Information and Disinformation: Social Media in the COVID-19 Crisis.

The World Health Organization (WHO) declared a COVID-19 pandemic last March 11, 2020.1,2 According to the WHO Director General, “In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled. There are now more than 118,000 cases in 114 countries, and 4,291 people have lost their lives. Thousands more are fighting for their lives in hospitals.” Soon after, Metro Manila was placed on a complete lockdown which started on March 15, 2020 and continues up to the time of this writing.2 So, what exactly is this COVID-19 pandemic? Will it be changing how we live our lives as healthcare professionals? What will be our role in taking care of patients with COVID-19? These and many other related questions require immediate answers as we face the threat of COVID-19. The WHO was first informed of cases of pneumonia of unknown cause in Wuhan City, China near the end of 2019. A novel coronavirus was identified as the cause by Chinese authorities and was initially named 2019-nCoV.3,4 This was later revised to COVID-19 (coronavirus disease of 2019) and the virus that causes it called SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2). In the first global epidemic caused by the “first” SARS coronavirus in 2003, the Philippines had a total of only eight confirmed patients. All the cases had contact with a nurse aide who had returned from Toronto, Canada where she got it. The index case and her father eventually died from SARS while the rest recovered.5 But, with COVID-19, at the time of writing this editorial, there were approximately 1,611 weekly cases with 112 weekly deaths in the Philippines and appears to be an increasing trend.6,7 By mid-March 2020, the WHO European Region had become the epicenter of the epidemic, reporting over 40% of globally confirmed cases. As of 28 April 2020, 63% of global mortality from the virus was from the Region, according to the WHO.3 There is much that we need to know about SARS-CoV-2, the virus that causes COVID-19. It belongs to the same family of coronavirus that causes SARS, MERS (Middle East Respiratory Syndrome), and even the common cold.3 Early studies report that SARS-CoV-2 was most often detected in respiratory samples from patients in China. However, live virus was also found in feces.8 It is thought that transmission mainly occurs through the respiratory route, probably as droplets, but extra respiratory sources may also be important. Risk factors for severe illness remain uncertain but old age and comorbidities such as cardiovascular disease, liver disease, kidney disease or malignant tumors, have emerged as likely important factors. There are no proven effective specific treatment strategies, and the risk-benefit ratio for commonly used treatments such as corticosteroids is not clear.7,8 COVID-19 may also cause damage to other organs such as the heart, the liver, and the kidneys, as well as to organ systems such as the blood and the immune system. Patients die of multiple organ failure, shock, acute respiratory distress syndrome, heart failure, arrhythmias, and renal failure.9,10 Among the WHO’s current recommendations, people with mild respiratory symptoms should be encouraged to isolate themselves, and social distancing is emphasized, and these recommendations apply even to countries with no reported cases.3,11 However, such measures could drastically affect the economy with impact on work practices as well as commercial establishments which depend on people’s patronage.12,13 Moreover, the psychological and mental burden that isolation and quarantine can bring about should also be considered. 14,15 For those in the academe, adjustments and quick transition to online learning strategies will need to be made.16 This will also affect how scientific research is done, particularly as we try to learn more about COVID-19.17 The longer the pandemic lasts, and the longer these measures need to be implemented, the more significant will the effects be on the economic and mental well-being of the people. There has certainly been a rush to get more information about COVID-19.18 Although well-intended in most cases, this has resulted into an “infodemic” with some erroneous or unscientific information about COVID-19. 19-21 Even mainstream scientific publications have not been spared by such faulty information. 22,23 Health professionals, therefore, who will be using the information found in these publications will need to be more vigilant in making sure that the data are properly collected and interpreted. We need to constantly update ourselves as new information becomes available.24-26 As in many viral diseases, the best way to combat COVID-19 could be vaccination. Based on the experience with developing vaccines for the other coronaviruses such as the ones causing SARS, MERS and even the common colds, the development of an effective vaccine against COVID-19 may be challenging.27-30 Even if one were to be quickly developed, having the resources needed to make enough vaccines for potentially all inhabitants of our planet are also staggering. And then of course, once a vaccine is available, each country would have to device its own vaccination strategy and all of its accompanying logistic considerations. And then there is the cost of such a vaccine. As a third world country, would the Philippines be able to afford enough vaccines for its citizens? Pending availability of an effective vaccine, one would need to look at actual treatment of COVID-19 patients. In the short-term, it may be possible to repurpose some of the currently available drugs we use for treating other viruses.31-33 In order to help address these, some wide-ranging initiatives have been set up. In March 2020, the UK Research and Innovation (UKRI) Medical Research Council and the UK National Institute of Health Research (NIHR) started the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial.34,35 It is the world’s largest clinical trial into treatments for COVID-19, with more than 40,000 participants across 185 trials sites in the UK. It is led by the University of Oxford. At about the same time, the WHO also announced the start of an international randomized and adaptive clinical trial SOLIDARITY which will also be looking at potential treatments for COVID-19. 36,37 The Philippines is set to participate in the SOLIDARITY trial.38 Use of personal protective equipment (PPEs) similar to how we have used them against Ebola and other viruses could also be beneficial.39 But similar to developing capacity for making enough vaccines, the ability to make enough PPEs, especially the disposable ones and bring these to where they are needed could also be additional challenges. In the Philippines, as in many other parts of the world, many healthcare workers report insufficient availability of PPEs which puts them at risk of getting COVID-19 from their patients.40,41 There are many more questions needing answers that we will need to deal with as we confront COVID-19. And, most likely, there will also be new challenges that can arise as the pandemic evolves. The combined efforts of the scientific and political communities will need to be engaged if we hope to successfully deal with this emergency. Joven Jeremius Q. Tanchuco, MD, MHA Professor, Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila Clinical Professor, Division of Pulmonary Medicine, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila REFERENCES WHO Director-General's opening remarks at the media briefing on COVID-19 [Internet]. 11 March 2020 [cited 2020 Apr 15]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Metro Manila to be placed on 'lockdown' due to COVID-19 [Internet]. [cited 2020 Apr 15]. Available from: https://cnnphilippines.com/news/2020/3/12/COVID-19-Metro-Manila-restrictions-Philippines.html Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-160. doi:10.23750/abm. v91i1.9397 Coronavirus disease (COVID-19) pandemic [Internet]. [cited 2020 Apr 15]. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov World Health Organization. SARS outbreak in the Philippines = Flambée de SRAS aux Philippines. Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire. 2003;78(22):189-192. https://apps.who.int/iris/handle/10665/232177 COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University ( JHU) [Internet]. [cited 2020 Apr 19]. Available from: https://www.arcgis. com/apps/dashboards/bda7594740fd40299423467b48e9ecf6. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time [published correction appears in Lancet Infect Dis. 2020;20(9):e215]. Lancet Infect Dis. 2020;20(5):533-534. doi:10.1016/S1473-3099(20)30120-1 Murthy S, Gomersall CD, Fowler RA. Critically Ill Patients With COVID-19. JAMA. 2020;323(15):1499-1500. doi:10.1001/JAMA.2020.3633. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. Woelfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Mueller MA, et al. Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster. medRXiv. March 8, 2020. Schmidt B, Davids EL, Malinga T. Quarantine alone or in combination with other public health measures to control COVID-19: A rapid Cochrane review. S Afr Med J. 2020;110(6):476-477. doi:10.7196/SAMJ. 2020.v110i6.14847 Tandon PN. COVID-19:

