Mental health and life satisfaction among Canadian paramedics during the COVID-19 pandemic: an update

IntroductionPrevious results suggest that COVID-19 adversely impacted a number of health and coping measures among Canadian paramedics, particularly females. Estimated prevalence for meeting screening criteria for mental health disorders and suicidal thoughts were higher than previously reported.ObjectivesTo provide an update on the impact of the COVID-19 pandemic on the wellbeing of Canadian paramedics with the inclusion of an additional year of participant data.MethodsSelf-reported questionnaire data was collected from paramedics across five Canadian provinces as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project. Validated psychological assessment tools were used to screen for major depressive disorder (MDD, PHQ-9 questionnaire) and probable post-traumatic stress disorder (PTSD, PC-PTSD-5 questionnaire). Satisfaction with life (SWL) scores were adapted from validated Canadian Census questions and confirmed by reliability analysis. All measures were compared before versus during the pandemic using Wilcoxon signed-ranked, Cliff's d, and differences in proportions tests where appropriate.ResultsQuestionnaires from an additional 1662 recruited paramedics were included, now totaling 3568 participants. Prevalence meeting screening criteria remained similar for MDD (31.6%) and PTSD (41.4%), with PTSD risk continuing to not be impacted by COVID-19. Paramedics continued to report higher median SWL scores (20 vs. 17, p<.001) prior to the pandemic, with a large effect size (d=0.58) that suggests a greater probability of reporting higher SWL prior to COVID-19. Suicidal ideation (i.e., ‘thoughts that you would be better off dead, or of hurting yourself in some way') was reported by 9.0% of paramedics, which was consistent with original findings.ConclusionOriginal findings appear stable with the addition of another year of participant data. Future analyses will be employed to investigate whether health and satisfaction measures differed between the original cohort and added participants by adjusting for questionnaire responses with respect to the pandemic timeline.

Changes to infection prevention and control measures used by Canadian paramedics in response to COVID-19

IntroductionCanadian Paramedic services modified infection prevention and control (IPAC) practices in response to COVID-19. These changes may affect risk of exposure to infectious disease agents and can be used to inform future IPAC practices. We characterized COVID-19-related IPAC changes in the provinces of Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan.Materials & MethodsQuestionnaire data (January 2021-Feb 2022) from the national COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project was used to identify which IPAC practices were in place prior to COVID-19, and which were modified in response to COVID-19, including the timing of changes (March-May 2020;June-Aug 2020;Sept-Nov 2020;Nov 2020-present).Results2939 participants were included (146, 1249, 139, 1317, 88 from Alberta, BC, Manitoba, Ontario, and Saskatchewan, respectively), of whom 2674 (91%) reported receiving IPAC training. IPAC measures that were common prior to COVID-19 included: personal protective equipment (PPE) training, patient screening, hand hygiene, N95/P100 respirators, gowns, impermeable suits, and cleaning/disinfection. COVID-related IPAC changes included: screening staff, social distancing, restricting aerosol generating procedures, masking patients, cloth face coverings, surgical masks, face shields, and elastomeric respirators. Changes were reported for all IPAC measures. Most (71%) of these changes were made early in the COVID-19 pandemic (March-May 2020). Differences in proportions across provinces, community practice settings, and professional regulation status were reported (p < .05) for hand hygiene, PPE training, screening of patients, face shields, and various respirator types.ConclusionCanadian paramedic services were quick to modify available IPAC measures. However, these changes were variable across provinces, regulation status, and setting for specific IPAC measures. Inconsistent IPAC measures across jurisdictions may contribute to variable risk of infectious disease exposure. An evidence-informed and nationally coordinated approach may provide more equitable exposure risk mitigation for paramedic workers.

Effects of with holding treatment on mental health in Canadian paramedics during the COVID-19 pandemic

