Coronavirus Disease 2019 Care Research Articles

General Vaccination and Active Prevention of COVID-19 Epidemic at the Primary Health Care Level: The Fifth Step of the National Mobilization Program against COVID-19

Background. One of the most effective ways to prevent coronavirus disease 2019 (COVID-19) is to perform general vaccination and actively prevent the outbreak at the primary health care level. The present study aimed to review the measures against COVID-19 in Iran from April to September 2021. Methods. A cross-sectional and descriptive study was conducted at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services was collected from databases, including first level electronic health record systems, the portal of Network Management Center, the portal of Infectious Diseases Management Center, and the portal of Health Observatory. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data. Results. In the fifth step of the national mobilization program against COVID-19 epidemic, a total of 1,228 vaccination centers with 6,490 stations were established across the country from April to September 2021. In these centers, more than 47 million doses of the COVID-19 vaccines were injected. At this step, over 15 million people exposed to close contact with infected people were intercepted. A home care team was deployed at each selected health center for COVID-19, providing 532,551 home care services. At the fifth step, the monitoring teams issued 1,015,831 warnings to trading, industrial, or administrative units, which led to the sealing of 73,443 units. Also, more than six million rapid tests were performed in homes and health units. During the same period, 30,843 vulnerable households received support packages. Conclusion. The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic.

Impact of Proinflammatory Cytokines

Background: The cytokine storm and specific biochemical results were both observed during Coronavirus disease 2019 (COVID-19) infection. The aim of this study was to see if there was any correlation between biochemical findings and cytokine levels. Methods: A total of 65 COVID-19 patients, including 32 males and 33 females with ages between (16 and 90 years) were enrolled in this study. Between December 2020 and February 2021, these patients were admitted to Al-Amal Specialized Hospital or ward of COVID-19 care in Al-Sader Hospital. These patients were classified into severe/critical (43 cases), mild/moderate (22 cases) according to the guidelines released by National Health World depending on SpO2 percentage. The biochemical indices were measured using FUJI DRI-CHEM NX500 automated clinical chemistry analyzer (FUJIFILM, Japan). The proinflammatory cytokine (interleukin-6 [IL-6], IL-1α, and IL-1β) were measured using ELISA technique. Results: IL-6 serum levels were negatively correlated with SpO2 (P = 0.002, R = - 0.372) and serum albumin (P = 0.034, R = - 0.301). IL-1α serum levels showed significant negative correlation with serum albumin levels (P = 0.039, R = - 0.259). Furthermore, a positive correlation found between IL-1β serum with serum levels of both AST and LDH (P = 0.049; R = 0.255; P = 0.054; R = 0.320 respectively). Discussion: Increased IL-6 serum levels have a direct impact on SpO2 percentage and serum albumin. Whereas the elevated levels of both IL-1α and IL-1β are a possible cause of acute inflammation and liver damage in COVID-19. Conclusions: This study further confirms the growing evidence on the direct role of proinflammatory cytokines in the biochemical changes shown in COVID-19.

192. COVID-19 Exposure and Care-Seeking Behaviors Among Vulnerable Urban Adolescents and Young Adults—Baltimore, Maryland USA

During the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Disease Control and Prevention called for pragmatic syndromic management approaches to compensate for reductions in care access to sexual health services due to COVID-19. This study seeks to determine the relationship between fear of COVID-19 acquisition and care seeking behaviors among urban adolescents and young Adults (AYA), with the aim of assessing the utilization of telemedicine as part of health services offered to AYA in Baltimore, MD.