The coronavirus disease of 2019 (COVID-19) pandemic has dramatically impacted the plastic surgery community across the globe, and it has been the center of discussion in public and private discourse throughout the year.1 Given this deep interest in the COVID-19 pandemic, we hypothesized that articles related to the COVID-19 pandemic in the plastic surgery literature would garner higher levels of attention than other articles. Using the Journal Citation Reports, 15 plastic surgery journals with the highest impact factor in 2019 were selected and all articles published in these journals in 2020 were extracted.2 For the 6815 articles identified, number of citations accrued and Altmetric score, which is a weighted calculation of the attention an article receives online, were recorded.3 COVID-19–related articles were identified by searching titles for “COVID,” “SARS,” “pandemic,” “corona,” “COVID-19,” or “SARS-CoV-2,” resulting in a total of 220 articles (3.2 percent). The Kruskal-Wallis test was used to assess Altmetric score and citations for COVID-19–related versus non–COVID-19 articles. For the COVID-19–related articles, we also assessed whether Altmetric score and citations varied by the type of article (commentary, original article, or guidelines), subspecialty of plastic surgery to which the article pertained, and the quarter of the year in which it was published. Despite the pandemic being a hot topic of discussion, the majority (n = 137, 62 percent) of COVID-19–related articles had an Almetric score of zero, meaning they were not disseminated at all on social media, news outlets, or other electronic forms of media. When compared to non–COVID-19 articles, however, COVID-19–related articles had a higher average Altmetric score (2.1 versus 1.4, p < 0.001, Fig. 1). Of the COVID-19–related articles, original articles had higher Altmetric scores as compared to editorials and guidelines (3.8 versus 1.3 and 1.5, respectively, p < 0.001). There was no association between Altmetric score and specialty (p = 0.24) or quarter of publication (p = 0.40).Fig. 1.: Altmetric score by article type. COVID-19–related articles had higher Altmetric scores than non–COVID-19 articles.COVID-19–related articles accrued a total of 247 citations, with an average of 1.1 citations per article, which is higher than the 0.2 citations non–COVID-19 articles accrued (p < 0.001) (Fig. 2). Among the COVID-19–related articles, over 65 percent of articles had zero citations and four articles alone accounted for 24 percent of all citations. Articles published earlier in the year had more citations than those published later (p < 0.001), which is expected as it takes time for articles to accrue citations. There was no association between number of citations and specialty (p = 0.16) or article type (p = 0.27).Fig. 2.: Number of citations by article type. COVID-19–related articles accrued more citations than non–COVID-19 articles.The high levels of interest in the COVID-19 pandemic were reflected in the plastic surgery literature. Altmetric score, a surrogate for interest and influence, was higher for COVID-19–related articles and highest for studies that analyzed original data.1 Impact, as measured by citations, was also higher for COVID-19–related articles, suggesting there was increased discussion among academics about the pandemic and its ramifications on plastic surgery. The impact and influence of the COVID-19 pandemic were felt by the plastic surgery community worldwide and also depicted in the literature. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation.

