The association between experience of COVID-19-related discrimination and psychological distress among healthcare workers for six national medical research centers in Japan

BackgroundDiscrimination has been identified as an important determinant of negative mental health outcomes. This study determined the association between the experience of COVID-19-related discrimination and psychological distress among healthcare workers (HCWs) in Japan. MethodsThis cross-sectional study conducted a health survey among 5,703 HCWs of six national medical and research centers in Japan from October 2020 to March 2021. COVID-19-related discrimination was defined either when participants or their family members were badmouthed or when they felt discriminated against in some way. We used the Kessler Psychological Distress Scale (K6) to assess the presence of severe psychological distress ([≥]13 points). We used logistic regression models to examine the association between discrimination and psychological distress. We also identified job-related factors associated with discrimination. ResultsOf the participants, 484 (8.4%) reported COVID-19-related discrimination and 486 (8.5%) had severe psychological distress. HCWs who were female vs. male (odds ratio [OR]=1.41, 95% confidence interval [CI]=1.28-1.55), had high vs. low viral exposure (OR=2.31, 95%CI=1.81-2.93), and worked for more than 10 hours/day vs. <8 hours/day (OR=1.42, 95%CI=1.35-1.49) were more likely to have experienced COVID-19-related discrimination. The OR (95%CI) of severe psychological distress was 1.83 (1.29-2.59) among those who experienced discrimination. The analysis was stratified by sociodemographic and job-related factors and the associations trended in the same direction across subgroups. ConclusionExperience of COVID-19-related discrimination was associated with severe psychological distress among HCWs. During the pandemic, effective measures should be taken to prevent the development of negative mental health outcomes in HCWs who experience discrimination.

Use of heat-not-burn tobacco products, moderate alcohol drinking, and anti-SARS-CoV-2 IgG antibody titers after BNT162b2 vaccination among Japanese healthcare workers

BackgroundThe effect of heat-not-burn (HNB) tobacco product use and moderate alcohol drinking on immunogenicity to coronavirus disease (COVID-19) vaccines remain elusive. This study aimed to examine the association of tobacco product use and alcohol consumption with anti-SARS-CoV-2 spike IgG antibody titers after the BNT162b2 vaccine. MethodsParticipants were 3,457 fully vaccinated healthcare workers in the 4 national centers for advanced medical and research in Japan. Smoking status and alcohol consumption were assessed via a questionnaire, and anti-SARS-CoV-2 spike IgG titers were measured by chemiluminescent enzyme immunoassay using serum collected on the median of 64 days after the second vaccination. Multilevel linear regression models were used to estimate the geometric mean titers (GMT) and the ratios of means (RoM) between groups. ResultsOf vaccinated participants, 99.5% (3,440/3,457) were seropositive. Compared with never-smokers (GMT=119), IgG antibody titers were significantly lower among HNB tobacco users (including those who also smoked cigarettes) (GMT=105; RoM=0.88 [95%CI: 0.78-0.99]) and exclusive cigarettes smokers (GMT=96; RoM=0.81 [95%CI: 0.71-0.92]). Compared with non-drinkers of alcohol (GMT=123), alcohol drinkers consuming <1 go/day (GMT=114; RoM=0.93 [95%CI: 0.88-0.98]), 1-1.9 go/day (GMT=105; RoM=0.85 [95%CI: 0.79-0.93]), and [≥]2 go/day (GMT=101; RoM=0.82 [95%CI: 0.72-0.94]) had significantly lower antibody titers (P for trend<0.01). Spline analysis showed a large reduction of antibody until around 1 go/day of alcohol consumption, and then they gradually decreased. ConclusionsResults suggest that in addition to conventional cigarette smoking and heavy alcohol drinking, use of HNB tobacco products and moderate alcohol drinking may be predictors of lower immunological response to COVID-19 vaccine. Key MessagesO_LIEpidemiological evidence regarding the association of smoking status and alcohol drinking with COVID-19 vaccine-induced antibody levels is scarce. C_LIO_LIUsers of heat-not-burn (HNB) tobacco products, as well as cigarettes smokers, had lower antibody titers than never-smokers. C_LIO_LINot only high-dose but moderate-dose alcohol intake was also associated with decreased vaccine-induced antibody levels. C_LIO_LIHNB tobacco product use and moderate alcohol drinking may be modifiers of COVID-19 vaccine-induced immunogenicity. C_LI

Electoral processes and COVID-19 infections in Japan

Election campaigns and polling stations might be areas of potential infections; however, it is unknown whether elections can impact the spread of coronavirus disease (COVID-19). This study aimed to evaluate the association between election process and COVID-19 infection in Japan. Quasi-experimental design using time-series COVID-19 cases data with an election intervention. We chose the cities where elections for major and/or city/ward assembly members were held in 2021 January in Japan. The study period for each city spans one weeks before the start date of the election campaign and three weeks after the voting day (36 days). The daily number of patients testing positive for COVID-19. We used Poisson regression analysis with sandwich estimator to evaluate the association between election and the spread of COVID-19 infections. For Miyakojima City, we assessed the relationship between election and COVID-19 infections by using the Box-Jenkins autoregressive integrated moving average (ARIMA) model. We also estimated the instantaneous reproduction number (Rt) in the city. There were 17 cities that met the inclusion criteria. In all models with three types of different lag effects (i.e., 4, 9, and 14 days), election was not a significant predictor of COVID-19 infections in the 17 cities. For Miyakojima City, the autoregressive integrated moving average (0, 0, 0) with a lag of 14 (=14) was the best model. The partial coefficient ({omega}) of the election was 11.91 (95% confidence interval: 3.10-20.72, P<0.001), indicating that the election was associated with an increase in the number of COVID-19 cases 14 days after the election campaign (mean: 12 cases/day). Rt hovered far above 1 during and after the election campaign in Miyakojima. Although elections were associated with an increased number of COVID-19 cases in Miyakojima, this association was not verified in the analysis including all 17 cities. Therefore, if preventive measures prescribed by election guidelines are followed, elections do not necessarily relate to a spread of COVID-19 as long as the election process does not involve activities necessitating close contact.