Forecasting models to guide intensive care COVID-19 capacities in Germany

HintergrundZeitdynamische Prognosemodelle spielen eine zentrale Rolle zur Steuerung von intensivmedizinischen COVID-19-Kapazitäten im Pandemiegeschehen. Ein wichtiger Vorhersagewert (Prädiktor) für die zukünftige intensivmedizinische (ITS-)COVID-19-Bettenbelegungen ist die Anzahl der SARS-CoV-2-Neuinfektionen in der Bevölkerung, die wiederum stark von Schwankungen im Wochenverlauf, Meldeverzug, regionalen Unterschieden, Dunkelziffer, zeitabhängiger Ansteckungsrate, Impfungen, SARS-CoV-2-Virusvarianten sowie von nichtpharmazeutischen Eindämmungsmaßnahmen abhängt. Darüber hinaus wird die aktuelle und auch zukünftige COVID-ITS-Belegung maßgeblich von den intensivmedizinischen Entlassungs- und Sterberaten beeinflusst.MethodeSowohl die Anzahl der SARS-CoV-2-Neuinfektionen in der Bevölkerung als auch die intensivmedizinischen COVID-19-Bettenbelegungen werden bundesweit flächendeckend erfasst. Diese Daten werden tagesaktuell mit epidemischen SEIR-Modellen aus gewöhnlichen Differenzialgleichungen und multiplen Regressionsmodellen statistisch analysiert.ErgebnisseDie Prognoseergebnisse der unmittelbaren Entwicklung (20-Tage-Vorhersage) der ITS-Belegung durch COVID-19-Patienten*innen werden Entscheidungsträgern auf verschiedenen überregionalen Ebenen zur Verfügung gestellt.SchlussfolgerungDie Prognosen werden der Entwicklung von betreibbaren intensivmedizinischen Bettenkapazitäten gegenübergestellt, um frühzeitig Kapazitätsengpässe zu erkennen und kurzfristig reaktive Handlungssteuerungen, wie etwa überregionale Verlegungen, zu ermöglichen.

Evaluating Racial/Ethnic Differences in Care Escalation Among COVID-19 Patients in a Home-Based Hospital.

The novel coronavirus disease 2019 (COVID-19) has infected over 414 million people worldwide with 5.8 million deaths, as of February 2022. Telemedicine-based interventions to expand healthcare systems’ capacity and reduce infection risk have rapidly increased during the pandemic, despite concerns regarding equitable access. Atrium Health Hospital at Home (AH-HaH) is a home-based program that provides advanced, hospital-level medical care and monitoring for patients who would otherwise be hospitalized in a traditional setting. Our retrospective cohort study of positive COVID-19 patients who were admitted to AH-HaH aims to investigate whether the rate of care escalation from AH-HaH to traditional hospitalization differed based on patients’ racial/ethnic backgrounds. Logistic regression was used to examine the association between care escalation within 14 days from index AH-HaH admission and race/ethnicity. We found approximately one in five patients receiving care for COVID-19 in AH-HaH required care escalation within 14 days. Odds of care escalation were not significantly different for Hispanic or non-Hispanic Blacks compared to non-Hispanic Whites. However, secondary analyses showed that both Hispanic and non-Hispanic Black patients were younger and with fewer comorbidities than non-Hispanic Whites. The study highlights the need for new care models to vigilantly monitor for disparities, so that timely and tailored adaptations can be implemented for vulnerable populations.

Impact of COVID-19 on Renal Function: A Multivariate Analysis of Biochemical and Immunological Markers in Patients.

IntroductionThere have been tremendous continuous efforts to understand the broad spectrum of disease and its sequelae since the start of the coronavirus disease 2019 (COVID-19) pandemic. Several studies have identified biomarkers that correlate with multiple organ failure in COVID-19 patients. The purpose of our study was to evaluate COVID-19-associated kidney injury.MethodsThis retrospective cross-sectional study was conducted at the Institute of Biochemistry, Madras Medical College, by reviewing the electronic records of 1,000 reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19-positive patients admitted at the COVID-19 care center. Data were extracted from the case records of 1,000 RT-PCR-positive patients with different CT chest grades plus comorbid conditions such as type 2 diabetes mellitus (T2DM), systemic hypertension (SHT), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and cerebrovascular accident (CVA) as Group I (n = 500). Group II (n = 500) comprised of COVID-19-positive patients with no comorbid conditions. The data were recorded from all the patients at the time of admission, prior to starting treatment. Patients with comorbid and non-comorbid conditions were compared according to different CT grades.ResultsCOVID-19 patients with different CT grades showed a significant relationship with creatinine, sodium, potassium, C-reactive protein (CRP), ferritin, total protein, and albumin with p-values of 0.04, 0.01, 0.02, 0.000, 0.00, 0.00, and 0.000, respectively, in Group I. In Group II, with various grades of CT changes, the neutrophil-lymphocyte ratio (NLR) and creatinine showed no significance. The sodium, potassium, CRP, ferritin, total protein, and albumin showed low significance with the chest CT grades.ConclusionsOur study demonstrated that COVID-19 can cause mild to moderate renal impairment in COVID-19 patients. Multiple factors contributed to this, such as the higher angiotensin-converting enzyme 2 (ACE2) expression on kidney cells, microinflammation, increased blood clotting, and probable direct infection of the kidney. A high NLR, increased inflammatory markers, and altered renal function analytes such as urea, creatinine, sodium, potassium, total protein, and albumin also confirmed this.

