COVID-19 Referral Hospital Research Articles

Sociodemographic characteristics and health access associated with COVID-19 infection and death: a cross-sectional study in Malang District, Indonesia

ObjectivesThis study aims to examine sociodemographic characteristics and health access associated with COVID-19 infection and death in Malang District, Indonesia.DesignA non-random cross-sectional study.SettingPopulation in 390 villages in Malang District, East...

Agilitas Organisasi: Meningkatkan Kepuasan Kerja Dan Komitmen Organisasi Tenaga Keperawatan Di Ruang Rawat Inap Pasien Covid-19

The Covid-19 pandemic has affected all aspects of people's lives and the world in a short time. The medical work environment dealing directly with patients is very stressful, especially for nurses who have to be in the inpatient room for 24 hours continuously. The purpose of this study was the extent to which hospital organizational agility could increase job satisfaction and organizational commitment of nurses working in inpatient room COVID-19 patients. This research method is a quantitative research method with data processing tools using the SmartPLS version 3.0. The research data was obtained from an online questionnaire using google form with a non-probability sampling technique, namely a convenience sampling technique (accidental sampling). The respondents of this study were 110 nurses who served in the Covid-19 inpatient service section at the Sentra Medika Group Hospital domiciled in West Java province which was appointed as a Covid-19 referral hospital by the Governor of West Java. The results showed that the direct effect coefficient of organizational agility on organizational commitment was 0.207, job satisfaction on organizational commitment was 0.484, and the indirect effect coefficient of organizational agility on organizational commitment through job satisfaction was 0.234. Thus, it can be concluded that organizational agility has a positive and significant effect on organizational commitment mediated by job satisfaction.

Risk Factors for Mortality Due to Covid-19: A Case Study at a Distric Hospital in March-September 2020

The Covid-19 pandemic, which becomes a global health problem, has widely impacted not only health but also social, economic, and politics in Indonesia. Previous studies have indicated that the patient's prognosis is influenced by the degree of disease, age, gender, and comorbidities. District hospital in Bojonegoro is a Covid-19 referral hospital and 37,1 % of patients who died in march-september 2020. This study was conducted to identify risk factors for death in patients with Covid-19 in hospital so we can reduce casa fatality rate in district hospital in Bojonegoro. The independent variables in the study were age, gender, and comorbid status, while the dependent variable was the output status (recovered or deceased). The study was conducted at a private hospital in East Java in October 2020 on 104 patients as subjects. Data were analyzed using the chi-square test. The results show that all the factors studied, age p = 0.006, gender p = 0.050, and comorbid status p = 0.001, have a statistically significant relationship with mortality. In short, at this hospital, advanced age, male gender, and comorbidities are the risk factors for Covid-19 death.

Seroepidemiology of SARS-CoV-2 in healthcare personnel working at the largest tertiary COVID-19 referral hospitals in Mexico City.

We performed a longitudinal SARS-CoV-2 seroepidemiological study in healthcare personnel of the two largest tertiary COVID-19 referral hospitals in Mexico City. All healthcare personnel, including staff physicians, physicians in training, nurses, laboratory technicians, researchers, students, housekeeping, maintenance, security, and administrative staff were invited to voluntarily participate, after written informed consent. Participants answered a computer-assisted self-administered interview and donated blood samples for antibody testing every three weeks from October 2020 to June 2021. A total of 883 participants (out of 3639 registered employees) contributed with at least one blood sample. The median age was 36 years (interquartile range: 28-46) and 70% were women. The most common occupations were nurse (28%), physician (24%), and administrative staff (22%). Two hundred and ninety participants (32.8%) had a positive-test result in any of the visits, yielding an overall adjusted prevalence of 33.5% for the whole study-period. Two hundred and thirty-five positive tests were identified at the baseline visit (prevalent cases), the remaining 55 positive tests were incident cases. Prevalent cases showed associations with both occupational (institution 2 vs. 1: adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.54-3.25; laboratory technician vs. physician: aOR = 4.38, 95% CI: 1.75-10.93) and community (municipality of residence Xochimilco vs. Tlalpan: aOR = 2.03, 95% CI: 1.09-3.79) risk-factors. The incidence rate was 3.0 cases per 100 person-months. Incident cases were associated with community-acquired risk, due to contact with suspect/confirmed COVID-19 cases (HR = 2.45, 95% CI: 1.21-5.00). We observed that between October 2020 and June 2021, healthcare workers of the two largest tertiary COVID-19 referral centers in Mexico City had similar level of exposure to SARS-CoV-2 than the general population. Most variables associated with exposure in this setting pointed toward community rather than occupational risk. Our observations are consistent with successful occupational medicine programs for SARS-CoV-2 infection control in the participating institutions but suggest the need to strengthen mitigation strategies in the community.

