting-up new rules to permit enough safety for the staff members and harmony between medical, nonmedical, and administrative departments within the facility. Organization and communication during the fast-paced preparation process were crucial to get enough qualified human resources, material resources, and clear procedural texts in place before cases arrived in huge numbers. A group of medical and administrative experts within a central crisis unit brought this challenge into reality.

Well-being in the Workplace: A Book Club Among Health Care Workers During the COVID-19 Pandemic.

INTRODUCTION/OBJECTIVES: A culture of joy in the workplace supports well-being, but less is known about the effect of a shared experience on well-being and burnout in a health care setting. This pilot study investigated personal well-being and occupational burnout among primary care staff who participated in a 3-month virtual book club. METHODS: In December 2021, health care workers from a primary care practice were invited to participate in a 3-month virtual book club. Participants were emailed a preintervention survey with questions regarding well-being and burnout, the pandemic's influence on emotional health, and demographic information. The book club met virtually every month from January 2022 through March 2022. After the March 2022 book club meeting, a paired postintervention survey was sent to participants with additional questions regarding their participation in the book club. Well-being and burnout were measured with the 11-point Well-Being Index, and the pandemic's influence on emotional health was assessed with the 64-point Pandemic Emotional Impact Scale. RESULTS: Of 12 book club participants, 9 participants (6 physicians and 3 nurses) completed surveys before and after the intervention. Postintervention improvement in the median score of the Pandemic Emotional Impact Scale was significant (7 points, P = .04). Although Well-Being Index results uniformly favored improved well-being after book club participation, the median improvement of 1 point was not significant (P = .69). CONCLUSIONS: Social connection through a virtual workplace activity such as a book club may contribute to well-being and may decrease occupational burnout.

Sickness absenteeism among primary health care workers in Qatar before and during the COVID-19 pandemic.

OBJECTIVES: To explore the patterns, trends, nature, and extent of changes in sickness absence among health care workers (HCWs) at the Primary Health Care Corporation (PHCC) in Qatar-during the COVID-19 pandemic compared to previous years and uncover the main associated factors. METHODS: We conducted a retrospective analysis of all sick leaves' records of PHCC HCWs regardless of their profession from January 2019 till August 2021. RESULTS: A total of 41,132 sick leaves were taken during the studied period. The majority of HCWs who availed sick leaves were between 30-39 years (45.9%), females (65.1%), and expatriates (65.1%). Compared with pre-COVID-19 (Jan 2019-Feb 2020), Wave 1 of COVID-19 had significantly less incidence of sick leaves per day per 1000 HCWs. While wave 2 had significantly higher incidence of sick leaves compared to both pre-COVID-19 and wave 1. The number of sick leaves per person among female HCWs was significantly higher than that of male HCWs. Moreover, the number of sick leaves per person among locals were about two times the number among expatriate HCWs. Physicians and nurses had significantly lower number of sick leave per person compared to other professions. The rates of sick leaves due to suspected or confirmed COVID-19 infection, back/neck pain and gastroenteritis were significantly higher in the second wave compared to the first wave of COVID-19. CONCLUSION: Overall and cause specific sick leave rates among HCWs varied significantly across different periods of the COVID-19 pandemic. COVID-19 related sick leave rate was higher during the second wave compared to first one. By addressing the root causes of sick leaves, it is possible to reduce the burden on HCWs and ensure their continued ability to provide essential care to those in need.

Posttraumatic growth levels of healthcare workers in two periods with different intensities of COVID-19 pandemic.

The COVID-19 pandemic threatens health-care workers' (HCW) mental health and well-being. Although traumatic life events may result in psychiatric disorders, occasionally they give rise to positive changes, such as post-traumatic growth. Accordingly, the present study evaluated the traumatic stress, anxiety, and depression levels of HCWs and their post-traumatic growth levels during the pandemic. In addition, the study aimed to assess the changes in psychological outcomes during the pandemic. For this aim, the data were collected in two different periods. The first data-collection period was between May and July 2020, and the second period started in November 2020 and ended in January 2021. The sociodemographic data form, Impact of Events Scale-Revised (IES-R), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Post-traumatic Growth Inventory (PTGI) were used to collect data. Sixty-six HCWs participated in the study. No significant differences appeared between the baseline scores and 6-month follow-up in the depression, anxiety, and traumatic stress levels of HCWs. Furthermore, the PTGI scores decreased significantly over time. Although the change in the psychological distress scores was not statistically significant, the depression and post-traumatic stress scores increased over time. Previous research specified an inverse-parabolic relationship between traumatic stress and PTGI. Our results support previous research; as the exposure to the stressors continues, individual traumatic stress levels increase, psychiatric disorders become frequent, and affirmative changes (like post-traumatic growth) decline.

SARS-CoV-2 antigen tests for screening of healthcare workers; experience with over 48,000 combined antigen tests and RT-PCR tests.