Effectiveness of Large-Scale Preparedness Training on Electrocardiogram for Medical, Surgical, and Pre-clinical Doctors: A Need-Based Initiative for COVID-19 Patient Care.

Introduction: One of the competencies expected of all doctors posted in coronavirus disease 2019 (COVID-19) wards, is ECG rhythm identification, interpretation, and intervention for immediate management of patients. This study was undertaken to evaluate the effectiveness of the ECG training module as a component of preparedness training to combat COVID-19.Methodology: This was a cross-sectional study conducted during training on ECG rhythm identification, interpretation, its management in COVID-19 patients. Study participants included faculty, senior residents, junior residents, and interns of medical, surgical, and paraclinical disciplines. The training session included one hour of didactic lecture and one and half hours of interactive session during which case scenarios were discussed. An objective assessment was conducted through pre-test and post-test. Mean of pre and post-test scores were compared using paired t-test for evaluating statistical significance. Feedback was also taken from participants.Results: Out of the 800 participants who gave consent, only 682 who completed both pre and post-test were included in the final analysis. Mean pre-test and post-test scores were 9.29/15 (61.9%) and 11.63/15 (77.5%), respectively, with a mean improvement of +2.34/15 (+15.6%). Of the participants, 38.6% obtained low scores in pre-test and 82% of respondents agreed that knowledge and skills gained from training would be useful in providing patient care.Conclusion: Low baseline knowledge on ECG highlights the need for re-training doctors posted in COVID-19 care on cardiac rhythm identification and interpretation. Interactive training is effective in improving ECG interpretative skills among doctors across disciplines and is the appropriate method to retrain/reskill, especially for large-scale capacity building.

Telecounseling and guided relaxation for addressing patient, student, and health-care worker distress: An experience

Introduction: In the face of the coronavirus disease 2019 (COVID-19) pandemic, the leadership of the institute felt a need for mental health interventions among patients admitted in COVID-19 isolation, university students, and health-care workers engaged in COVID-19 care. This article aims to share our experience in providing these services. Methodology: COVID-19 inpatients were telephonically counseled. Counseling protocol was based on national guidelines. Students of the university were assessed for emotional problems using a symptom checklist and Kessler 10-item Distress Scale. Subsequently, the faculty assigned as mentors were trained in providing telephonic psychological first aid (PFA) to the students. Psychosocial help was offered to health-care workers through daily guided relaxation sessions. Results: Forty-two of 69 COVID-19 inpatients were telephonically contacted. New-onset mental health problems were found in 40%. Half of the COVID-19 confirmed patients and half of the females had a higher prevalence of mental health problems. On the symptom checklist, 330 students were responded. Worry about the future, contagion, and boredom were reported by the majority of students. On the Kessler 10-item Distress Scale, 272 students were responded. Thirty-seven percent had likely mental disorders (22 males and 79 females). Twenty-two students contacted psychiatrists through mentors and were provided teleconsultation. Eighty health-care workers attended guided relaxation sessions. Twenty-nine responded on the feedback form. Most respondents felt guided relaxation was useful in reducing stress, with strongly agree (n = 12) and agree (n = 14) responses. Conclusions: Emotional problems were significantly prevalent among students and COVID-19 patients. Training faculty in PFA can help address students in distress. Guided relaxation may help frontline workers manage stress.

Asymptomatic COVID-19 Infection among Healthcare Workers in Dedicated Tertiary Care Facility of Kolkata, India

