COVID-19 vaccine uptake,effectiveness, and waning in 82,959 health care workers: A national prospective cohort study in Wales

BackgroundWhile population estimates suggest high vaccine effectiveness against SARS-CoV-2 infection, the protection for health care workers, who are at higher risk of SARS-CoV-2 exposure, is less understood.MethodsWe conducted a national cohort study of health care workers in Wales (UK) from 7 December 2020 to 30 September 2021. We examined uptake of any COVID-19 vaccine, and the effectiveness of BNT162b2 mRNA (Pfizer-BioNTech) against polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection. We used linked and routinely collected national-scale data within the SAIL Databank. Data were available on 82,959 health care workers in Wales, with exposure extending to 26 weeks after second doses.ResultsOverall vaccine uptake was high (90%), with most health care workers receiving the BNT162b2 vaccine (79%). Vaccine uptake differed by age, staff role, socioeconomic status; those aged 50–59 and 60+ years old were 1.6 times more likely to get vaccinated than those aged 16–29. Medical and dental staff, and Allied Health Practitioners were 1.5 and 1.1 times more likely to get vaccinated, compared to nursing and midwifery staff. The effectiveness of the BNT162b2 vaccine was found to be strong and consistent across the characteristics considered; 52% three to six weeks after first dose, 86% from two weeks after second dose, though this declined to 53% from 22 weeks after the second dose.ConclusionsWith some variation in rate of uptake, those who were vaccinated had a reduced risk of PCR-confirmed SARS-CoV-2 infection, compared to those unvaccinated. Second dose has provided stronger protection for longer than first dose but our study is consistent with waning from seven weeks onwards.     

The public health response to the COVID-19 pandemic for people with disabilities

With the rapidly changing landscape of the COVID-19 outbreak, how to best address the needs and continue to protect the health and well-being of people with disabilities (PwDs) is a global public health priority. In this commentary we identify three public health areas of ongoing need and offer possible strategies to address each. These areas include: the types of data that would help clarify risks for PwDs and help assure their safety long term; the prevention, treatment and mitigation measures for PwDs that are needed through the duration of the outbreak; and the issues of equity in access to and quality of medical care for PwDs. Because of the rapid nature of the public health response, it is critical to reassess and readjust our approach to best address the needs of PwDs in the months and years to come and to incorporate these new practices into future emergency preparedness responses.     

Marketing the COVID-19 vaccine and the implications for public health

COVID-19 vaccines are new brands of consumer health technology being introduced to the market. Considering consumer behaviour approaches in this time of crisis, the risk of vaccine hesitancy, the call for more transparency and effective messaging to gain trust, and equitable distribution of this vaccine, this is unexplored theoretical terrain. This commentary takes a multidisciplinary approach to understand and theoretically explore the marketing, distribution, and acceptance of the COVID-19 vaccine. The paper integrates marketing principles, including advertisement and branding of consumer health technology with supply chain management, public affairs, and public health. A theoretical framework was presented to illustrate this relationship and key areas of concerns. The practical implications relevant to equity, ethics, education, employment, and the economic impact was presented.     

COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study

BackgroundFrom September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population.MethodsWe conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors.ResultsWe derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18–49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%CI 2.45–2.63), compared with those aged 18–29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14–1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61–0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09–1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41–1.63), compared to two-adult only households. HCWs aged 60 + years old were less likely to get breakthrough infections, compared to those aged 18–29 (aHR 0.42, 95%CI 0.38–0.47).ConclusionVaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children.     

Respiratory protection for health care workers: A 2020 COVID-19 perspective

As the US health care system began to respond to the coronavirus disease-2019 pandemic, demand for respiratory personal protective equipment (PPE) increased precipitously, as did the number of users. This commentary discusses ensuing deviations from accepted respiratory PPE program practices, which potentially increased risk to health care workers. Such lapses included omitting user training and fit testing, provision of unapproved devices, and application of devices in settings and ways for which they were not intended. The temporary compromise of professionally accepted standards due to exigencies must not become the new normal. Rather, the current attention to PPE should be leveraged to enhance practice, motivate vital research, and strengthen professional, governmental, and institutional capabilities to control health care worker exposures to infectious hazards.     

