Comparison of performance and anthropometric parameters in paediatric competitive athletes during COVID-19 pandemic in the Czech Republic.

OBJECTIVES: In 2020, measures against the spread of COVID-19 were adopted, including nationwide school closures, restrictions on the free movement of persons and leisure time sports activities. The aim was to assess the impact of COVID-19-associated restrictions on the performance of paediatric and adolescent competitive athletes by comparing basic anthropometric and performance parameters. METHODS: The sample comprised 389 participants (115 girls, 274 boys). All participants were examined during regular preventive sports health checks from September to November 2019 and a year later. At the initial examination, the mean age of the entire sample was 12.2 ± 2.7 years (median 12.0, minimum 7.0; maximum 17.0). The examination consisted of a complete medical history and physical examination including maximal exercise testing on a leg cycle ergometer. RESULTS: In the entire sample, as well as in the boy and girl subgroups, body height, weight, body mass index (BMI), BMI percentile, and power output significantly increased according to a percentile graph for boys and girls in 2020. A reduction in power output (W/kg) was found. By 2020, W/kg dropped in 56.4% of the youngest participants (7-13 years), 75% of those aged 14-16 years and 64.9% of the oldest individuals (16-17 years). The percentage of the youngest children with power output reductions was statistically significantly lower than the percentages of the other age subgroups (p = 0.007). There were no significant differences in results between genders. CONCLUSIONS: Performance and anthropometric parameters worsened especially among older children. This should be reflected when planning epidemic measures in case of any similar situation in the future.

Trends in SARS-CoV-2 cycle threshold values in the Czech Republic from April 2020 to April 2022.

The inability to predict the evolution of the COVID-19 epidemic hampered abilities to respond to the crisis effectively. The cycle threshold (Ct) from the standard SARS-CoV-2 quantitative reverse transcription-PCR (RT-qPCR) clinical assay is inversely proportional to the amount of SARS-CoV-2 RNA in the sample. We were interested to see if population Ct values could predict future increases in COVID-19 cases as well as subgroups that would be more likely to be affected. This information would have been extremely helpful early in the COVID-19 epidemic. We therefore conducted a retrospective analysis of demographic data and Ct values from 2,076,887 nasopharyngeal swab RT-qPCR tests that were performed at a single diagnostic laboratory in the Czech Republic from April 2020 to April 2022 and from 221,671 tests that were performed as a part of a mandatory school surveillance testing program from March 2021 to March 2022. We found that Ct values could be helpful predictive tools in the real-time management of viral epidemics. First, early measurement of Ct values would have indicated the low viral load in children, equivalent viral load in males and females, and higher viral load in older individuals. Second, rising or falling median Ct values and differences in Ct distribution indicated changes in the transmission in the population. Third, monitoring Ct values and positivity rates would have provided early evidence as to whether prevention measures are effective. Health system authorities should thus consider collecting weekly median Ct values of positively tested samples from major diagnostic laboratories for regional epidemic surveillance.

COVID-19 in patients with chronic lymphocytic leukemia: a multicenter analysis by the Czech CLL study group.

Patients with chronic lymphocytic leukemia (CLL) have a high risk of poor outcomes related to coronavirus disease 2019 (COVID-19). This multicenter cohort study evaluated the impact of COVID-19 infection on the population of CLL patients in the Czech Republic. Between March 2020 and May 2021, 341 patients (237 males) with CLL and COVID-19 disease were identified. The median age was 69 years (range 38-91). Out of the 214 (63%) patients with the history of therapy for CLL, 97 (45%) were receiving CLL-directed treatment at diagnosis of COVID-19: 29% Bruton tyrosine kinase inhibitor (BTKi), 16% chemoimmunotherapy (CIT), 11% Bcl-2 inhibitor, and 4% phosphoinositide 3-kinase inhibitor. Regarding the severity of COVID-19, 60% pts required admission to the hospital, 21% pts were admitted to the intensive care unit (ICU), and 12% received invasive mechanical ventilation. The overall case fatality rate was 28%. Major comorbidities, age over 72, male gender, CLL treatment in history, CLL-directed treatment at COVID-19 diagnosis were associated with increased risk of death. Of note, concurrent therapy with BTKi compared to CIT was not associated with better outcome of COVID-19.