Introduction: In view of the present Coronavirus Disease 2019 (COVID-19) pandemic it is of utmost importance to look out for the ‘trojan horse’ that is the asymptomatic population who are potential for spreading the disease. Healthcare Workers (HCWs) are the most vulnerable group. The possibility of having the infection does not always correlate well with the symptoms. It urges the need for development of certain special plans beyond continuous surveillance and symptom monitoring. Aim: To explore asymptomatic COVID-19 infection among HCWs as a potential source of transmission. Materials and Methods: This hospital-based cross-sectional study was conducted at Medical College and Hospital, Kolkata , West Bengal, India, from June 2020 to September 2020. The data were collected from 714 HCWs over a period of three months of study period, with the help of a standard questionnaire and blood sample was analysed by serological assessment of Immunoglobulin G (IgG) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by EUROIMMUN Kit, EnzymeLinked Immunosorbent Assay (ELISA). Epi info software 7, available from the World Health Organization (WHO) site was used to manage and analyse the data. Results: The mean age was 35.30±11.79 years. Out of 714 people, 54.8% (391/714) were male and 45.2% (323/714) were female. In this survey, 9.16% of HCWs in COVID-19 designated duties were IgG positive; whereas 21.89% of HCWs designated in other parts of area were detected to be IgG positive. Seroprevalence was least amongst nursing staffs with 5.41% (8/148); among doctor’s it was 9.62% (41/426). Most interestingly among ward boys and cleaners this prevalence was found to be 29.90% (29/97) being the highest. Overall seroprevalence for IgG against SARS-CoV-2 was found to be 12.75% (91/714). Conclusion: This serosurvey at this tertiary COVID-19 care facility is a unique venture to look for the possible sources of super-spread. The high rate of sero-positivity among ward boys and cleaners might be due to their lack of knowledge and training regarding steps to prevent a droplet borne pandemic. This study also points out that if adequate precautions are taken, infectivity is not to an alarming extent, even in a fullfledged COVID-19 care hospital.

CoRe study: COVID-19 and remdesivir: An insight into the current health planning and policy.

The ongoing coronavirus disease-2019 (COVID-19) pandemic has witnessed rampant use of the repurposed drug, remdesivir, despite its conflicting evidence and rapidly changing guidelines. A cross-sectional, country-wide, questionnaire-based, electronic survey was conducted among the healthcare professionals involved in COVID-19 management from April 18 to May 18, 2021. Out of 231 responses, 185 were included. Significantly, greater knowledge of trials was reported by the frontline healthcare professionals compared to those who are not involved in COVID-19 care. Medicine practitioners and pulmonologists expressed greater willingness to continue remdesivir (Odds ratio (OR) 5.329, 95% Confidence interval (CI) 2.31-12.291 and 5.063, 95% CI 1.414-18.129, respectively). The rationale attributed was personal experience, current guidelines, non-availability of any alternate antiviral drug, expert recommendations, and local hospital policy either alone (20%, 8.1%, 5.9%, 2.7%, and 2.2%, respectively) or in combination (46.5%, 39.5%, 29.2%, 21.1%, and 15.7%, respectively). Awareness of evidence and knowledge of landmark studies made no statistically significant impact on clinical decision-making. Improved clinical outcomes were reported by 10/22 (45.4%) practitioners who used remdesivir for unconventional indications. The study throws critical insights into the current perspectives of doctors on remdesivir in clinical management and its potential impact on current health planning strategies.

Hydroxychloroquine pre-exposure prophylaxis for COVID-19 among healthcare workers: Initial experience from India.

Background:Hydroxychloroquine (HCQ) had generated considerable interest for coronavirus disease 2019 (COVID-19) prophylaxis. We conducted a prospective observational study at a tertiary care hospital in India, with dedicated COVID-19 care facilities.Objectives:Primary objective was incidence of adverse effects, secondary objective being efficacy in preventing COVID-19.Methods:Healthcare workers were recruited and grouped based on voluntary HCQ prophylaxis as per national guidelines. Side effects in HCQ group were graded in accordance with national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) version 5.0. At 3–7-week follow-up, groups were compared for COVID-19 exposure, symptoms development and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR results.Results:Among 358 participants recruited, 216 (60.3%) were males and mean age was 31.2 ± 6.6 years. Chemoprophylaxis was initiated by 258 (72%) participants. After loading dose, 7 (2.7%) reported grade 2 and 1 (0.4%) grade 3 adverse effects. Discontinuation of HCQ due to side effects was reported in 11 (4.3%) participants. Electrocardiogram was done by 50 (19.4%) participants on HCQ; no abnormalities were noted. A total of 106 (41%) among those taking and 63 (63%) among those not taking HCQ were tested for SARS-CoV-2 due to influenza-like illness or significant exposure. Among all participants, 25 (6.9%, 95% confidence interval [CI] 4.3–9.6) developed COVID-19 during the study period. In the group taking HCQ, 10 (3.9%) tested positive compared to 15 (15%) in the group not taking HCQ (P < 0.001). Odds ratio with HCQ intake was 0.34 (95% CI 0.13–0.83, P = 0.01) and the number needed to treat was 12.Conclusion:HCQ is safe at the recommended dose for pre-exposure prophylaxis of COVID-19.

