Pandemic fatigue impedes mitigation of COVID-19 in Hong Kong.

Hong Kong has implemented stringent public health and social measures (PHSMs) to curb each of the four COVID-19 epidemic waves since January 2020. The third wave between July and September 2020 was brought under control within 2 m, while the fourth wave starting from the end of October 2020 has taken longer to bring under control and lasted at least 5 mo. Here, we report the pandemic fatigue as one of the potential reasons for the reduced impact of PHSMs on transmission in the fourth wave. We contacted either 500 or 1,000 local residents through weekly random-digit dialing of landlines and mobile telephones from May 2020 to February 2021. We analyze the epidemiological impact of pandemic fatigue by using the large and detailed cross-sectional telephone surveys to quantify risk perception and self-reported protective behaviors and mathematical models to incorporate population protective behaviors. Our retrospective prediction suggests that an increase of 100 daily new reported cases would lead to 6.60% (95% CI: 4.03, 9.17) more people worrying about being infected, increase 3.77% (95% CI: 2.46, 5.09) more people to avoid social gatherings, and reduce the weekly mean reproduction number by 0.32 (95% CI: 0.20, 0.44). Accordingly, the fourth wave would have been 14% (95% CI%: -53%, 81%) smaller if not for pandemic fatigue. This indicates the important role of mitigating pandemic fatigue in maintaining population protective behaviors for controlling COVID-19.

Pandemic fatigue and attenuated impact of avoidance behaviours against COVID-19 transmission in Hong Kong by cross-sectional telephone surveys.

OBJECTIVES: This study aims to explore the attenuated impact of reported avoidance behaviours adherence on the transmission of COVID-19 through cross-sectional surveys in Hong Kong, in order to make up for the lack of research on avoidance behaviours fatigue. DESIGN: 40 cross-sectional telephone surveys. SETTING: All districts in Hong Kong. PARTICIPANTS: 31 332 Cantonese or English-speaking participants at age of 18 years or above. METHODS: We collected data on behaviours and estimated the average effective reproduction number ([Formula: see text]) among the Hong Kong adult population during the COVID-19 epidemic wave in November-December 2020 and compared with the preceding epidemic in June-July 2020. RESULTS: We observed a reduction in adherence to voluntary avoidance behaviours due to pandemic fatigue, but continued adherence to regulated avoidance behaviours. The average [Formula: see text] during the post-work from home period was higher in November-December wave with estimated [Formula: see text] of 0.81 (95% CI: 0.75 to 0.87) compared with the June-July wave with an [Formula: see text] of 0.67 (95% CI: 0.60 to 0.75). CONCLUSIONS: The declined effectiveness of social distancing interventions in reducing COVID-19 transmission was associated with fatigue with voluntary avoidance behaviours in Hong Kong population, implying a need for the government to reinvigorate the public to maintain effective pandemic control.

Chest compression quality during CPR of potential contagious patients wearing personal protection equipment.

AIM OF THE STUDY: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions. METHODS: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded. RESULTS: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario, 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle. CONCLUSION: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT: For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Reduction of Fatigue and Musculoskeletal Complaints in Garment Sewing Operator through a Combination of Stretching Brain Gym® and Touch for Health.

The purpose of this study was to assess the effect of using a combination of stretching and Brain Gym®(BG) + Touch for Health (TfH) movements to reduce fatigue and musculoskeletal complaints (MSCs) in garment-sewing operators. A quasi-experimental study was performed on 53 respondents with two sessions of stretching movements and BG + TfH movements of 5 min duration, three times a week for four weeks. Fatigue was measured using a reaction timer and MSCs were measured using a Nordic Body Map questionnaire. Wilcoxon and Mann-Whitney U tests were performed to examine the differences of pre/post and between the intervention group (IG) and control group (CG). A significant difference was found in IG for pre- and post-fatigue (p < 0.001) and MSCs (p < 0.001), while in CG there was no difference in fatigue (p = 0.200) and MSCs (p = 0.086). Significant differences were found between the IG and CG groups in terms of fatigue (p = 0.046), as well as in MSCs (p < 0.001). A significant decrease in MSCs per part body in IG was found on the left wrist, left hand, and left knee. The percentage of MSC severity decreased in all parts of the body, except the right shoulder, left elbow, and right thigh.

Addressing fatigue in medical residents with biomathematical fatigue modeling.

Fatigue in resident physicians has been identified as a factor that contributes to burnout and a decline in overall wellbeing. Fatigue risk exists because of poor sleep habits and demanding work schedules that have only increased due to the COVID-19 pandemic. At this time, it is important not to lose sight of how fatigue can impact residents and how fatigue risk can be mitigated. While fatigue mitigation is currently addressed by duty hour restrictions and education about fatigue, Fatigue Risk Management Systems (FRMSs) offer a more comprehensive strategy for addressing these issues. An important component of FRMS in other shiftwork industries, such as aviation and trucking, is the use of biomathematical models to prospectively identify fatigue risk in work schedules. Such an approach incorporates decades of knowledge of sleep and circadian rhythm research into shift schedules, taking into account not just duty hour restrictions but the temporal placement of work schedules. Recent research has shown that biomathematical models of fatigue can be adapted to a resident physician population and can help address fatigue risk. Such models do not require subject matter experts and can be applied in graduate medical education program shift scheduling. It is important for graduate medical education program providers to consider these alternative methods of fatigue mitigation. These tools can help reduce fatigue risk and may improve wellness as they allow for a more precise fatigue management strategy without reducing overall work hours.