Endothelial dysfunction in COVID-19: A potential predictor of long-COVID?

* Abbreviations: COVID-19 — : coronavirus disease of 2019 LGBTQ — : lesbian, gay, bisexual, transgender, queer, and/or questioning Vulnerable pediatric populations (including youth who are lesbian, gay, bisexual, transgender, queer, and/or questioning [LGBTQ]; homeless; maltreated; in foster care; and struggling with substance use disorders) warrant particular consideration during the coronavirus disease of 2019 (COVID-19) pandemic. It is likely that stay-at-home orders, combined with increased economic instability and family pressures, will increase their risks for harm and, in some cases, may make it untenable (and potentially dangerous) for them to shelter in place. Simultaneously, safety nets that protect youth (child protective services, medical and mental health providers, and educators) have fewer staff available or are inaccessible because of the COVID-19 crisis. These conditions highlight how morbidity and mortality in vulnerable pediatric populations will likely extend beyond the pandemic itself. For some children and youth, home can be isolating and, in some cases, dangerous. Adverse childhood experiences, including physical abuse, sexual abuse, and neglect, are common, with an estimated 678 000 children and adolescents experiencing maltreatment in 2018, and young children are at highest risk for serious harm.1 These risks increase for specific populations. Indeed, LGBTQ and gender nonconforming youth (up to 16% of all youth) are at far higher risk of experiencing physical and sexual abuse, with the level of gender nonconformity predictive of … Address correspondence to Rachel I. Silliman Cohen, MD, Child Abuse Research Education and Service Institute, School of Osteopathic Medicine, Rowan University, 42 E Laurel Rd, Stratford, NJ 08084. E-mail: sillimancohen{at}rowan.edu