Coronavirus Disease 2019 (COVID-19) During Pregnancy among African Women: Characteristics of Pregnant Woman at the Start of Pandemic in Ouagadougou, Burkina Faso

Introduction: Little work has been done on coronavirus disease 2019(COVID-19) in pregnant women particularly among African women. Further knowledge is needed to address this gap. During this COVID-19 epidemic, we found and report five (5) confirmed cases of COVID-19 in pregnancy in Burkina Faso. The objective of this study is to describe the clinical characteristics and evolution of COVID-19 among pregnant women that were admitted and treated in hospitals in Ouagadougou. Methodology: This is a case study carried out on COVID-19 care sites in the city of Ouagadougou. All pregnant women admitted between March 9th and June 30th with a positive reverse transcriptase polymerase reaction (RT-PCR) test for SARS- Cov-2 were included in our study population. Results: Five cases of COVID-19 in pregnancy were identified and the mean age of the patients was 27.2 years ± 4.9. The mean gestational age was 20 weeks amenorrhea (WA). Clinically, three (3) patients developed fever, two (2) patients had myalgia, dysphonia, one (1) patient cough, anorexia, asthenia, anosmia and ageusia. Three patients were treated with hydroxychloroquine in combination with azithromycin. The materno-fetal prognosis was good with three virological cures. In one case, there was a persistence of virology and in another case the patient refused the follow-up. Conclusion: The maternofoetal prognosis of women with COVID-19 is good apart from the occurrence of respiratory signs. While there is no reliable evidence to support the possibility of vertical transmission of COVID-19 infection from mother to baby, the infection and inflammation that occurred in response to the viral infection could affect the development of the fetus hence an interest in monitoring the growth of babies.

Determinants of Mortality in Patients with Acute Kidney Injury Caused by Coronavirus Disease 2019 Infection in a Tertiary Care Hospital of South India.

Acute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19), and its severity is linked to the adverse outcomes of multiorgan involvement. We attempted to assess the clinical outcomes and determinants of mortality in patients admitted to our COVID-19 care center from May to November 2020 who developed AKI through a retrospective examination of their case records. The data of those who developed AKI were analyzed for their clinical parameters, clinical presentation, history, laboratory parameters, urine output measurements, requirements for dialysis, treatment, and treatment outcomes (discharge or death). These outcomes were correlated to the comorbidities, laboratory parameters, the Kidney Disease Improving Global Outcomes (KDIGO) AKI stage, sequential organ failure assessment score, and need for dialysis or renal replacement therapy. Of 1890 patients admitted, 132 (6.98%) patients developed AKI. Of 450 deaths from all causes, 67 (14%) were in AKI patients. There were 100 (75.8%) males and 32 (24.8%) females. The mean age was 62.05 ± 11.48 years. The median duration of stay was 7 days (interquartile range: 4--11.75 days). The number of patients in AKI Stages 1, 2, and 3 was 1 (0.75%), 64 (48.48%), and 67 (50.75%), respectively. The most common symptoms were breathlessness (85.6%), fever (84.5%), myalgia (81.19%), and weakness (76.5%). Multivariate analysis showed that the determinants of mortality were a partial pressure of oxygen saturation (pO2) of <75% and of 76%-85% compared with a pO2 of >85%, not receiving remdesivir, and KDIGO Stage >2.

A cross-sectional survey of sleep patterns and quality and its association with psychological symptoms among doctors working in a COVID-19 care facility.

The coronavirus disease 2019 (COVID-19) outbreak has led to several psychological symptoms among frontline doctors of which sleep disturbances are common. Stress due to isolation and disease-related factors are known to be associated with sleep disturbances. The aim of this study is to establish the prevalence of poor sleep and its association with psychological symptoms among doctors working in COVID-19 tertiary hospital. A cross-sectional online survey was conducted among 150 doctors who were treating COVID-19 patients. The survey contained a semi-structured questionnaire including sociodemographic details, Depression Anxiety Stress Scale 21, and Pittsburgh Sleep Quality Index scale. Analysis was done using the SPSS v20. Of 150 doctors, we found 67 (44.67%) and 83 (55.33%) doctors were poor sleepers and good sleepers, respectively. Those who were married (P = 0.001), had higher working hours per month (P = 0.001), the presence of family history of psychiatric illness (P = 0.008), and history of substance use (P = 0.007) were associated with poor sleep. Furthermore, poor sleep was associated with higher stress (P = 0.001), anxiety (P = 0.001), and depression (P = 0.001). A multiple logistic regression revealed that family history of psychiatric illness (odds ratio [OR]-5.44, P = 0.01) and the presence of substance use (OR-7.77, P = 0.01) predicted poor sleep. Sleep pattern abnormalities were present in 45% of the frontline COVID-19 doctors studied. Family history of psychiatric illness and substance use was associated with higher chances of having poor sleep. It is important to recognize and manage sleep abnormalities as these could be initial signs of a psychiatric disorder or manifestations of underlying stress, especially in the vulnerable population.