Opinions of citizens of the Czech Republic on the role of nurses in primary care during the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVE: In spite of the general current decrease in COVID-19 incidence, the epidemiological situation on the territory of the Czech Republic is still unfavourable. Nurses play an essential role in the fight against this disease. MATERIAL AND METHODS: A non-standardized questionnaire was used to discover the expectations regarding nursing care provided during the COVID-19 pandemic. The sample of respondents was constructed using quota selection. The sample consisted of 1,815 respondents. RESULTS: The study identified a significant correlation between the age of respondents and the method used to contact general practitioners (p < 0.001). The oldest respondents (65+) more likely contacted GPs by phone. Respondents with basic education used outpatient services more often before than during the pandemic (p < 0.05). The behaviour of nurses was considered as professional and accommodating. The oldest respondents (65+) reported nurses did not to make them feel rushed. Other age groups rated nurses more critically (p < 0.01). Respondents, especially women, described the psychological burden on nurses during the COVID-19 pandemic as demanding (p < 0.01). Women, more than men, reported that nurses lacked protective equipment during the pandemic (p < 0.05). The use of an online system was significantly influenced by respondent education (p 0.001). Respondents with lower education were less likely to welcome this option. CONCLUSIONS: Due to the persisting COVID-19 incidence on the territory of the Czech Republic, citizens` opinions of the position of nurse in primary care in the period of COVID- 19 pandemics need to be known.The behaviour of nurses was considered to be accommodating and satisfactory.

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area.

COVID-19 in the Czech Republic 2020 and 2021: comparative analysis of probable work-related transmission of the coronavirus SARS-CoV-2.

OBJECTIVES: The aim of the analysis was to determine the probable places of coronavirus transmission in association with the work and compare the situation between 2020 and 2021. METHODS: The work analysed data from the Information System of Infectious Diseases managed by the Institute of Health Information and Statistics of the Czech Republic in the period from March 2020 - December 2021. RESULTS: 2,483,219 COVID-19 cases were officially confirmed (732,202 during 2020 and 1,338,790 in 2021), from them 140,368 (6%) represented work-related disease, 520,830 cases (21%) work-related contact, and 1,822,021 (73%) out-of-work contact. There were identified 13 occupations with the highest incidence of COVID-19 in the observed period (458,341 cases), in descending order - clerk, machinist, teacher, craftsman, worker/agency worker, driver, sales worker/cashier, warehouse worker/expediter, nurse, manager, food worker, paramedic, and social worker. Comparing 2020 and 2021, there was a difference in the ranking of occupations by incidence of disease. In 2021, the risk of infection acquiring increased for the occupations clerk, machinist, craftsman, worker/agency worker, manager, and food worker, while it decreased for the health professions (nurse, other paramedic, physician) and for social worker; 5,514 cases of COVID-19 were recognized as an occupational disease in 2020 and 2021, from them 5,483 cases (99.4%) in the health and social care economic activity sector. CONCLUSION: The available data show probable exposures to an infectious agent (without proof of specific contact with the source of the infection), of which 27% cases of COVID-19 are related to work (cases of work-related disease and work-related contact represented together the closest relationship to work). Different relevant anti-epidemic measures in the workplace have considerable practical importance for epidemic control. The use of personal protection of the mouth and nose with respirators/muffs is essential to reduce the risk of airborne transmission.

The challenges of telemedicine in the Czech Republic from an expert perspective.

Health policy makers are striving to implement new approaches in healthcare with a focus on digital solutions. The COVID-19 pandemic has contributed to an unprecedented acceleration in the spread of information and communication technologies (ICT) in healthcare and has accelerated the use of telemedicine. The aim of the research was to identify problems related to the implementation of telemedicine in practice, to propose possible solutions and to identify the challenges of telemedicine in the Czech Republic in the future. The study is based on the results of a two-phase qualitative expert investigation. Data collection in the first phase took the form of individual semi-structured interviews with experts who have practical experience in the field of telemedicine. The follow-up second phase was conducted in the form of guided group discussions with experts focusing on health, financial and legislative aspects of telecare. It turned out that the introduction and expansion of telemedicine requires changes in the technological infrastructure, in the organization of care and work, and in the adjustment of the legislative environment. It is also necessary to consider the need to overcome several barriers at the level of the healthcare system, healthcare providers, healthcare professionals and patients. On the other hand, a condition for the successful introduction and development of telemedicine is coordinated cooperation between various institutions and stakeholders. The introduction of telemedicine should also be preceded by studies (research) and in-depth analyses. Telemedicine education of healthcare professionals and support for patients in developing their digital competences are also important.