The coronavirus disease of 2019 (COVID-19) pandemic drastically changed the 2020 to 2021 residency application process.1 The American Association of Medical Colleges released recommendations against visiting rotations and in-person interviews. Traditionally competitive fields, including plastic surgery, strongly encouraged students to participate in visiting rotations, which offer students an opportunity to network broadly, experience the specialty outside their own school’s department, and learn about different residency training programs.1,2 Loss of in-person evaluations may impact programs’ assessments of applicants and applicants’ impressions of programs. In this article, we describe how integrated plastic surgery programs adapted for the 2021 application cycle by developing a social media presence and implementing virtual opportunities. An official list of accredited integrated plastic surgery residency programs was obtained from the Electronic Residency Application Service, identifying 82 programs. All programs were included and reviewed for the presence of departmental and residency Twitter, Instagram, and Facebook accounts. Platforms, program websites, and the American Council of Academic Plastic Surgeons website were reviewed for posts regarding virtual subinternship and open house opportunities. The Visiting Student Application Service website was reviewed for virtual subinternship opportunities. All data were collected on September 9, 2020. Social media presence and virtual opportunities are profiled in Tables 1 and 2. In total, 138 social media accounts were identified, 65 programs (80 percent) had an online presence on either Twitter, Instagram, or Facebook, and 12 (15 percent) had a presence on all three platforms. Table 1. - Social Media Characteristics of Integrated Plastic Surgery Programs: Ownership and Creation Date of Program Social Media Accounts Program Characteristics No. of Accounts (%) No. Established before 2020 (%) No. Established after 2020 (%) Twitter Departmental Twitter 27 (33%) 23 (85%) 4 (15%) Residency Twitter 4 (4%) 4 (100%) 0 (0%) Instagram Departmental Instagram 22 (27%) 21 (96%) 1 (4%) Residency Instagram 49 (60%) 38 (78%) 11 (22%) Facebook Departmental Facebook 30 (37%) 28 (93%) 2 (7%) Residency Facebook 6 (7%) 5 (83%) 1 (17%) Table 2. - Social Media Characteristics of Integrated Plastic Surgery Programs: Number of Programs with Open House and Subinternship Opportunities Program Characteristics Twitter Instagram Facebook Programs with open house opportunities on social media, no. 10 (12%) 36 (44%) 6 (7%) Programs with virtual subinternship opportunities on social media, no. 2 (2%) 8 (10%) 1 (1%) Open houses were listed by 50 programs (61 percent) on American Council of Academic Plastic Surgeons and four program websites (5 percent). Instagram offered 88 total open house opportunities, and 17 programs (21 percent) posted more than one offering. Three virtual subinternships (4 percent) were identified through the Visiting Student Application Service website and none through American Council of Academic Plastic Surgeons or program websites. Two virtual subinternships listed on the Visiting Student Application Service website were not advertised on social media, and six virtual subinternships available on social media were not listed on the Visiting Student Application Service website. Hosting of virtual open houses appears to be the preferred method of outreach to applicants this year, adhering to COVID-19 social distancing recommendations and travel limitations. Open houses hosted by residency training programs may have increased impact over virtual subinternships, creating program diversity for applicants. The apparent lack of virtual subinternship standardization through an official American Association of Medical Colleges platform is novel, and we recommend exploration of program social media to elucidate opportunities. We anticipate that letters of recommendation from students’ home institutions and program director communication will play an enhanced role in the 2021–2022 residency application year. Almost all integrated plastic surgery residency social media accounts were made before 2020 (Fig. 1). Instagram is the preferred social media platform of integrated programs, supported by 2020 studies.3,4Fig. 1.: Date of social media account foundation.This article has limitations, including its retrospective nature. Data may be skewed due to the constantly changing social media platforms. In addition, the opening of departmental grand rounds, didactic conferences, and the like were not captured. Integrated plastic surgery residency programs adapted to the novel COVID-19 pandemic by creation of virtual open houses for applicants. Programs demonstrated minimal virtual subinternship opportunities. Instagram is the preferred social media outlet for integrated plastic surgery residencies. DISCLOSURE None of the authors has a financial interest in any of the products mentioned in this article. No funding was received for this article.