Predictors of In-hospital Outcomes in Patients with Cirrhosis and Coronavirus Disease-2019

Background: Coronavirus disease-2019 (COVID-19) cases continue to increase globally. Poor outcomes in patients with COVID-19 and cirrhosis have been reported; predictors of outcome are unclear. The existing data is from the early part of the pandemic when variants of concern (VOC) were not the major circulating strains. Aims: We aimed to assess the outcomes and predictors in patients with cirrhosis and COVID-19. We also compared the differences in outcomes between the first wave of pandemic and the second wave. Methods: In this retrospective analysis of a prospectively maintained database, data on consecutive cirrhosis patients (n=221) admitted to the COVID-19 care facility of a tertiary care center in India were evaluated for presentation, severity of liver disease, severity of COVID-19, and outcomes. Results: The clinical presentation included: 18 (8.1%) patients had compensated cirrhosis, 139 (62.9%) acute decompensation (AD), and 64 (29.0%) had acute-on-chronic liver failure (ACLF). Patients with ACLF had more severe COVID-19 infection than those with compensated cirrhosis and AD (54.7% vs 16.5% and 33.3%, P< 0.001). The overall mortality was 90 (40.7%), highest among ACLF (71.9%). On multivariate analysis, independent predictors of mortality were high leukocyte count, alkaline phosphatase, creatinine, child class, model for end-stage liver disease (MELD) score and COVID-19 severity. The second wave had more cases of severe COVID-19 as compared to the first wave, with similar MELD score and child score. The overall mortality was similar between the two waves. Conclusion: Patients with COVID-19 and cirrhosis have high mortality (40%), particularly those with ACLF (72%). A higher leukocyte count, creatinine, alkaline phosphatase, Child class, and MELD score are predictors of mortality.

Burnout, posttraumatic stress disorder, and sleep quality among nurses during the COVID-19 pandemic: a systematic review

Background and aims: Nurses are in direct contact with healthcare clients. Infectious diseases epidemics, such as the coronavirus disease 2019 (COVID-19) pandemic, cause high levels of stress for nurses. The aim of this study was to evaluate burnout, posttraumatic stress disorder (PTSD), and sleep quality (SQ) among nurses during the COVID-19 pandemic. Methods: In this review, the Google Scholar, PubMed, ISI, Scopus, EMBASE, and Psych INFO databases were searched using the keywords "posttraumatic stress disorder", "burnout", "sleep quality", "nurse", "mental health", and "coronavirus disease 2019" to find relevant studies published in English between May 2020 to July 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to appraise the quality of the retrieved studies. Results: The prevalence rates of burnout, PTSD, and low SQ were 25%–60%, 16%–68%, and 18%–38%, respectively. Nurses’ gender, job satisfaction, affiliated hospital ward, work experience, levels of stress and anxiety, and care provision in the frontline of COVID-19 care affected the prevalence of burnout, PTSD, and low SQ. Conclusion: Burnout, PTSD, and low SQ are highly prevalent among nurses during the COVID-19 pandemic. Psychological counseling centers in hospitals need to provide nurses with training and counseling about the management of their mental health problems.