Fear, Anxiety, and Depression among Employees of the Department of Rehabilitation Medicine - Philippine General Hospital amidst Changes from the COVID-19 Pandemic: A Cross-sectional Study

Objective. This study described levels of fear, anxiety, depression, and contributing factors among health providers and administrative staff of the Department of Rehabilitation Medicine, Philippine General Hospital (PGH-DRM) during the COVID-19 pandemic.
 Methods. The cross-sectional study was conducted from August to November 2020. We recruited 71 participants who were working in the premises of the hospital and those who were working from home by purposive sampling. The fear numerical rating scale and Hospital Anxiety and Depression Scale were used to determine the presence of fear, anxiety, and depression. The 36-Item Short Form Survey (SF-36) was used to determine the baseline level of physical and mental wellness among participants.
 Results. Seventy-three percent of the full-time, permanent employees of the PGH-DRM unit joined the study. Majority of the respondents were health providers (86%) but only one hospital staff had high-risk contact with patients with COVID-19. Most participants (63%) did a combination of on-site work and home-based work and three (4%) worked entirely from home. Moderate to severe levels of fear was reported by 54% of the participants. Fear levels were highest among those who worked on-site. Anxiety was borderline in 32%, and abnormal in 30%, while depression was borderline in 21%, and abnormally high in 34% of the participating employees. Feelings of anxiety were higher among those who worked on-site and who worked both on-site and from home, while depression was highest among those who worked from home. The SF-36 Physical Health Summary score (x̄ = 72.49) was higher than the Mental Health Summary score (x̄ = 55.45). Employees who worked from home had the highest SF-36 summary scores for both mental and physical health.
 Conclusion. The employees of the DRM had low-risk contact work assignments when the PGH transitioned to a tertiary level COVID-19 referral hospital. Half of the employees experienced fear, anxiety, and depression and had low SF-36 summary scores in mental health. Further studies are needed to determine the key factors that affect their mental health and well-being during the pandemic. A relevant mental health and wellness program is strongly recommended.

Comparative Study of Nurse Compliance in the Implementation of Effective Communication Methods Situation, Background, Assessment, Recommendation (SBAR) In Referral and Non Referral Hospitals COVID-19 Aceh Province

Communication is one of the most important things in providing services to patients because everything related to Covid-19 patients must be conveyed clearly, well and correctly. Communication Situation, Background, Assessment, Recomendation is a strategy that has been developed to address the problems that often occur in the realm of health services that are used to improve and improve health professional services and to reduce the occurrence of errors in service. The study used comparative studies by comparing 2 groups of hospitals as a comparison tool. The location of this study is in 2 different hospitals namely Fauziah Bireuen Hospital and Pidie Jaya Hospital and was conducted in December 2021. The instrument used is a questionnaire designed by the researcher to then conduct a test of validity and reliability. Data analysis using mann whitney statistical tests. The results of the study were obtained from both hospitals that were compared to both in the compliant category. Only in Non Referral Hospitals there are few nurses who have not done effective communication SBAR. As for the bivariate results obtained is the value of p value 0.000 < 0.05. If the value p value < the critical limit of 0.05 then there is a meaningful difference between the two groups or that means H1 is accepted. Nurses who served at Covid-19 Referral Hospital were declared compliant in carrying out effective communication with the SBAR method at the time of handover. The conclusion obtained from the results of this study is that nurses who serve in Covid-19 Non Referral Hospitals are declared compliant in carrying out effective communication with the SBAR method at the time of handover, there are differences related to the implementation of effective communication with the SBAR method at the time of handover between Covid-19 Referral Hospital and Non Referral Hospital Covid-19.

Clinical characteristics and risk factors for mortality among COVID-19 hospitalized patients in UAE: Does ethnic origin have an impact.