COVID-19 and Routine Childhood and Adolescent Immunizations: Evidence from Louisiana Medicaid

The COVID-19 pandemic disrupted routine vaccinations for children and adolescents. However, it remains unclear whether the impact has been different for children and adolescents from low-income families. To address this, we compared monthly routine vaccination use per 1000 vaccine-eligible children and adolescents enrolled in Louisiana Medicaid in the years before (2017–2019) and during the COVID-19 pandemic (2020). Compared to the 2017–2019 average vaccination rates, we found a 28% reduction in measles, mumps, and rubella (MMR), a 35% reduction in human papillomavirus (HPV), and a 30% reduction in tetanus, diphtheria, pertussis (Tdap) vaccinations in 2020. Vaccine uptake was lower in April 2020 after the declaration of a state of emergency and in late summer when back-to-school vaccinations ordinarily occur. We found little evidence of recovery in later months. Our findings suggest that a substantial number of disadvantaged children may experience longer periods of vulnerability to preventable infections because of missed vaccinations.     

One health disparities and COVID-19

 The global impact of the COVID-19 pandemic has disproportionately affected some communities and populations more than others. We propose that an interdisciplinary framework of ‘One Health Disparities’ advances understanding of the social and systemic issues that drive COVID-19 in vulnerable populations. One Health Disparities integrates the social environment with One Health perspectives on the interconnectedness of human, animal, and environmental health. To apply this framework, we consider One Health Disparities that emerge in three key components of disease transmission: exposure, susceptibility, and disease expression. Exposure disparities arise through variation in contact with COVID-19’s causative agent, SARS-CoV-2. Disparities in susceptibility and disease expression also exist; these are driven by biological and social factors, such as diabetes and obesity, and through variation in access to healthcare. We close by considering how One Health Disparities informs understanding of spillback into new animal reservoirs, and what this might mean for further human health disparities.Lay summaryOne Health focuses on interconnections between human, animal, and environmental health. We propose that social environments are also important to One Health and help illuminate disparities in the coronavirus pandemic, including its origins, transmission and susceptibility among humans, and spillback to other species. We call this framework One Health Disparities.     

Impact of COVID-19: Nursing challenges to meeting the care needs of people with developmental disabilities

BackgroundPeople with developmental disabilities (DD) are a population at high-risk for poor outcomes related to COVID-19. COVID-19-specific risks, including greater comorbidities and congregate living situations in persons with DD compound existing health disparities. With their expertise in care of persons with DD and understanding of basic principles of infection control, DD nurses are well-prepared to advocate for the needs of people with DD during the COVID-19 pandemic.ObjectiveTo assess the challenges faced by nurses caring for persons with DD during the COVID-19 pandemic and how the challenges impact people with DD.MethodsWe surveyed 556 DD nurses, from April 6–20, 2020. The 35-item mixed-method survey asked nurses to rate the degree of challenges faced in meeting the care needs of people with DD. We analyzed responses based on presence of COVID-19 in the care setting and geographically. One open-ended question elicited challenges not included in the survey, which we analyzed using manifest content analysis.ResultsStartlingly, nurses reported being excluded from COVID-19 planning, and an absence of public health guidelines specific to persons with DD, despite their high-risk status. Obtaining PPE and sanitizers and meeting social-behavioral care needs were the most highly ranked challenges. COVID-19 impacted nurses’ ability to maintain adequate staffing and perform essential aspects of care. No significant geographic differences were noted.ConclusionsDD nurses must be involved in public health planning and policy development to ensure that basic care needs of persons with DD are met, and the disproportionate burden of COVID-19 in this vulnerable population is reduced.     