Analysis of Obligatory Involvement of Medical Students in Pandemic Response in the Czech Republic: Competencies, Experiences, and Legal Implications.

Objectives: Medical students in the Czech Republic were mandated by the law to take part in the COVID-19 pandemic response in order to expand healthcare capacity. Our study aimed to analyze student's competencies defined in the legislation and compare them with competencies assigned to them in clinical settings during their deployment. Methods: Online survey with statistical analysis of collected data. Results: The survey was completed by 997 respondents. A major convergence between the system of credentials defined in the legal framework and the competencies that students performed were identified. Conclusion: Medical students represented a valuable resource for addressing shortages of qualified healthcare staff in critical situation. However, the system of competencies and credentials must be aligned with the educational framework to clearly define acquisition of competencies during the course of medical studies and the legal framework regulating students' deployment must ensure consistency of actual and formal competencies in order to guarantee high standards of care and safety of the patients.

Indication criteria for monoclonal antibody treatment for COVID-19 in the era of vaccination: is an update needed?

This study describes a cohort of 223 patients who received anti-S protein monoclonal antibody (mAb) treatment for COVID-19 after having met the indication criteria set by the national guidelines in the Czech Republic at the time. The authors compare the vaccinated and unvaccinated subpopulations of this cohort. The results show that most of the patients (73.5%) already had significant circulating levels of anti-S antibodies detectable at the time of treatment. The authors confirm a positive correlation between number of vaccine doses and S-protein antibody levels. The data show, that vaccinated patients are overall less likely to be hospitalized than unvaccinated ones. The authors recommend a change in the national guidelines for mAb treatment in the Czech Republic.

Czech Consumers' Preference for Organic Products in Online Grocery Stores during the COVID-19 Pandemic.

A major advantage of online organic produce shopping is the fact that it saves energy and reduces emissions otherwise generated by customers during their time spent on the road and while shopping. Organic products in general positively impact sustainability, the environment, and the regions of their origin along with the social changes in these regions and further rural development. Moreover, these products positively impact the perceived health benefits and quality of food labeled as organic. The Czech Republic has currently seen a rise in organic food purchasing and supply trends. This study maps the factors possibly influencing consumers' decision to go shopping for organic food online. Observed factors include the following demographic characteristics of consumers (respondents): gender, age, education, household income, number of children in the household and number of household members. A total of 757 respondents from the Czech Republic from September 2020 to December 2020 took part in the research. Logistic regression, used for data processing, identified the statistically significant effects of education, income and number of household members on online purchases. These conclusions were confirmed by a detailed contingency tables analysis, including the almost monotonous trend of the dependencies, with only minor deviations in a maximum of one category. The strongest influence of some categories on the emergence of partial dependencies was found by residue analysis. The research confirmed that the frequency of online grocery shopping increases significantly with increasing education and income of respondents and decreases with increasing the number of household members. Most respondents apparently shop for groceries online because of time savings, better product choice and more convenient and easier search.

Influence of COVID-19-Related Restrictions on the Prevalence of Overweight and Obese Czech Children.

Apart from influencing the health of the worldwide population, the COVID-19 pandemic changed the day-to-day life of all, including children. A sedentary lifestyle along with the transformation of eating and sleep habits took place in the child population. These changes created a highly obesogenic environment. Our aim was to evaluate the current weight in the child population and identify the real effects of the pandemic. Height and weight data were collected by pediatricians from the pre-COVID-19 and post-COVID-19 periods from 3517 children (1759 boys and 1758 girls) aged 4.71 to 17.33 years. We found a significant rise in the z-score BMI between pediatric visits in the years 2019 and 2021 in both sexes aged 7, 9, 11, and 13 years. Especially alarming were the percentages of (severely) obese boys at the ages of 9 and 11 years, which exceed even the percentages of overweight boys. With the use of statistical modeling, we registered the most dramatic increment at around 12 years of age in both sexes. Based on our research in the Czech Republic, we can confirm the predictions that were given at the beginning of the pandemic that COVID-19-related restrictions worsened the already present problem of obesity and excess weight in children.