BackgroundThe relationship between COVID-19 patient’s clinical characteristics and disease manifestation remains incompletely understood. The impact of ethnicity on mortality of patients with COVID-19 infection is poorly addressed in the literature. Emerging evidence suggests that many risk factors are related to symptoms severity and mortality risk, emphasizing the necessity of fulfilling this knowledge gap that may help reducing mortality from COVID-19 infections through tackling the risk factors.AimsTo explore epidemiological and demographic characteristics of hospitalized COVID-19 patients from different ethnic origins living in the UAE, compare them to findings reported across the globe and determine the impact of these characteristics and ethnicity on mortality during hospitalization.MethodsA single center, retrospective chart review study of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The following outcomes were assessed: patients’ clinical characteristics, disease symptoms and severity, and association of ethnicity and other risk factors on 30-day in hospital mortality.ResultsA total of 3296 patients were recruited in this study with an average age of 44.3±13.4 years old. Preliminary data analysis indicated that 78.3% (n = 2582) of cases were considered mild. Average duration of hospital stay was 6.0±7.3 days and 4.3% (n = 143) were admitted to ICU. The most frequently reported symptoms were cough (32.6%, n = 1075) and fever (22.2%, n = 731). The 30-day mortality rate during hospitalization was 2.7% (n = 90). Many risk factors were associated with mortality during hospitalization including: age, respiratory rate (RR), creatinine, and C-reactive protein, oxygen saturation (SaO2), hemoglobin, hematocrit, ferritin, creatinine, C-reactive protein, anemia, COPD, Chronic kidney disease, dyslipidemia, Vitamin-D Deficiency, and ethnic origin (p <0.05). Multiple logistic regression analysis showed that higher mortality rates during hospitalization was associated with anemia, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and Middle Eastern origin (p<0.05).ConclusionThe results indicated that most COVID-19 cases were mild and morality rate was low compared to worldwide reported mortality. Mortality rate during hospitalization was higher in patients from Middle East origin with preexisting comorbidities especially anemia, COPD, and chronic kidney disease. Due to the relatively small number of mortality cases, other identified risk factors from univariate analysis such as age, respiratory rate, and Vitamin-D (VitD) deficiency should also be taken into consideration. It is crucial to stratify patients on admission based on these risk factors to help decide intensity and type of treatment which, possibly, will reduce the risk of death.

Nurse workforce scheduling: A qualitative study of Indonesian nurse managers' experiences during the COVID-19 pandemic.

The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources. This study aimed to explore the experiences of nurse managers in managing staff nurses' work schedules during the COVID-19 pandemic. A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study. Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff. The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.

Analisis Determinan Kesehatan Terhadap Kepatuhan Pemakaian Alat Pelindung Diri (Proteksi Radiasi) Bagi Radiografer di Wilayah Pasuruan Dan Sidoarjo

Background: Hospitals in Pasuruan and Sidoarjo are Covid-19 referral hospitals that are very at risk of occupational infections for officers. Radiographer are workers who have more direct contact with patients, therefore nurses must apply the use of Personal Protective Equipment (APD) following the Standard Operating Procedure (SOP). The purpose of the study was to analyze the influence of health determinants (supervision, self-efficacy, and work culture) on compliance with the use of personal protective equipment (radiation protection) for radiographers in the Pasuruan and Sidoarjo regions.Methods: Design observational research with a cross-sectional approach. The population of all radiographers in the Pasuruan and Sidoarjo is 100 people. Sampled all 100 radiographers with total sampling techniques. Independent variables of supervision, self-efficacy, and work culture. Variable dependent compliance with the use of personal protective equipment (radiation protection) for radiographers.Results: The results showed there was an influence of radiographer surveillance patterns on compliance with the use of personal protective equipment (radiation protection) for radiographers (p-value 0.000), there was an effect of radiographer self-efficacy on compliance with the use of personal protective equipment (radiation protection) for radiographers (p-value 0.000), there was the influence of radiographer work culture on compliance with the use of personal protective equipment (radiation protection) for radiographers (p-value 0.000).Conclusions: Supervision, self-efficacy, and work culture are among the factors that significantly influence radiographer adherence to the use of PPE. The hope is that by having a good knowledge of K3, nurses will be more obedient to protection as prevention of infection transmission.

