Healthcare worker perspectives on COVID-19 vaccines: Implications for increasing vaccine acceptance among healthcare workers and patients

ObjectiveTo understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities.MethodsA dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021–4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers.Results517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider’s recommendation as most helpful for their patients.ConclusionHealthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information.     

新型冠状病毒肺炎流行对HIV感染者卫生需求影响的快速评估

目的 了解新型冠状病毒肺炎暴发流行对HIV感染者卫生需求影响，为政府和感染者社区快速制定应对措施提供参考依据。方法 于2020年2月5-10日，通过网络招募年满18周岁并已开始服用抗反转录病毒药物（ARV）的HIV感染者参加网络匿名调查，了解新型冠状病毒肺炎流行期间，受访者在预防新型冠状病毒肺炎、获取HIV防治相关服务和心理支持需求等方面的信息。结果 调查共收集1 014份来自全国各省的HIV感染者的调查问卷，93.79%的调查对象表示自己所在的社区提供了新型冠状病毒肺炎的预防信息，同时更加关心HIV感染者相关的新型冠状病毒肺炎预防措施以及防护品短缺问题；32.64%的调查对象表示自己现有的ARV不足以满足交通和旅行管制期间的需求，其中部分感染者在未来1个月面临断药风险。湖北省需要补充药物的HIV感染者中，64.15%的人表示因为"封锁和行动受限"而难以获得HIV治疗药物。调查还发现，28.93%的调查对象希望获得社会心理支持；对政府的期待方面，85.31%的调查对象希望可以进一步完善HIV感染者异地取药流程。结论 HIV感染者希望了解该人群预防新型冠状病毒肺炎暴发的相关信息，部分返乡或居住在交通管制地区的感染者，仍存在定期领药等方面的困难。疫情形势下，HIV感染者获取药物面临困难，我们应当进一步开展系统调查了解新型冠状病毒肺炎流行对HIV感染的影响，并提高卫生系统应急储备和处置能力。     

Mental health status of healthcare workers at a third line tunisian hospital during COVID-19 pandemic

Introduction: During the COVID-19(coronavirus-19 disease) pandemic, health care workers (HCWs) faced the risk of infection and distressing work to meet health requirements. The aim of the present stud ywas to evaluate perceptions of HCWs of their security at work in COVID-19 units and their coping strategies, at the military hospital of Tunis, during the second wave of COVID-19. Methods:A cross-sectional study was conducted via an auto-questionnaire on February 2021.HCWs of the military hospital of Tunis were included. Participants were asked about their perceived security at work in COVID-19 units and their coping behaviors. Mental disorders were assessed, via qualitative questionnaires. Results:A total of 110 HCWs’ responses were collected. Fifty-eight participants (52.7%) were females. The mean age was 33.7 years (SD 9.3). They were doctors at 45.5% and nurses at 39.1%. HCWs declared having worked in COVID-19 units in 81.8% of cases. The participants reported their fears about being infected in 58.2% and infecting family members in 85.5% of cases. Protective factors included information about the disease (80%), availability of personal protective equipment (PPE) (80.9%), support from colleagues(72.7%)or superiors at work (50.9%), and ability to communicate with others (63.6%). Depression, anxiety, and insomnia were found in respectively 25.5%, 30%, and 41.8% of HCWs. In multivariate analysis, suffering from a traumatic distress was significantly associated with anxiety and depression (p<0.01 and, p<0.05 respectively). In addition, insomnia severity was linked to age (p=0.05) and having colleagues infected with COVID-19 (p<0.05). Conclusion:In the present study, HCWs of the military hospital of Tunis stated having high levels of insomnia, anxiety, and depression since the early outbreak of the COVID-19 pandemic. These mental disorders may have a negative impact on the quality of life of HCWs and should be enhanced by psychological support and preventive measures.     