Shedding persistency and intensity patterns of feline coronavirus (FCoV) in feces of cats living in breeding catteries in the Czech Republic.

Infection with feline coronavirus (FCoV) is a major problem in multiple-cat households, where many cats are kept together in a small space such as catteries and shelters. Sixty cats from 19 breeding catteries included in the study were evaluated for their shedding persistency and intensity patterns using qPCR identification of FCoV in feces. Cats were identified based on shedding persistency as non-shedders (NS) if all four samples negative, intermittent shedders (IS) when at least one positive and one negative sampling followed by another positive sampling, persistent shedders (PS) if all four samples positive and shedders with unclear status (US) if the shedding patterns could not be determined based on only 4 samples. There were 11 NS (18%), 15 IS (25%) and 15 PS (25%) and in 19/60 cats (32%), the shedding patterns could not be determined based only on four samplings. The intensity of shedding was evaluated based on the total number of FCoV particles shed during the 12 months of the study. There were 11 non-shedders (18%), 2 very low intensity shedders (3%), 9 low intensity shedders (15%), 25 medium intensity shedders (42%) and 13 high intensity shedders (22%). Intermittent shedders were shedding significantly lower FCoV particles compared to the persistent shedders (p = 0.0082). Permanent shedders represent the most important source of FCoV infection in multi-cat households and identifying permanent shedders in is the key to minimize the viral load in the environment to control FCoV in a shelters and breeding catteries.

Czech public health - past and present.

The article deals with the concept, development, and current state of public health in the Czech lands as a theoretical and practical scientific discipline, as it has been formed and profiled during more than two hundred years of history. It identifies five developmental stages, which briefly characterizes and introduces important representatives of the field at the time. It describes the transformation of public health care after 1989 and points out some of the consequences of institutional reduction associated with the weakening of the field, which became fully apparent during the COVID-19 pandemic.

Protection provided by vaccination, booster doses and previous infection against covid-19 infection, hospitalisation or death over time in Czechia.

Studies demonstrating the waning of post-vaccination and post-infection immunity against covid-19 generally analyzed a limited range of vaccines or subsets of populations. Using Czech national health data from the beginning of the covid-19 pandemic till November 20, 2021 we estimated the risks of reinfection, breakthrough infection, hospitalization and death by a Cox regression adjusted for sex, age, vaccine type and vaccination status. Vaccine effectiveness against infection declined from 87% at 0-2 months after the second dose to 53% at 7-8 months for BNT162b2 vaccine, from 90% at 0-2 months to 65% at 7-8 months for mRNA-1273, and from 83% at 0-2 months to 55% at 5-6 months for the ChAdOx1-S. Effectiveness against hospitalization and deaths declined by about 15% and 10%, respectively, during the first 6-8 months. Boosters (third dose) returned the protection to the levels observed shortly after dose 2. In unvaccinated, previously infected individuals the protection against infection declined from 97% after 2 months to 72% at 18 months. Our results confirm the waning of vaccination-induced immunity against infection and a smaller decline in the protection against hospitalization and death. Boosting restores the original vaccine effectiveness. Post-infection immunity also decreases over time.

Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys.

AIMS: The United Nations warned of COVID-19-related mental health crisis; however, it is unknown whether there is an increase in the prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic. METHODS: We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalised Czech adults (18+ years) from both November 2017 (n = 3306; 54% females) and May 2020 (n = 3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk and alcohol-related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders. RESULTS: The prevalence of those experiencing symptoms of at least one current mental disorder rose from a baseline of 20.02 (95% CI = 18.64; 21.39) in 2017 to 29.63 (95% CI = 27.9; 31.37) in 2020 during the COVID-19 pandemic. The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 v. 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 v. 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 v. 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 v. 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviours (4.07% v. 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively). CONCLUSIONS: This study provides evidence matching concerns that COVID-19-related mental health problems pose a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasises an urgent need to scale up mental health promotion and prevention globally.