To the Editor Every effort is being made at the White House, federal, and state government levels along with individual component medical societies to suppress spreading of coronavirus disease of 2019 (COVID-19), manage infected patients properly, and provide financial and emotional support not only for infected patients and family members but also for the business community. Guidelines and executive orders issued by the White House, federal, and state governments recommend that elective surgical procedures including gastrointestinal (GI) endoscopies be postponed. On March 15, 2010 guidelines were jointly published by American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for GI Endoscopy.1 An elective procedure is defined as one that can be delayed without undue risk to the current or future health of patient as determined by the patient's treating physician (New Jersey Executive Order No. 109, March 27, 2020). Elective procedures that may be delayed and urgent/emergent procedures that may not be delayed are listed in the New York Society for Gastrointestinal Endoscopy Guidelines for Endoscopy Units during the COVID-19 pandemic.2 The reasons for postponing elective surgery are mainly to conserve medical resources including health care providers, hospital capacities, essential personal protective equipment (PPE), and ventilators to reduce the risk of bringing the novel coronavirus into medical facilities and obviously to suppress further spreading of this virus. Although the foregoing reasons are sufficient to recommend the postponing of elective procedures, there are additional factors that need to be considered. The management of patients undergoing GI endoscopic procedures using intravenous sedation with propofol, particularly for colonoscopy and esophagogastroduodenoscopy (EGD) present additional concerns that should be mentioned. Regurgitation and vomiting resulting in pulmonary aspiration under deep propofol sedation can occur, especially during a difficult colonoscopy, and silent regurgitation with pulmonary aspiration during EGD is not uncommon. When pulmonary aspiration occurs, the symptoms and signs of pneumonitis or pneumonia are very similar to COVID-19, including fever, coughing, shortness of breath, and chest X-ray (CXR)findings of areas of consolidation with ground-glass opacities. This will induce unnecessary confusion not only for the patient but also for the care givers and provoke anxiety and emotional burden. Frequently reported signs and symptoms of patients admitted to the hospital with COVID-19 include fever (77%–98%), cough (46%–82%), myalgia or fatigue (11%–52%), and shortness of breath (3%–31%).3 Patients presenting for screening GI endoscopies are generally older with multiple comorbidities including cardiovascular, pulmonary, endocrine (diabetes), cerebrovascular, renal, and hepatic conditions. If such patients were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), their illness would progress much more severely, resulting in a higher mortality rate.3 Furthermore, patients on corticosteroids and/or other immunosuppressants for cancer treatment may develop more severe symptoms.3 A report from China states that a person can carry and transmit COVID-19 without showing symptoms during their incubation period.4 The Chinese Centers for Disease Control and Prevention (CDC) analyzed records of all of China's reported cases of COVID-19 from December 8 to February 11 found that 1.2% of patients confirmed to be infected showed no symptoms.5 The incubation period of COVID-19 is estimated at 4 days ranging from 2 to 7 days but may last longer than 14 days.3 The incubation period of a woman in aforementioned case in China turned out to be 19 days.5 An asymptomatic patient during his/her incubation period scheduled for an urgent endoscopic procedure can transmit this virus to other patients and health care providers. While body fluids other than respiratory secretions have not been clearly implicated in transmission of COVID-19, unprotected contact with other body fluids including stool and vomitus presents a risk of contracting COVID-19.3,6 Sudden explosive vomiting or regurgitation or explosion of stool is not uncommon during colonoscopies. This can produce large droplets or aerosolized small particles and/or directly contaminate surfaces of equipment or personnel in the procedure room. The importance of using PPE should never be overlooked even in the care of asymptomatic patients. (Airborne transmission by aerosolized small particles is prevented more efficiently by N95 facemask or respirator rather than a standard surgical facemask.) In conclusion, postponing elective GI endoscopic procedures would definitely help conserve medical resources and slow the spread of SARS-CoV2. Asymptomatic transmission is a real possibility in the large cohort of high-risk elderly patients typically found in the endoscopic centers. This can occur either by direct contact with respiratory secretions from the infected patients or by large droplets or small aerosolized particles from vomitus and stool. More serious and rapid progression of the illness is concerning in these elderly patients with multiple comorbidities. Other consideration should be the similarity of symptoms between COVID-19 and aspiration pneumonitis or pneumonia. All of the foregoing factors should be strongly considered when weighing the risk/benefit ratio of endoscopic procedures on a patient who belongs to "nonurgent but higher priority status" such as cancer evaluations or evaluation of severe GI symptoms. Kang H. Rah, MDDepartment of AnesthesiologyRutgers State University of New JerseySomerset, New Jersey[email protected] Anna Platovsky, MDDepartment of GastroenterologyRobert Wood Johnson (RWJ) Endosurgical Center and Digestive Disease Center of New JerseySomerset, New Jersey