IntroductionPsychological effects of withholding treatment that could have benefited a patient during a pandemic remain largely unknown. It is also unclear to what extent their reasons for withholding treatment contributed to the subsequent impact on mental health outcomes. Paramedics may have withheld treatments either due to fear of exposure, being directed by their service, or both. As such, the present research aimed to characterize withholding treatment and investigate potential negative mental health outcomes.Materials and MethodsParamedics from five provinces (Alberta, British Columbia, Manitoba, Ontario, Saskatchewan) working during the COVID-19 pandemic completed online questionnaires assessing withholding treatment (i.e., due to fear of exposure, directed by their service, or both), and mental health outcomes including depression (PHQ-9) and post-traumatic stress (PTSD) symptoms (PC-PTSD-5) as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) study.ResultsOf the 1453 participants, 54.2% reported withholding treatment due to fear of exposure (4.3%), as directed by their service (76.5%) or both (19.2%). Participants who withheld treatment reported higher rates of PTSD (M=2.6, p < .01) and depression (M=8.2, p < .001) symptoms than those that did not withhold treatments (MPTSD=2.3;Mdepression=6.4). Reason for withholding treatment and PTSD symptom severity were associated (p<.01). Paramedics who withheld treatment due to fear of exposure were more likely to report probable PTSD symptoms (23.5%) than those who withheld treatments as directed by their service (8.7%) or both (12.2%). Depression symptom severity did not differ by reasons for withholding treatment.ConclusionsWithholding treatment is potentially traumatic and may influence the development of depression and PTSD symptoms. Withholding due to fear of exposure rather than being directed to increased PTSD symptoms. Further research will investigate the mental health impact of withholding treatment and reported reasons for withholding over time.

Risk of SARS-CoV-2 infection in a large cohort of Ontario workers

IntroductionWork is a key determinant of COVID-19 outcomes, however occupational surveillance is a critical information gap in many countries, including Canada. Understanding the risk of SARS-CoV-2 by occupation can identify high risk groups that can be targeted for prevention strategies.Materials and MethodsThe cohort includes 1,205,847 former workers compensation (non-COVID-19) claimants (aged 15–65) linked to health databases in Ontario, Canada. Incident cases were defined as either having a confirmed positive polymerase chain reaction (PCR) test in the Ontario Laboratory Information System (OLIS), or an International Classification of Diseases (ICD-10-CA) diagnostic code of U07.1 in hospitalization or emergency department records (February 2020-December 2021). Workers were followed until diagnosis, death, emigration, age 65 or end of follow-up. Sex- and age-adjusted Cox proportional hazards models were used to estimate hazards ratios (HR) and 95% confidence intervals (CI) by occupation, compared to all other cohort members. Analyses were also conducted to examine occupational trends in testing and diagnosis during waves of infection.ResultsOverall, 80,740 COVID-19 cases were diagnosed among workers during follow-up, of those, 80% were diagnosed with a positive PCR test. Associations were identified between COVID-19 diagnosis and employment in nursing (HR=1.44, CI95%=1.40–1.49), air transport operating (HR=1.61, CI95%=1.47–1.77), textile/fur/leather products fabricating, assembling, and repairing (HR=1.38, CI95%=1.25–1.54), apparel and furnishing services (HR=1.38, CI95%=1.19–1.60), and janitor and cleaning services (HR=1.11, CI95%=1.06–1.16). Restricted analyses where health care workers were omitted from the comparison group strengthened some associations for other high-risk workers. Test positivity ranged between 4–16% across major occupation groups. Risks varied over time and with changes in protective measures in workplaces and in broader communities.ConclusionsElevated risk of SARS-CoV-2 infection in health care, manufacturing, transportation, and service workers were identified, underscoring the importance of including occupational data in COVID-19 surveillance. Occupational trends in severe outcomes and vaccination are also being explored.

A Prospective Observational Cohort Comparison of SARS-CoV-2 Seroprevalence Between Paramedics and Matched Blood Donors in Canada During the COVID-19 Pandemic.

STUDY OBJECTIVE: SARS-CoV-2 represents an occupational risk to paramedics, who work in uncontrolled environments. We sought to identify the occupation-specific risk to paramedics by comparing their seroprevalence of SARS-CoV-2 infection-specific antibodies to that of blood donors in Canada. METHODS: In this prospective cohort study, we performed serology testing (Elecsys Anti-SARS-CoV-2 nucleocapsid assay) on samples from paramedics and blood donors (January to July 2021) in Canada. Paramedic samples were compared to blood donor samples through 1:1-matched (based on age, sex, location, date of blood collection, and vaccination status) and raking weighted comparisons. We compared the seroprevalence with a risk difference (and 95% confidence interval [CI]) and performed secondary analyses within subgroups defined by vaccination status. RESULTS: The 1:1 match included 1,627 cases per group; in both groups, 723 (44%) were women, with a median age of 38. The raking weighted comparison included 1,713 paramedic samples and 19,515 blood donor samples, with similar characteristics. In the 1:1 match, the seroprevalence was similar (difference 1.2; 95% CI -0.20 to 2.7) between paramedics (5.2%) and blood donors (3.9%). The raking weighted comparison was consistent (difference 0.97; 95% CI -0.10 to 2.0). The unvaccinated paramedic samples, in comparison to the blood donor samples, demonstrated a higher seroprevalence in the 1:1 (difference 5.9; 95% CI 1.8 to 10) and weighted (difference 6.5; 95% CI 1.8 to 10) comparisons. Among vaccinated cases, the between-group seroprevalence was similar. CONCLUSION: Overall, paramedics demonstrated similar evidence of prior SARS-CoV-2 infection to that of blood donors. However, among unvaccinated individuals, evidence of prior infection was higher among paramedics compared to blood donors.