Constructing high-quality rest facilities to maximise performance and ensure patient safety.

INTRODUCTION: Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being. METHODS: An audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care. RESULTS: The majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020). CONCLUSIONS AND IMPLICATIONS: This report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.

Traditional Chinese medicine auricular point acupressure for the relief of pain, fatigue, and gastrointestinal adverse reactions after the injection of novel coronavirus-19 vaccines: a structured summary of a study protocol for a multicentre, three-arm, single-blind, prospective randomized controlled trial.

OBJECTIVES: To investigate if traditional Chinese medicine (TCM) auricular point acupressure (APA) can alleviate and (or) reduce the pain (including injection site pain, headache, other muscle and joint pain), fatigue, and gastrointestinal adverse reactions (including nausea, vomiting, diarrhea), after the injection of novel coronavirus-19 vaccines (NCVs). TRIAL DESIGN: The study is designed as a multicentre, parallel-group, three-arm, single-blind, prospective, randomized (1:1:1 ratio) study. PARTICIPANTS: More than 360 participants will be recruited from healthy people who vaccinate NCVs in 5 community healthcare centres in the Sichuan province of China and 1 university hospital (Hospital of Chengdu University of Traditional Chinese Medicine). INCLUSION CRITERIA: ①Vaccinators meets the conditions of NCVs injection and have no contraindications to it. The details shall be subject to the instructions of the NCVs used and the statement of medical institutions. The first dose of NCVs injection shall be completed within 24 hours from the time of injection to the time of enrolment; ②No redness, swelling, injury or infection of the skin or soft tissue of both ears, which is not suitable for APA; ③No history of alcohol and adhesive tape contact allergy; ④18-59 years old, regardless of gender; ⑤Those who were able to complete the questionnaire independently at the time of the first and second dose of NCVs and on the 3rd, 7th and 15th day after the first and second dose of NCVs respectively; ⑥Those who agree to participate in the trial and sign the informed consent, and can seriously abide by the precautions after the injection of NCVs and the requirements of traditional Chinese medicine auricular point plasters sticking and acupressure. EXCLUSION CRITERIA: ①Those who are not suitable to be vaccinated because they belong to the contraindication or cautious population; ②Those who have participated in other clinical trials within 4 weeks before the start of this study; ③No chronic/habitual/persistent headache, Muscle or joint pain, fatigue, diarrhea, nausea, retching or vomiting before the injection of NCVs, and no related diseases present (details of this item is listed in full protocol); ④Those who are in use or have received TCMAPA within 2 weeks before the trial; ⑤Pregnant or lactating women; ⑥Participants with other serious primary diseases and psychosis. INTERVENTION AND COMPARATOR: ①Auricular point acupressure group: participants receive bilateral, symptom-specific TCMAPA in 5 auricular points (per side, 10 points bilateral) for 5 days, 3-4 times (about 1 min each time) of self-acupressure per day, after each NCVs injection (10 days in total). ②Sham auricular point acupressure group: participants receive bilateral, none symptom-specific, sham APA in 5 auricular points (per side, 10 points bilateral) for 5 days, 3-4 times (about 1 min each time) of self-acupressure per day, after each NCVs injection (10 days in total). ③Blank control group: Non-intervention blank control. The Hebei medical device Co. Ltd, Hebei, China manufactured the auricular point sticking plasters. MAIN OUTCOMES: Primary outcomes are all scores of visual analogue scale (VAS) based on subjective judgment of the participants included, including VAS score of pain at injection site, headache, muscle and joint pain, fatigue, nausea, retching, vomiting and diarrhea. Time points for outcomes above are the same: ①Immediately after first and second injection of the vaccine (Baseline assessment); ②Three days after first and second injection of the vaccine; ③Seven days after first and second injection of the vaccine; ④Fifteen days after first and second injection of the vaccine. RANDOMISATION: Participants will be randomized in 1:1:1 ratio to each group by computerized random number generator, and independently in each sub-centre. BLINDING (MASKING): Participants, information collectors and statistical evaluators will be blinded between APA group and sham APA group. No blinding in the control group. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): No less than 360 participants will be randomized in 1:1:1 ratio to each group. TRIAL STATUS: Protocol version 2.0 of February 3rd, 2021. Recruitment is expected to start on February 18th, 2021, and to finish on March 12th, 2021. TRIAL REGISTRATION: This trial was registered in the China Clinical Trial Registry (ChiCTR) ( ChiCTR2100043210 ) on 8th February, 2021. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Tuina (massage) therapy for diarrhea in COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: In the beginning of December 2019, the novel coronavirus pneumonia was first detected in Wuhan, China. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. Accumulating evidence suggests that gastrointestinal symptoms, such as diarrhea, are common among patients with COVID-19. Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. It can act on the subcutaneous muscular layer, enhance the local blood circulation and tissue metabolism of the skin, thus exert its effects on digestive systems and alleviate aversive diarrhea symptoms. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for diarrhea symptoms in COVID-19. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating exercise-induced fatigue: China National Knowledge Infrastructure, Wanfang and Pubmed Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients. The outcomes will include the improvement of diarrhea symptoms and adverse effect. CONCLUSIONS: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients.Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.