SARS-CoV-2 in hospital air as revealed by comprehensive respiratory viral panel sequencing

SummaryBackgroundNosocomially acquired severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection has become the most significant pandemic of our lifetime. Though its transmission was essentially attributed to droplets from an infected person, with recent advancements in knowledge, aerosol transmission seems to be a viable pathway, as well. Because of the lower biological load in ambient aerosol, detection of SARS-CoV-2 is challenging. A few recent attempts of sampling large aerosol volumes and using next-generation sequencing (NGS) to detect the presence of SARS-CoV-2 in the air at very low levels gave positive results. These results suggest the potential of using this technique to detect the presence of SARS-CoV-2 and use it as an early warning signal for possible outbreak or recurrence of coronavirus disease 2019 (COVID-19).AimTo assess efficacy of comprehensive respiratory viral panel (CRVP) sequencing and RT-PCR for low-level identification of SARS-CoV-2 and other respiratory viruses in indoor air.MethodsA large volume of indoor aerosol samples from three major hospitals involved in COVID-19 care in Kuwait was collected. Viral RNA was isolated and subjected to comprehensive respiratory viral panel sequencing (CRVP) as per the standard protocol to detect the SARS-CoV-2 and other respiratory viruses in the hospital aerosol and monitor variations within the sequences. RT-PCR was also employed to estimate the viral load of SARS-CoV-2.Findings13 of 15 (86.7%) samples exhibited SARS-CoV-2 with a relative abundance of 0.2–33.3%. The co-occurrence of human adenoviruses (type C1, C2, C5, C4), respiratory syncytial virus (RSV), influenza B, and non-SARS-CoV-229E were also recorded. Alignment of SARS-CoV-2 sequences against the reference strain of Wuhan China revealed variations in the form of single nucleotide polymorphisms (SNPs-17), insertions and deletions (indels-1). These variations were predicted to create missense (16), synonymous (15), frameshift (1) and stop-gained (1) mutations with a high (2), low (15), and moderate (16) impact.ConclusionsOur results suggest that using CRVP on a large volume aerosol sample was a valuable tool for detecting SARS-CoV-2 in indoor aerosols of health care settings. Owing to its higher sensitivity, it can be employed as a surveillance strategy in the post COVID times to act as an early warning system to possibly control future outbreaks.

Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

Care of older people and people requiring palliative care with COVID-19: guidance from the Australian National COVID-19 Clinical Evidence Taskforce.

IntroductionOlder people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia.Main recommendationsThe panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care.Changes in management as result of the guidelineThe practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.

414. Observed Time Burden with Nursing Practices in an Emergency Room COVID-19 Isolation Zone at a University Affiliated Hospital in Korea

BackgroundThe coronavirus disease 2019 (COVID-19) has caused great burdens on emergency room (ER) and front-line ER healthcare personnel faced with great challenges, including threats to their safety. This study aimed to provide a basis for additional workload of ER nurses who are charged with providing care for COVID-19 confirmed or suspicious cases.Table 1. Summary of Frequency and Time Burden with Nursing Practices in an Emergency Room COVID-19 Isolation Zone. Note. IV, intravenous; IM, intramuscular; ID, intradermal; SC, subcutaneous; PPE, personal protective equipment; CPR, cardiopulmonary resuscitation MethodsWith institutional review board approval, we recruited ER nurses who were assigned to COVID-19 isolation zone with more than 6 months’ ER work experience. After their demographic information were collected through a questionnaire, their nursing practices and practice time during their 1 shift (day or evening) were recorded by one researcher using a stopwatch and an observation form. For each observation shift, unit-related information was collected, including the numbers of hospitalized patients, admission, discharge, and transfer of patients. For each nursing practice, frequency and total time spent were analyzed using descriptive statistics with SPSS 26.0 program. ResultsFrom January 4 to February 22, 2021, a total 18 nurses (27.4 years old on average with 25.2 months of ER experience) were observed from 20 different shifts. During the observation period, the average number of nurses’ working hours was 8.27 ± 0.39 hours. A total of 6,567 tasks were monitored with 337,703 seconds (93.81 hours) of the total time spent. Infection control practices were most frequent (33.88%) followed by nursing management (27.80%), assessment and observation (11.07%), medication (10.35%), pre and post examination care(4.86%), education (4.37%), communication (4.10%), safety care (1.10%), and others (0.03; Table 1). Nursing management (e.g., nursing recording) was most time-consuming (49.29%) followed by assessment and observation (15.03%), medication (12.94%), patient education (6.10%), infection control (5.30%), and safety care (1.64%).ConclusionThis study showed that infection control practices were most frequent while time spent was relatively insignificant among ER nurses in charge of COVID-19 isolation zones. Further studies for more observations or with different study designs at other ER settings are necessary to understand nurse’s burdens with COVID-19 emergency care.Disclosures All Authors: No reported disclosures