Role of population and test characteristics in antigen-based SARS-CoV-2 diagnosis, Czechia, August to November 2021.

BackgroundAnalyses of diagnostic performance of SARS-CoV-2 antigen rapid diagnostic tests (AG-RDTs) based on long-term data, population subgroups and many AG-RDT types are scarce.AimWe aimed to analyse sensitivity and specificity of AG-RDTs for subgroups based on age, incidence, sample type, reason for test, symptoms, vaccination status and the AG-RDT's presence on approved lists.MethodsWe included AG-RDT results registered in Czechia's Information System for Infectious Diseases between August and November 2021. Subpopulations were analysed based on 346,000 test results for which a confirmatory PCR test was recorded ≤ 3 days after the AG-RDT; 38 AG-RDTs with more than 100 PCR-positive and 300 PCR-negative samples were individually evaluated.ResultsAverage sensitivity and specificity were 72.4% and 96.7%, respectively. We recorded lower sensitivity for age groups 0-12 (65.5%) and 13-18 years (65.3%). The sensitivity level rose with increasing SARS-CoV-2 incidence from 66.0% to 76.7%. Nasopharyngeal samples had the highest sensitivity and saliva the lowest. Sensitivity for preventive reasons was 63.6% vs 86.1% when testing for suspected infection. Sensitivity was 84.8% when one or more symptoms were reported compared with 57.1% for no symptoms. Vaccination was associated with a 4.2% higher sensitivity. Significantly higher sensitivity levels pertained to AG-RDTs on the World Health Organization Emergency Use List (WHO EUL), European Union Common List and the list of the United Kingdom's Department of Health and Social Care.ConclusionAG-RDTs from approved lists should be considered, especially in situations associated with lower viral load. Results are limited to SARS-CoV-2 delta variant.

Nationwide observational study of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the Czech Republic.

The worldwide outbreak of the novel 2019 coronavirus disease (COVID-19) has led to recognition of a new immunopathological condition: paediatric inflammatory multisystem syndrome (PIMS-TS). The Czech Republic (CZ) suffered from one of the highest incidences of individuals who tested positive during pandemic waves. The aim of this study was to analyse epidemiological, clinical, and laboratory characteristics of all cases of paediatric inflammatory multisystem syndrome (PIMS-TS) in the Czech Republic (CZ) and their predictors of severe course. We performed a retrospective-prospective nationwide observational study based on patients hospitalised with PIMS-TS in CZ between 1 November 2020 and 31 May 2021. The anonymised data of patients were abstracted from medical record review. Using the inclusion criteria according to World Health Organization definition, 207 patients with PIMS-TS were enrolled in this study. The incidence of PIMS-TS out of all SARS-CoV-2-positive children was 0.9:1,000. The estimated delay between the occurrence of PIMS-TS and the COVID-19 pandemic wave was 3 weeks. The significant initial predictors of myocardial dysfunction included mainly cardiovascular signs (hypotension, oedema, oliguria/anuria, and prolonged capillary refill). During follow-up, most patients (98.8%) had normal cardiac function, with no residual findings. No fatal cases were reported.Conclusions: A 3-week interval in combination with incidence of COVID-19 could help increase pre-test probability of PIMS-TS during pandemic waves in the suspected cases. Although the parameters of the models do not allow one to completely divide patients into high and low risk groups, knowing the most important predictors surely could help clinical management.

The Impact of Distance Education during the COVID-19 Pandemic on Physical Activity and Well-Being of Czech and Polish Adolescents.