Effectiveness and safety profile of mesenchymal stem cell secretome as a treatment for severe cases of COVID-19: a randomized controlled trial

Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over MSCs. We conducted a study to investigate secretomes’ effectiveness and safety profile as a treatment for severe COVID-19. Methods: A double-blind, multicenter, randomized, placebo-controlled trial was conducted between February 2021 and July 2021 in three top COVID-19 referral hospitals in the Greater Jakarta area, Indonesia. Eligible subjects (n=40) were randomized in a 1:1 ratio to an intervention group (n=20) and a control group (n=20). The primary outcome of this study was the changes in inflammatory markers and the ratio of inflammatory to anti-inflammatory markers. The secondary outcomes of this study included clinical outcome, laboratory outcome, radiological outcome, RT-PCR result conversion, and safety profile of MSC secretome. Results: Our analysis showed that on the 14th day after placebo administration, IL-6 level in the control group was significantly increased [4.110 (2.403–12.820) at baseline to 13.320 (2.958–33.285) on the 14th day after intervention, p=0.017]. The IL-6/IL-10 ratio in the control group was significantly increased (p=0.036) on the 14th day after placebo administration. We also found that most of the subjects who received placebo had high levels of IL-6 and ferritin (p=0.043) on the seventh day after the intervention. However, we found no significant differences in inflammatory marker levels on the seventh day and 14th day after intervention between both groups. There was no adverse event reported. There were no significant differences in the laboratory outcome, radiology outcome, RT-PCR result conversion, and safety profiles between both groups. Conclusions: MSC secretome can control inflammation in patients with severe COVID-19 and has a good safety profile. MSC secretome is a promising treatment modality for severe COVID-19.

Cutaneous manifestations of COVID-19 in a tertiary COVID-19 referral hospital in the Philippines

BackgroundReports on COVID-19 skin manifestations and associated clinical outcomes are limited. Like viral diseases, cutaneous findings may be present and can help in confirmation and prognostication among those suspected or diagnosed with COVID-19.ObjectiveTo determine COVID-19 cutaneous manifestations and their association with disease severity and course.MethodsThis study was conducted in a designated COVID-19 referral hospital from January 1 to March 31, 2021. Skin manifestations recorded from January 1 to February 17 were retrospectively gathered. Reports from February 18 to March 31 were prospectively collected using a dermatologic checklist which was incorporated into all official medical records.ResultsA total of 507 confirmed patients with COVID-19 were included. COVID-19 skin signs were detected in 39 patients (7.7%). Morbilliform lesions were most common. Skin signs were significantly associated with severe or critical cases (odds ratio, 3.4; 95% CI, 1.3-8.7) and mortality (relative risk, 2.9; 95% CI, 2.0-4.2).LimitationsUnderestimation of prevalence of COVID-19 skin signs due to exclusion of outpatient and discharged patients and the subjective assessment in the retrospective part.ConclusionCutaneous signs were significantly associated with severe/critical COVID-19 as well as death among 507 hospitalized patients in a Philippine COVID-19 referral hospital.

Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center.

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO2 and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO2, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO2 level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO2 of −1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0–4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

Health Care Providers' Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran.

This study aimed to investigate the health care providers’ attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients.

The Psychological Condition of Healthcare Professionals during the COVID-19 Pandemic at a Referral Hospital in Southeast Sulawesi, Indonesia

Background: A significant increase in positive cases in Indonesia has increased the number of health care personnel, nurses, and physicians who have been exposed to COVID-19, which creates a unique psychological burden for health professionals.&#x0D; Aim: The purpose of this study is to analyze the relationship between the psychological responses of health professionals and anxiety/depression in the hospital by using the Fear of COVID-19 scales and the Hospital Anxiety And Depression Scale (HADS), respectively.&#x0D; Methods: The method is quantitative with a cross-sectional survey approach using an online questionnaire. A total of 207 health professionals working at the COVID-19 referral hospital are selected as participants.&#x0D; Results: The result of the Pearson correlation test showed that the highest fear level of health professionals against COVID-19 was 41.5 %, while the most anxiety and depression levels are at the usual level of 76.3 % and 60.4 %, respectively. There is a direct relationship between fear of COVID-19 and anxiety and depression, with significant values of 0.000 and 0.026, respectively.&#x0D; Conclusions: This research shows the significance of paying close attention to the psychological state of health professionals during a pandemic. As a result, the government must support their mental health by providing counselling with more accurate and up-to-date information.