BACKGROUND: To prevent spread to patients and co-workers, health care workers (HCWs) infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) should quickly be identified. Although real time polymerase chain reaction (RT-PCR) is the gold standard, this test takes several hours, during which a HCW is unable to work. Antigen (Ag) tests may be an efficacious means of screening HCWs since they are easy to perform and provide fast results. METHODS: In this study, 48,010 paired results of Ag-testing and RT-PCR, performed on HCWs between January 2021 and April 2022, were evaluated to determine the diagnostic accuracy of SARS-CoV-2 Ag-tests in diagnosing potentially infectious individuals. This analysis was performed with cycling threshold values (Ct-values) ≤30 and ≤25 as cut-offs. RESULTS: Respectively 3.1% (n = 1507) and 0.3% (n = 140) of Ag-tests were positive or indeterminate, and thus indicative for SARS-CoV-2 infection. In total, 2479 (5.2%) RT-PCRs were positive, of which 1529 (61.7%) had a Ct-value ≤25 and 402 (16.2%) a Ct-value between 26 and 30. At Ct-value ≤30 as a cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Ag-tests were 79.0%, 99.8%, 93.8% and 99.1%, respectively. At Ct-value ≤25, sensitivity further improved to 92.0%, by which the NPV increased to 99.7%. CONCLUSIONS: To prevent transmission from HCWs to patients and co-workers, while maintaining workforce capacity, Ag-tests are a valuable addition to RT-PCR tests, as they have a quick turnaround time and excellent sensitivity for identifying individuals with high potential for transmission.

Droplet nuclei are generated during colonoscopy and are decreased by the use of carbon dioxide and water immersion technique.

OBJECTIVES: The COVID-19 pandemic has raised concerns on whether colonoscopies (CS) carry a transmission risk. The aim was to determine whether CS are aerosol-generating procedures. METHODS: This was a prospective observational trial including all patients undergoing CS at the Prince of Wales Hospital from 1 June to 31 July 2020. Three particle counters were placed 10 cm from each patient's anus and near the mouth of endoscopists and nurses. The particle counter recorded the number of particles of size 0.3, 0.5, 0.7, 1, 5, and 10 µm. Patient demographics, seniority of endoscopists, use of CO2 and water immersion technique, and air particle count (particles/cubic foot, dCF) were recorded. Multilevel modeling was used to test all the hypotheses with a post-hoc analysis. RESULTS: A total of 117 patients were recruited. During CS, the level of 5 µm and 10 µm were significantly higher than the baseline period (P = 0.002). Procedures performed by trainees had a higher level of aerosols when compared to specialists (0.3 µm, P < 0.001; 0.5 µm and 0.7 µm, P < 0.001). The use of CO2 and water immersion techniques had significantly lower aerosols generated when compared to air (CO2 : 0.3, 0.5, and 0.7 µm: P < 0.001; water immersion: 0.3 µm: P = 0.048; 0.7 µm: P = 0.03). There were no significant increases in any particle sizes during the procedure at the endoscopists' and nurses' mouth. However, 8/117 (6.83%) particle count tracings showed a simultaneous surge of all particle sizes at the patient's anus and endoscopists' and nurses' level during rectal extubation. CONCLUSION: Colonoscopy generates droplet nuclei especially during rectal extubation. The use of CO2 and water immersion techniques may mitigate these risks.

Impact of Personal Protective Equipment on the Quality of Chest Compressions in Prehospital Care: A Prospective Randomized Crossover Study

Introduction:The use of personal protective equipment (PPE) in prehospital emergency care has significantly increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic. Several studies investigating the potential effects of PPE use by Emergency Medical Service providers on the quality of chest compressions during resuscitation have been inconclusive.Study Objectives:This study aimed to determine whether the use of PPE affects the quality of chest compressions or influences select physiological biomarkers that are associated with stress.Methods:This was a prospective randomized, quasi-experimental crossover study with 35 Emergency Medical Service providers who performed 20 minutes of chest compressions on a manikin. Two iterations were completed in a randomized order: (1) without PPE and (2) with PPE consisting of Tyvek, goggles, KN95 mask, and nitrile gloves. The rate and depth of chest compressions were measured. Salivary cortisol, lactate, end-tidal carbon dioxide (EtCO2), and body temperature were measured before and after each set of chest compressions.Results:There were no differences in the quality of chest compressions (rate and depth) between the two groups (P >.05). After performing chest compressions, the group with PPE did not have elevated levels of cortisol, lactate, or EtCO2 when compared to the group without PPE, but did have a higher body temperature (P <.001).Conclusion:The use of PPE during resuscitation did not lower the quality of chest compressions, nor did it lead to higher stress-associated biomarker levels, with the exception of body temperature.

COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study.

BACKGROUND: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. OBJECTIVE: This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. METHODS: We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. RESULTS: The hardest-hit neighborhoods (comprising 20% of the population) accounted for 53.87% (44,937/83,419) of community cases, 48.59% (2356/4849) of facility staff cases, and 42.34% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). CONCLUSIONS: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work.