BACKGROUND: The aim of this study was to identify the changes in the structure of weekly physical activity (PA) and well-being among adolescent boys and girls between habitual education (HE) and distance education (DE) during the pandemic in secondary schools. METHODS: The research was carried out in 12 Czech and 18 Polish schools during 2019 to 2020 academic session for HE and 2020 to 2021 academic session for DE. The research involved 723 girls and 626 boys aged 15 to 18 years. The structure of the weekly PA was assessed using the International Physical Activity Questionnaire-Long Form, while well-being was assessed using the World Health Organization-5 Well-Being Index. RESULTS: There was a statistically significant decrease of PA among boys in school PA, transportation PA, recreation PA, vigorous PA, moderate PA, walking, and overall weekly PA during the DE resulting from the pandemic. In girls, during DE, a decrease was observed in school PA, vigorous PA, and overall PA. During DE, a high level of well-being was reported by only 34.9% of girls (43.8% during HE) and 50% of boys (65.6% during HE). CONCLUSIONS: The observed low PA and high incidence of depressive symptoms in adolescents in distance education during pandemic constraints are a challenge for schools to change in supporting physical activity, eliminating similar negative impacts on school life in the future.

Declining neutralizing antibody levels after SARS-CoV-2 mRNA vaccination: observational data from community point-of-care testing service in Brno, Czechia.

OBJECTIVES: Understanding immune response is critical for control of COVID-19 pandemic. However, recent studies show that vaccine-induced humoral immunity may not be long-lasting and weaker in SARS-CoV-2 variants of concern. METHODS: In May 2021, 253 self-nominated persons were tested for antibodies against SARS-CoV-2 in 1 to 104 days (mean 41, median 28) after two doses of Moderna and Pfizer-BioNTech vaccines in the city of Brno, Czechia. Two point-of-care iCHROMA™ II immunofluorescence assays were used: COVID-19 Ab against mix of SARS-CoV-2 nucleocapsid and spike proteins (IgG Ab); and COVID-19 nAb against S1-RBD protein (nAb). Results were analysed in relation to gender, age, vaccine, and past COVID-19 disease. RESULTS: Antibodies nAb were detectable in 92.9% (95% CI: 89.7-96.0) of vaccinees. We observed statistically insignificant decrease of positive results from 93.9% (95% CI: 89.5-98.3) and 97.0% (95% CI: 92.8-100.0) in the first and second month after vaccination, respectively, to 91.7% (95% CI: 83.8-99.5) and 78.3% (95% CI: 61.4-95.1) in the third and fourth month, respectively. Quantitative results showed decreasing level of nAb in both genders, age groups and vaccines. Higher levels of nAb were found in younger age group and in COVID-19 convalescents. IgG Ab showed little dynamics in time. CONCLUSIONS: We found robust humoral response after vaccination with mRNA vaccines, however, decreasing nAb levels suggest that vaccine-induced humoral immunity is rapidly waning. This finding is relevant for adjustment of vaccination strategies with regard to inclusion of booster dose(s).

Palliative care practice and moral distress during COVID-19 pandemic (PEOpLE-C19 study): a national, cross-sectional study in intensive care units in the Czech Republic.

BACKGROUND: Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seems to be modified during the COVID-19 pandemic with potential burden of moral distress to health care providers (HCPs). We seek to assess the practice of EOL care during the COVID-19 pandemic in ICUs in the Czech Republic focusing on the level of moral distress and its possible modifiable factors. METHODS: Between 16 June 2021 and 16 September 2021, a national, cross-sectional study in intensive care units (ICUs) in Czech Republic was performed. All physicians and nurses working in ICUs during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyse possible modifiable factors of moral distress. RESULTS: In total, 313 HCPs (14.5% out of all HCPs who opened the questionnaire) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to moral distress during the COVID-19 pandemic. 63.1% (n = 113) of nurses and 71.6% of (n = 96) physicians had experience with the perception of inappropriate care. If inappropriate care was perceived, a higher chance for the occurrence of moral distress for HCPs (OR, 1.854; CI, 1.057-3.252; p = 0.0312) was found. When patients died with dignity, the chance for moral distress was lower (OR, 0.235; CI, 0.128-0.430; p < 0.001). The three most often reported differences in palliative care practice during pandemic were health system congestion, personnel factors, and characteristics of COVID-19 infection. CONCLUSIONS: HCPs working at ICUs experienced significant moral distress during the COVID-19 pandemic in the Czech Republic. The major sources were perceiving inappropriate care and dying of patients without dignity. Improvement of the decision-making process and communication at the end of life could lead to a better ethical and safety climate. TRIAL REGISTRATION: NCT04910243 .