Ischemic stroke in COVID-19 patients: a cross-sectional study from an Indonesian COVID-19 referral hospital

BackgroundCOVID-19 increases the risk of acute ischemic stroke. The objective of this study is to identify the risk factors, comorbidities, and outcomes in COVID-19 patients with acute ischemic stroke at University of Indonesia Hospital.ResultsThe clinical condition of COVID-19 patients with ischemic stroke is more severe for patients older than 55 years (p < 0.05), patients at the critical COVID-19 clinical stage, and patients with atrial fibrillation (p < 0.05). The level of C-reactive protein (CRP) more than 60 mg/L correlated with the outcome of the patient as well.ConclusionThe study concluded that, age, COVID-19 clinical degree, and atrial fibrillation significantly affect the outcome in COVID-19 patients with stroke.

Explaining the challenges of hospitals admitting COVID-19 patients from the perspective of managers (a qualitative study).

Crises are often unavoidable events that occur around the world. Hospitals play an important role in treating patients and preventing extensive injuries in times of crisis, requiring adequate preparedness. In order to design a proper planning system, it is essential to be aware of the challenges of hospitals during a crisis. The purpose of this study was to explain the challenges of hospitals admitting COVID-19 patients in the city of Mashhad, Iran, from the perspective of their managers. This study employed a qualitative approach, using the method of conventional content analysis and was conducted from May to July 2020. A purposive sampling method was used to recruit the senior managers of hospitals admitting COVID-19 patients in Mashhad. The interviews were conducted face to face, with open-ended questions following an interview guide based on semi-structured questions, and continued until data saturation was reached. Data were analyzed using Atlas Ti software. After the implementation of the interviews, first 665 initial codes were extracted from the data, and after removing the overlapping sequences, a total of 115 codes were obtained. Three categories (organizational challenges, extra organizational challenges, and challenges related to information domain), 13 sub-categories, and 33 codes were extracted from the content analysis of the interviews. The main themes propounded in the field of challenges of COVID-19 referral hospitals in Mashhad were organizational challenges, extra organizational challenges, and information domain challenges. The results of this study showed that the hospitals admitting COVID-19 patients in Mashhad faced many challenges. To improve the quality of services in postcrisis phase, replacing hospitals' equipment, revising curriculums at medical universities, staff retraining, recruiting skilled human resources, and creating a supportive community context are necessary. For sure, the COVID-19 crisis will not be the last one, we have to be prepared for the bigger health crisis.

Prevalence of dry eye syndrome associated to face mask among Tabanan General Hospital Health workers in 2021

Background: The continuous development of COVID-19 has made face masks became a mandatory part of our daily routine, but there has been an increase in dry eye syndrome (DES) from the regular used of face masks. Health workers who are obliged to use face masks are the one that has risk factors for experiencing DES, including health workers at Tabanan General Hospital, as one of the COVID-19 referral hospitals in Bali. The purpose of this study was to calculate the prevalence of DES associated to face masks and characteristics of DES among Tabanan General Hospital health workers in 2021. Methods: This research was a descriptive cross sectional study that conducted at Tabanan General Hospital from March to April 202. The sample was 64 health workers at Tabanan General Hospital with consecutive sampling techniques using the Ocular Surface Disease Index (OSDI) questionnaire. Data were collected by using questionnaire. Data were annalyse descriptively by using SPSS 25 and the result were provide in table. Results: The prevalence of DES associated to face masks among Tabanan General Hospital health workers in 2021 was 70.3%, with a prevalence of mild degrees 15.6%, moderate 12.5%, and severe 42.2%. The prevalence of surgical mask users was greater than Filtering Face Piece (FFP) 2 mask users in mild and severe degrees of DES. Characteristics of DES among Tabanan General Hospital health workers in 2021 were found mostly in age 30-39 years old, more in females, without DM history, non-smokers, and without eye surgery history. Conclusion: Most of the health workers at Tabanan General Hospital experiencing DES associated to face masks, and mostly with a severe degree. Among those with DES, there were more surgical mask users than FFP2 mask users. Future studies are needed to analyze the association between DES and face masks.