BackgroundThe coronavirus disease of 2019 (COVID-19) pandemic has challenged the existing healthcare delivery systems worldwide and overwhelmed the globally short healthcare workforce, particularly nurses. Nurses are recognized as front-line responders to the COVID-19 pandemic and are crucial healthcare members to win the fight against the evolving COVID-19. Considering the long-lasting shortage of national nurses, and turnover of the current nursing workforce, it is essential to consider unconventional strategies aiming at expanding the national nursing workforce in order to embrace the impact of COVID-19.ObjectiveThis study aimed to measure senior nursing students and intern’s willingness to treat patients with COVID-19. Further, this study investigated their feelings, knowledge, and concerns regarding treating patients with COVID-19.MethodsThis quantitative, cross-sectional study utilized self-reported survey gathered from a convenience sample of 178 senior nursing students and interns. A 7-item scale was used to measure the participants’ willingness to treat patients with COVID-19. The data were collected between March 2020 and April 2020.ResultsOut of 178 participants, 50.56% were at Level 8, 89.33% were single, and 53.37% had a very satisfactory grade point average. The highest proportion of the respondents (38.20%) felt neutral about treating patient with COVID-19, while 53.93% had good knowledge about COVID-19. The perceived willingness to treat of participants had an overall mean score of 20.19, which indicated neutral willingness to treat patients with COVID-19. Participants’ feelings about treating patients with COVID-19 predicted their willingness to treat patients with COVID-19 (P<0.001).Conclusion/RecommendationThere is a clear need for educational and training programs both in clinical practice and academia for the improvement among nursing students and interns who reported paucity of knowledge about COVID-19. Furthermore, hospital institutions should provide additional incentives or hazard protections to maintain and even increase the number of staff at the frontline who are willing to care for patients amid the deadly pandemic of COVID-19.

Evaluating the Effectiveness of COVID-19 Vaccines in Adults with Sickle Cell Disease during the Omicron Period of COVID-19 Pandemic

Corona Virus Disease of 2019 (COVID-19) spread across the globe, causing distress among various populations, including healthcare providers. This disease has had an unparalleled effect on the world's economic situation, livelihood, mental and physical well-being across the globe.The study aimed to determine the prevalence of depression and identify the occupational and psychological factors associated with depression among health care providers during the COVID-19 pandemic in a regional referral hospital in Kisumu County. We conducted a hospital-based cross-sectional study at JOOTRH where a total of 202 respondents participated in the study. The survey questionnaire consisted of four components: demographic factors, occupational factors, and psychological factors. Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9). Data was analysed using the statistical package for Social Science version 28. Pearson chi-square was used to determine the occupational and psychological factors associated with depression during the COVID-19 pandemic at p ≤.05. The overall prevalence of depression was at 57.4%. The occupational and psychological factors associated with depression among healthcare providers during the COVID-19 pandemic included being over 30 years old, married, having over 6 years of work experience, COVID-19 training, having an irregular work schedule, lacking psychological support services, and facing stigma. The study findings revealed a considerable proportion of depressive symptoms among health providers during the COVID-19 pandemic at JOOTRH. Older age, being married, more years of work experience, previous exposure to pandemic, having COVID-19 training, and irregular work schedule, experience of stigma, and lack of psychological support were significantly associated with depression.

Deployment of Neurosurgeons at the Warfront Against Coronavirus Disease of 2019 (COVID-19)

Corona Virus Disease of 2019 (COVID-19) is an unprecedented challenge to health care systems globally and locally. The study aimed to assess generalized anxiety disorder and associated factors among health care providers (HCP) during COVID-19 pandemic. A total of 202 health care providers participated in the study. This was a hospital-based cross-sectional study. The survey questionnaire consisted of six components: demographic factors, occupational factors, psychological factors, socioeconomic factors, and the multi-dimensional scale of perceived social support (MSPSS). The symptoms of anxiety were measured by a standardized questionnaire, a 7-item Generalized Anxiety Disorder scale (GAD-7). Chi-Square statistic was used as a selection criterion for the predictors of generalized anxiety disorder to be included in the final binary regression analysis model at α<0.05. Among 202 health care providers interviewed, the overall prevalence of anxiety symptoms was 59.9%. Some of the aspects that reduced the risk of GAD were; being a younger HCP (OR 0.11, P = 0.004), fewer years of experience (OR 0.09, P = 0.008), availability of workplace precautionary measures (OR 0.06, P = 0.004), lower income level (OR = 0.04, P = 0.014), living alone (OR = 0.02, P = 0.008) and permanent employment terms (OR = 0.0001, P< 0.0001). On the other hand, insufficient state of personal protective equipment (PPEs) (OR = 10.64, P = 0.033), having a family member as a COVID-19 contact (OR = 11.24, P = 0.023) and facing COVID-19 related stigma (OR = 8.06, P = 0.001) significantly increased the odds of GAD. The study result is a call to prioritize the health care providers' psychological well-being by putting in place measures to preserve and enhance their resilience in order to ensure they work optimally and sustain service delivery during a pandemic.