新型冠状病毒肺炎临床及影像学研究进展

新型冠状病毒肺炎疫情作为严重的突发传染性公共卫生事件,造成躯体损害的同时,也对心理健康带来消极影响。广东省深圳市南山区整合全区心理卫生资源,组建一支包含心理志愿者、心理咨询师、精神科医师的专业队伍,建立一个集心理评估、心理诊疗、公益热线、心理自助一体化的新型公共心理卫生服务体系,为集中医学观察点对象提供三级分类心理干预。本文主要针对深圳市南山区在疫情期间医学观察点以“四位一体”心理服务内容和分级分层管理为核心的“一站式”心理服务管理模式进行综述,旨在为重大突发公共卫生事件的心理干预提供参考。     

Thermal discomfort in healthcare workers during the COVID-19 pandemic

Introduction:Due to the COVID-19 pandemic, healthcare workers are now required to use additional personal protective equipment (PPEs) to protect themselves against the virus. That led to an increased clothing insulation which is negatively affecting the perceived healthcare workers’ thermal sensation.Objectives:While demonstrating through software simulations the potential level of thermal discomfort healthcare workers involved in the COVID-19 emergency can be subjected to, this work aims at identifying measures to improve thermal sensation perception and acceptable thermal conditions for medical personnel.Methods:After having obtained the insulation values of individual clothing used by staff during COVID-19 emergency through the use of a thermal well-being evaluation software, the Fanger indexes (PMV - Predicted Mean Vote and PPD - Predicted Percentage of Dissatisfied) were calculated in order to estimate staff satisfaction to microclimatic conditions.Results:The use of COVID-19 additional PPEs with an air temperature equal to 22 °C (normally considered optimal) brings the PMV index equal to 0.6, which corresponds to 11.8 % being unsatisfied (PPD) due to perceived heat.Discussion:The use of additional protective devices significantly increases the clothing insulation level, facilitating the onset of conditions of thermal discomfort in the health workers. Workers engaged in the execution of nasopharyngeal swabs were most affected by the summer weather conditions and certainly represent the most critical category, for which it would be recommended to implement a higher turnover of service to reduce individual exposure time and consequent discomfort.     

Training methods and association with worker injury on Colorado dairies: a survey

The goals of this study were to define the current methods for training entry-level workers on Colorado dairies, to measure the relationship of training methods to the incidence of work-related injuries on those operations, and to characterize the nature and cause of injuries reported by participating workers. Seventy-two workers from 15 dairies from Weld, Morgan, Larimer and Yuma counties volunteered to be interviewed privately in the language of their choice. Training methods were classified by content (task training versus safety training), method of delivery (on-the-job verbal instruction, on-the-job demonstration, on-the-job supervision, classroom- based, and / or reading materials); and instructor (supervisor and/or co-worker). The majority (84.7%) of interviewed workers were Mexican-born, Spanish-speaking males. Most workers reported the training to be a combination of verbal instruction, demonstration and supervision. Twenty-nine of 72 (40.3%) of all participants suffered at least one work-related injury in the 12 months prior to the interview. Entry-level safety training had no protective effect (P = 0.463) on the reported incidence of injury in dairy workers in the previous year. However, workers that received task-related training were four times less likely to suffer a work-related injury (P = 0.008). Training conducted by a co-worker also had a significant protective effect against work-related injuries (P = 0.028). Dairy workers identified direct contact with livestock or machinery as the main cause for work-related injuries, and most injuries occurred while medicating sick cows and milking.     