Syndemic aspects between COVID-19 pandemic and social inequalities

Although the coronavirus disease 2019 (COVID-19) pandemic has reached all over the world population, it has demonstrated a heterogeneous impact on different populations. The most vulnerable communities which coexist daily with the social inequalities like low access to hygiene and personal protection products, crowded residences, and higher levels of chronic diseases have a higher risk of contact and the spread of infection, beyond unfavorable clinical outcomes. The elevation of the risk of infection exposure can be related to gender due to the presence of a larger contingent of women in essential services, as well as frontline and cleaning professionals who regardless of gender have the greatest exposure to the virus. Such exposures can contribute to the development of fear of contaminating themselves or their family members associated also with the work stress, both of which are related to the emergence of mental disturbances in these populations. Furthermore, conditions of unsanitary living and low socioeconomic status, populations at war, pre-existing social barriers, and ethnicity have contributed to more impact of the pandemic both in the exposure to the virus and access to health services, COVID-19 management, and management of other pathologies. At the same time, factors such as the closing of non-essential services, the loss of jobs, and the increase in household spending aggravated the social vulnerabilities and impacted the family economy. Lastly, the COVID-19 pandemic contributed still more to the impact on women's health since it propitiated a favorable environment for increasing domestic violence rates, through the segregation of women from social life, and increasing the time of the victims with their aggressors.     

医疗卫生和卫生健康信息等领域卫生健康标准在新型冠状病毒肺炎疫情防控中的应用与思考

目的 通过对新型冠状病毒肺炎疫情防控工作中涉及医院感染控制领域、卫生防护领域、卫生健康信息领域及卫生应急和生物安全领域等方面卫生健康标准的技术要素进行分析,为进一步优化疫情防控指南提供支持。方法 收集新型冠状病毒肺炎疫情防控中涉及以上相关内容的卫生健康标准,并将标准中的技术要素等与《医疗机构内新型冠状病毒感染预防与控制技术指南（第一版）》等相关指南进行对比。结果 现行卫生健康标准的适用范围、技术要素基本覆盖疫情防控工作需要。结论 现行卫生健康标准的贯彻实施会为疫情防控工作提供有力的技术支撑。而疫情期间防控工作的经验,也有利于相关卫生健康标准的进一步修订。     

Social and Policy Determinants of COVID-19 Infection Across 23 Countries: An Ecological Study

ObjectivesThis study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries.MethodsCOVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection.ResultsA higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=−0.672, −0.445, and −0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=−0.215 and −0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=−0.423). A national Bacillus Calmette–Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=−0.362 and −0.449, respectively).ConclusionsThese findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.     

Providing care to patients with COVID-19 in a reference hospital: health care staff intentional behavior and factors that affect it

ObjectiveThe investigation of intentional behavior of hospital staff to care for COVID-19 patients and the study of the factors that influences it.MethodThis is a cross-sectional study, of 261 physicians and nurses working in a COVID-19 reference hospital. Data were collected by an anonymous questionnaire including demographic and professional characteristics and a scale measuring behavioral intention based on the Theory of Planned Behavior of Ajzen. Statistical analysis was performed by SPSS 21.ResultsMean age of participants was 40.8 years old, while most of them were nurses (75.7%). Behavioral intention mean score was 18.2 (5–21), which shows high intention to care for COVID-19 patients. Bivariate analysis between independent variables showed that behavioral intention mean score was higher for those that had cared for COVID-19 patients and those that did not (19.0% vs. 16.7%, p < 0.001). Multivariate linear regression analysis identified that increased subjective norms (the perceived social pressure to perform or not the behavior) score was associated with increased behavioral intention score (p < 0.001). Also, participants that provided care for COVID-19 patients had higher behavioral intention score (p < 0.001).ConclusionHealthcare staff, that cared for COVID-19 patients had high behavioral intention to continue caring for them. This finding could be used to inform policies and training for staff that will be employed in COVID-19 units.     

COVID-19 and deprivation amplification: An ecological study of geographical inequalities in mortality in England

‘Deprivation amplification’ is used to understand the relationship between deprivation, scale and COVID-19 mortality rates. We found that more deprived Middle Super Output Areas (MSOAs) in the more deprived northern regions suffered greater COVID-19 mortality rates. Across England, the most deprived 20% of MSOAs had higher mortality than the least deprived (44.1% more COVID-19 deaths/10,000). However, the most deprived MSOAs in the north fared worse than equally deprived areas in the rest of England (14.5% more deaths/10,000, beta = 0.136, p < 0.01). There was also strong evidence of spatial clustering and spill-overs. We discuss these findings in relation to ‘deprivation amplification’, the ‘syndemic pandemic’, and the health and place literature.