Evaluation of the Performance of a Multiplexed Serological Assay in the Detection of SARS-CoV-2 Infections in a Predominantly Vaccinated Population.

SARS-CoV-2 seroprevalence studies may be complicated by vaccination efforts. It is important to characterize the ability of serology methods to correctly distinguish prior infection from postvaccination seroreactivity. We report the performance of the Meso Scale Discovery (MSD) V-PLEX COVID-19 Coronavirus Panel 2 IgG assay. Using serum samples from a prospective cohort of paramedics, we calculated the performance of the V-PLEX nucleocapsid ("N") assay to classify prior SARS-CoV-2 infections, defined as a (i) history of a positive SARS-CoV-2 PCR test or (ii) positive serology results using the Roche Elecsys total nucleocapsid anti-SARS-Cov-2 assay. We calculated sensitivity and specificity at the optimal threshold (defined by the highest Youden index). We compared subgroups based on vaccination status, and between models that excluded prior infections 3 to 12 months before sample collection. Of 1119 participants, 914 (81.7%) were vaccinated and 60 (5.4%) had evidence of a preceding SARS-CoV-2 infection. Overall and within vaccinated and unvaccinated subgroups, the optimal thresholds were 828 AU/mL, 827 AU/mL, and 1324 AU/mL; with sensitivities of 0.95 (95% CI: 0.94 to 0.96), 0.95 (0.94 to 0.96), 0.94 (0.92 to 0.96) and specificities of 0.88 (0.86 to 0.90), 0.87 (0.85 to 0.89), and 0.94 (0.89 to 0.98), respectively. N-assay specificity was significantly better in unvaccinated (versus vaccinated) individuals (P = 0.005). Overall optimal thresholds based on the AUC values were higher for samples from unvaccinated participants, especially when examining infections within the preceding 9 months (5855 versus 1704 AU/mL). Overall, V-PLEX nucleocapsid assay cutoff values were higher among unvaccinated individuals. Specificity was also significantly higher among unvaccinated individuals. Different thresholds were required to achieve optimal test performance, especially for detecting SARS-CoV-2 infections within the preceding 9 months. IMPORTANCE Among a cohort of adult paramedics in Canada, we investigated the performance of nucleocapsid (N) antibody detection (measured with a V-PLEX assay) to identify previous COVID-19 infections and compared differences among vaccinated and unvaccinated. Our data indicate that vaccinated and unvaccinated groups require different thresholds to achieve optimal test performance, especially for detecting COVID-19 within the preceding 9 months. Overall, specificity was significantly higher among unvaccinated, compared to vaccinated individuals.

A Higher Antibody Response Is Generated With a 6- to 7-Week (vs Standard) Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine Dosing Interval.

The optimal dosing interval for severe acute respiratory syndrome coronavirus 2 vaccines remains controversial. In this prospective study, we compared serology results of paramedics vaccinated with mRNA vaccines at the recommended short (17-28 days) vs long (42-49 days) interval. We found that a long dosing interval resulted in higher spike, receptor binding domain, and spike N terminal domain antibody concentrations.

COVID-19 Experiences, PPE, and Health Concerns in Toronto, Canada Bicycle Delivery Workers: Cross-sectional Pilot Survey.

OBJECTIVES: To pilot recruitment methods for bicycle delivery workers in Toronto, Canada and to assess workers' experiences with COVID-19 and personal protective equipment (PPE). METHODS: This was a cross-sectional study. An online survey was deployed and advertised via social media with both paid and free postings in July and August of 2020. An incentive draw was used to motivate participation. These analyses summarized descriptive statistics of the sample and variables relevant to COVID-19. RESULTS: Complete responses were received from 35 participants. No participants reported a diagnosis of COVID-19, however four participants indicated experiencing symptoms. Most participants reported they used PPE, especially masks and/or respirators (97.1%) and 71.4% of participants indicated their employer provided them with PPE (masks or gloves). Participants expressed concern about precarious work and uncertainty about their own COVID-19 exposure risk. CONCLUSIONS: Bicycle delivery workers are a precarious working population that may be difficult to reach for research recruitment purposes. Given their essential role in deliveries during the COVID-19 pandemic, further work is needed to characterize exposures and risks in this population.