Infection and death by COVID-19 in a cohort of healthcare workers in Mexico

Objective:This study aimed to estimate the risk of SARS-Cov2 infection and severe COVID-19 among healthcare workers from a major social security system.Methods:This study actively followed a cohort of social security workers from March to December 2020 to determine the number of laboratory-confirmed symptomatic cases, asymptomatic associated contacts and COVID-19-associated hospitalizations and deaths. Workers were classified into those providing direct care to infected patients (COVID teams), other active healthcare workers (OAHCW), and workers under home protection (HPW). The number of cases and rates were also estimated by job category.Results:Among a total of 542 381 workers, 41 461 were granted stay-at-home protection due to advanced age or comorbidities. Among the 500 920 total active workers, 85 477 and 283 884 were classified into COVID teams and OAHCW, respectively. Infection rates for COVID teams, OAHCW, and HPW were 20.1% [95% confidence interval (CI) 19.8–20.4], 13.7% (95% CI 13.5–13.8), and 12.2% (95% CI 11.8–12.5), respectively. The risk of hospitalization was higher among HPW. COVID teams had lower mortality rate per 10 000 workers compared to HPW (5.0, 95% CI 4.0–7.0 versus 18.1, 95% CI 14.0–23.0). Compared to administrative workers, ambulance personnel (RR 1.20; 95% CI 1.09–1.32), social workers (RR 1.16; 95% CI 1.08–1.24), patient transporters (RR 1.15; 95% CI 1.09–1.22) and nurses (RR 1.13; 95% CI 1.10–1.15) had a higher risk of infection after adjusting for age and gender. Crude differences in mortality rates were observed according to job category, which could be explained by differences in age, sex, and comorbidity distribution. Diabetes, obesity, hypertension, hemolytic anemia, and HIV were associated with increased fatality rates.Conclusions:COVID team workers had higher infection rates compared to the total population of active workers and HPW. Doctors had lower risk of infection than respiratory therapists, nurses, and patient transporters, among whom interventions should be reconsidered to reduce risks. The presence of comorbidities, such as diabetes, obesity, arterial hypertension, hemolytic anemia, and HIV, increased the likelihood of complications caused by COVID-19, culminating in a poor prognosis.     

Relationship between occupational injury and gig work experience in Japanese workers during the COVID-19 pandemic: a cross-sectional internet survey

This study evaluated the relationship between occupational injury risk and gig work, which included the exchange of labor for money between individuals or companies via digital platforms. As Japan has experienced a severe economic decline during the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of individuals have engaged in gig work. While few studies have evaluated occupational risks in gig work, several traffic accidents associated with food delivery gig work have been reported in the mass media. In this study, 18,317 individuals completed an internet survey that collected information pertaining to their involvement in gig work and experience of related occupational injuries; data regarding several confounding factors were also recorded. Multiple logistic regression analysis showed that workers involved in gig work had a greater risk of any minor occupational injuries (odds ratio, 3.68; 95% confidence interval, 3.02–4.49) and activity-limiting injuries (odds ratio, 9.11; 95% confidence interval, 7.03–11.8) than those not involved in gig work, after adjusting for age, sex, household income, lifestyle factors, and work-related factors. The results of this study indicate that gig workers are exposed to greater occupational hazards during the COVID-19 pandemic. Additional studies are warranted to clarify the causal mechanism for this relationship.     

Social inequalities in protective behaviour uptake at the start of the COVID-19 pandemic: results from a national survey

ObjectivesWe aimed to assess social patterns of handwashing, social distancing, and working from home at the start of the COVID-19 pandemic in Canada, and determine what proportions of the overall prevalence and social inequalities in handwashing and social distancing are related to inequalities in the opportunity to work from home, to guide pandemic preparedness and response.MethodsUsing cross-sectional data from the Canadian Perspectives Survey Series, collected between March 29 and April 3, 2020, among Canadian adults (N=4455), we assessed prevalence of not working from home, social distancing in public, or practicing frequent handwashing, according to age, sex, marital status, immigration, education, chronic disease presence, and source of COVID-19 information. Multivariate regression, population attributable fraction estimation, and generalized product mediation analysis were applied.ResultsAbsence of frequent handwashing and distancing was more common among those working outside than within the home (prevalence differences of 7% (95% CI: 4, 10) and 7% (95% CI: 3, 10), respectively). Inequalities in handwashing and distancing were observed across education and immigration status. Over 40% of the prevalence of non-uptake of handwashing and distancing was attributable to populations not being able to work from home. If all worked from home, over 40% (95% CI: 8, 70) of education-based inequalities in handwashing and distancing could be eliminated, but differences by immigration status would likely remain.ConclusionFor pandemic response, both workplace safety initiatives and mechanisms to address the inequitable distribution of health risks across socio-economic groups are needed to reduce broader inequalities in transmission risk.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00553-0.     