SARS-CoV-2 loads in urine, sera and stool specimens in association with clinical features of COVID-19 patients

BackgroundCOVID-19 pandemic continues to be a priority in public health worldwide, and factors inherent to SARS-CoV-2 pathogenesis and genomic characteristics are under study. Investigations that evaluate possible risk factors for infection, clinical manifestations, and viral shedding in different specimens also need to clarify possible associations with COVID-19 prognosis and disease outcomes. Study designIn this study, we evaluated SARS-CoV-2 positivity and estimated viral loads by real-time RT-PCR in stool, sera, and urine samples from 35 patients, with a positive SARS-CoV-2 RNA molecular test in respiratory sample, attended at a University COVID-19 referral hospital in Goiania, Goias, Brazil. Whole-genome sequencing was also performed in samples with higher viral load. ResultsThe positivity index was 51.43%, 14.28%, and 5.71% in stool, sera, and urine specimens, respectively. The median viral load was 8.01 × 106 GC/g, 2.03 × 106 GC/mL, and 1.36 × 105 GC/mL in stool, sera, and urine, respectivelly. Of all patients, 88.57% had previous comorbidities, and 48.39% of them had detectable SARS-CoV-2 RNA in at least one type of clinical specimen evaluated by this study (stool, sera or urine). A higher viral load was observed in patients with more than two previous comorbidities and that were classified as severe or critical conditions. Samples with the highest viral loads were sequenced and characterized as B.1.1.33 variant. ConclusionWe conclude that SARS-CoV-2 RNA is present in more than one type of clinical specimen during the infection, and that the most critical patients had detectable viral RNA in more than one clinical specimen at the same time point.

COVID-19 and the Mental Health of Frontline Nurses: A Cross-sectional Study in Southwestern Iran

Background: Nurses, as frontline health workers, are exposed to the risks of adverse mental health outcomes due to their direct contact with COVID-19 patients. Objectives: The present study aimed to investigate the mental health of frontline nurses in Behbahan, southwestern Iran. Methods: In this web-based cross-sectional study, data from 173 frontline nurses were collected in 3 COVID-19 referral hospitals in Behbahan, southwestern Iran. This study included demographic information and General Health Questionnaire (GHQ-28). Logistic regression analysis was used to examine the variables affecting mental health. Results: The present study included 173 frontline nurses (nurses and nurse assistants), 71.7% of whom were female and 28.3% of whom were male. Further, 76.3% of frontline nurses were suspected of poor mental health, and 23.7% were mentally healthy. The results of the multivariable logistic regression model showed that female participants had poorer mental health than men (odds ratio [OR], 2.51; 95% CI, 1.16 - 5.41; P = 0.01). The mental health of nurses with a history of COVID-19 infection was poorer than that of nurses without a history of COVID-19 infection (OR, 3.3; 95% CI, 1.42 - 7.53; P = 0.006). Conclusions: The findings of our study showed that female nurses with a history of COVID-19 were more at risk for poor mental health. These groups need more attention and support in epidemics.

Impact of prior infection status on antibody response to the BNT162b2 mRNA COVID-19 vaccine in healthcare workers at a COVID-19 referral hospital in Milan, Italy

ABSTRACT In Italy, SARS-CoV-2 vaccination campaign prioritized healthcare workers (HCWs) to receive two doses of BNT162b2 vaccine, irrespective of a previous SARS-CoV-2 infection. In this real-life study, we compared the humoral response to BNT162b2 vaccine in HCWs with and without a previous SARS-CoV-2 infection. Of the 407 HCWs enrolled, 334 (82.1%) were SARS-CoV-2-naive and 73 (17.9%) SARS-CoV-2-experienced. Post-vaccine humoral response was detectable in more than 98% of HCWs. Overall, the median level of anti-S IgG in SARS-COV-2-experienced HCWs was twice as high as those of SARS-CoV-2-naive subjects (24641.0 AU/mL [IQR: 15273.0–>40000.0] versus 13053.8 [IQR: 7303.3–20105.8]; p < .001), irrespective of the time elapsed from SARS-CoV-2 previous infection. In a subgroup of SARS-CoV-2-naive and -experienced subjects who received only one dose of the vaccine, the latter showed 32 times higher levels of anti-S IgG compared to the former. Although no serious adverse events have been reported, mild to moderate side effects occurred more frequently after the first dose in the SARS-CoV-2-experienced than in naive subjects (67% versus 42%, respectively; p < .001). Notably, post-vaccination anti-SARS-CoV-2 spike IgG levels ≥20,000 AU/mL were independently associated with the risk of fever ≥38°C (adjusted odds ratio [aOR] 5.122, 95% CI 2.368–11.080, p < .0001). Our study showed high responsiveness of BNT162b2 vaccine and a relationship between levels of antibody response and reactogenicity. It suggests that a single dose of mRNA vaccine might evoke effective protection in SARS-CoV-2-experienced subjects.