Background: The urgency for heightened levels of the Coronavirus disease of 2019 (COVID-19) awareness is due to their estimated face-to-face participation in the COVID-19 pandemic and similar pandemics. The unavailability of updated pandemic information is a significant challenge. There is no available data or previous studies undertaken to investigate the level of pandemic awareness of medical students in Trinidad, Tobago, or the wider Caribbean. Methods: A cross-sectional study of medical students, years one to five, at the University of the West Indies (UWI) St. Augustine campus, Faculty of Medical Sciences, was conducted using random sampling. Data was collected using a 20-item questionnaire structured to test awareness. Chi-square analysis was done using SPSS version 28.0.1.0 (142). Results: Of the 137 participants, 100% claimed to be aware of the COVID-19 pandemic, mainly via social media and the Ministry of Health press conferences. Though all claimed to be aware, 98.5% were aware of COVID-19 being a viral infection, whilst 87.6% were aware of the modes of transmission. Less than half of the population (45.3%) stated they were prepared to be a frontline worker exposed to and treating COVID-19 patients, while the majority (76.6%) were worried about exposure to the virus. Conclusions: The data collected in this research indicated that the level of awareness increases with higher levels of education, whereas age has no effect. Additionally, it was determined that undergraduate medical students had an average knowledge base of COVID-19 but would need training programs to increase their preparedness as future healthcare professionals. Lastly, it was discovered that the two top sources of information were social media and press conferences held by the government.

Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. To characterize inpatient adaptations to care for non-ICU COVID-19 patients. Cross-sectional survey. A network of 72 hospital medicine groups at US academic centers. COVID-19 testing, approaches to personal protective equipment (PPE), and features of respiratory isolation units (RIUs). Fifty-one of 72 sites responded (71%) between April 3 and April 5, 2020. At the time of our survey, only 15 (30%) reported COVID-19 test results being available in less than 6 hours. Half of sites with PPE data available reported PPE stockpiles of 2 weeks or less. Nearly all sites (90%) reported implementation of RIUs. RIUs primarily utilized attending physicians, with few incorporating residents and none incorporating students. Isolation and room-entry policies focused on grouping care activities and utilizing technology (such as video visits) to communicate with and evaluate patients. The vast majority of sites reported decreases in frequency of in-room encounters across provider or team types. Forty-six percent of respondents reported initially unrecognized non-COVID-19 diagnoses in patients admitted for COVID-19 evaluation; a similar number reported delayed identification of COVID-19 in patients admitted for other reasons. The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads rapidly, causing outbreaks that grow exponentially within a short period before interventions are sought and effectively implemented. Testing is part of the first line of defense against Corona Virus Disease of 2019 (COVID-19), playing a critical role in the early identification and isolation of cases to slow transmission, provision of targeted care to those affected, and protection of health system operations. Laboratory tests for COVID-19 based on nucleic acid amplification techniques were rapidly developed in the early days of the pandemic, but such tests typically require sophisticated laboratory infrastructure and skilled staff. In March 2020, Zimbabwe confirmed its first case of COVID-19; this was followed by an increase in infection rates as the pandemic spread across the country, thus increasing the demand for testing. One national laboratory was set to test all the country's COVID-19 suspect cases, building pressure on human and financial resources. Staff burnout and longer turnaround times of more than 48 h were experienced, and results were released late for clinical relevance. Leveraging on existing PCR testing platforms, including GeneXpert machines, eased the pressure for a short period before facing the stockout of SARs-CoV-2 cartridges for a long time, leading to work overload at a few testing sites contributing to long turnaround times. On September 11, WHO released the interim guidance to use antigen rapid diagnostic test as a diagnostic tool. The Zimbabwe laboratory pillar quickly adopted it and made plans for its implementation. The National Microbiology Reference Laboratory verified the two emergency-listed kits, the Panbio Abbott and the Standard Q, Biosensor, and they met the WHO minimum performance of ≥97% specificity and ≥80% sensitivity. Decentralizing diagnostic testing leveraging existing human resources became a game-changer in improving COVID-19 containment measures. Task shifting through training on Antigen rapid diagnostic tests (Ag-RDT) commenced, and testing was decentralized to all the ten provinces, from 1 central testing laboratory to more than 1,000 testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.