Factors influencing acceptance of the COVID-19 vaccine in Malaysia: a web-based survey

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has set a precedent for the fastest-produced vaccine as a result of global collaboration and outreach. This study explored Malaysians’ acceptance of the COVID-19 vaccine and its associated factors.Methods A cross-sectional anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years old via social media platforms between July 10, 2020 and August 31, 2020.Results In the analysis of 4,164 complete responses, 93.2% of participants indicated that they would accept the COVID-19 vaccine if it was offered for free by the Malaysian government. The median out-of-pocket cost that participants were willing to pay for a COVID-19 vaccine was Malaysian ringgit (MYR) 100 (interquartile range [IQR], 100) if it was readily available and MYR 150 (IQR, 200) if the supply was limited. Respondents with a low likelihood of vaccine hesitancy had 13 times higher odds of accepting the COVID-19 vaccine (95% confidence interval [CI], 8.69 to 19.13). High perceived risk and severity were also associated with willingness to be vaccinated, with adjusted odds ratios of 2.22 (95% CI, 1.44 to 3.41) and 2.76 (95% CI, 1.87 to 4.09), respectively. Age and ethnicity were the only independent demographic characteristics that predicted vaccine uptake.Conclusion Public health strategies targeting perceived risk, perceived susceptibility and vaccine hesitancy could be effective in enhancing vaccine uptake.     

Gender difference in working from home and psychological distress - A national survey of U.S. employees during the COVID-19 pandemic

The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work. While the general subject of working from home has recently drawn increased attention, few studies have assessed gender differences in vulnerability to the potential mental health effects of working from home. Using data from 1,585 workers who participated in the Health, Ethnicity, and Pandemic (HEAP) study, a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020, associations of working from home with psychological distress were examined with weighted logistic regression among 1,585 workers and stratified by gender. It was found that workers who worked from home had higher odds of psychological distress (aOR and 95% CI = 2.62 [1.46, 4.70]) compared to workers who did not work from home, adjusting for demographic factors, socioeconomic status, and health behaviors. In gender-stratified analyses, this positive association between working from home and psychological distress was significant in women (aOR and 95% CI = 3.68 [1.68, 8.09]) but not in men. These results have implications for female workers’ mental health in the transition towards working from home in the COVID-19 pandemic era.     

Delay between COVID-19 complete vaccination and SARS-CoV-2 infection among healthcare workers

ObjectivesHealthcare workers (HCWs), at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccination, which became mandatory for them on September 15th, 2021 in France. In November they were confronted to the fifth COVID-19 wave despite excellent vaccine coverage. We aimed to estimate the incidence of SARS-CoV-2 infection after complete vaccination among HCWs with different vaccination schemes, and its determinants.MethodsWe enrolled all HCWs in the university hospital of Rennes, France who had received complete vaccination (two doses of COVID-19 vaccine). The delay from last vaccination dose to SARS-CoV-2 infection was computed. Fitted mixed Cox survival model with a random effect applied to exposure risk periods to account for epidemic variation was used to estimate the determinants of SARS-CoV-2 infection after complete vaccination.ResultsOf the 6674 (82%) HCWs who received complete vaccination (36% BNT162b2, 29% mRNA-1273, and 34% mixed with ChAdOx1 nCoV-19) and were prospectively followed-up for a median of 7.0 [6.3–8.0] months, 160 (2.4%) tested positive for SARS-CoV-2 by RT-PCR. Incidence density of SARS-CoV-2 infection after complete vaccination was 3.39 [2.89–3.96] infections per 1000 person-month. Median time from vaccine completion to SARS-CoV-2 infection was 5.5 [3.2–6.6] months. Using fitted mixed Cox regression with the delay as a time-dependent variable and random effect applied to exposure risk periods, age (P < 0.001) was independently associated with the incidence of SARS-CoV-2 infection. Vaccine schemes were not associated with SARS-CoV-2 infection (P = 0.068). A period effect was significantly associated with the incidence of SARS-CoV-2 infection (P < 0.001).ConclusionsIn this real-world study, incidence of SARS-CoV-2 infection increases with time in fully vaccinated HCWs with no differences according to the vaccination scheme. The short delay between complete vaccination and incident SARS-CoV-2 infection highlights the need for sustained barrier measures even in fully vaccinated HCWs.     

A national survey of COVID-19 vaccine acceptance in Nigeria

IntroductionThe COVID-19 vaccine is essential to reduce the global impact of the pandemic. Understanding its acceptance is key to Nigeria’s national COVID-19 control strategies.MethodsBetween the 6th and 22nd of January 2021, we conducted a non-probability convenience sampling of 3076 respondents using online and in-person interviews to assess the prevalence and predictors of the COVID-19 vaccine acceptance in Nigeria.FindingsOf the 3076 recruited participants, 74.7% (n = 2300/3076) had tertiary education. The median age group was 30–39 years (35.1%, n = 1097/3076) whereas 31% (n = 952/3076) of all respondents had a monthly income<30,000 Naira (65 USD). The survey results indicated that a wide range of the respondents were in government employment (34.1%, n = 1050/3076). The majority of our study participants (92.2%, n = 2835/3076) believe that COVID-19 is real and not a hoax. Only 27.9% (n = 858/3076) of the study participants have been tested for COVID-19 and 17.8 % (n = 152/858) of the tested respondents were COVID-19 positive by PCR. Half (50.7%; n = 1560/3076) of the study participants were willing to take the vaccine once available. The majority of the respondents (81.1%, n = 2496/3076) were not willing to pay for the vaccine. Only 15.9% (n = 483/3076) of the respondents rated the government’s handling of the pandemic above average. The potential acceptance of the COVID-19 vaccine was significantly affected by the age and the monthly income of the respondents. Respondents older than 60 years old (OR: 3.02, 95% CI: 1.69,5.41; p < 0.001) and those that earn between 250,000–500,000 Naira monthly (OR: 1.38; 95% CI: 1.11,1.70; p < 0.001) were more likely to accept the COVID-19 vaccine respectively. In addition, the respondents’ perception of the existence of the disease (OR: 1.45; 95% CI: 0.99,2.18; p > 0.05), the need for a COVID-19 vaccine (OR: 16; 95% CI: 11.63,22.10; p < 0.001), the willingness to pay (OR: 1.68; 95% CI: 1.39,2.01; p < 0.001) and the rating of the government handling of the pandemic (OR: 2.25; 95% CI: 1.57,3.23; p < 0.001) were critical to the acceptance of the COVID-19 vaccine.InterpretationWith 50.7% vaccine acceptance, Nigeria’s public health policymakers must prioritize and develop strategies that will effectively increase COVID-19 vaccine acceptance across the country with emphasis on trust, transparency and strong leadership.     

Spatiotemporal transmission dynamics of the COVID-19 pandemic and its impact on critical healthcare capacity

The role of geospatial disparities in the dynamics of the COVID-19 pandemic is poorly understood. We developed a spatially-explicit mathematical model to simulate transmission dynamics of COVID-19 disease infection in relation with the uneven distribution of the healthcare capacity in Ohio, U.S. The results showed substantial spatial variation in the spread of the disease, with localized areas showing marked differences in disease attack rates. Higher COVID-19 attack rates experienced in some highly connected and urbanized areas (274 cases per 100,000 people) could substantially impact the critical health care response of these areas regardless of their potentially high healthcare capacity compared to more rural and less connected counterparts (85 cases per 100,000). Accounting for the spatially uneven disease diffusion linked to the geographical distribution of the critical care resources is essential in designing effective prevention and control programmes aimed at reducing the impact of COVID-19 pandemic.