COVID-19 Surge Research Articles

Increases in Ambulance Call Volume Are an Early Warning Sign of Major COVID-19 Surges in Children.

Background: Infectious diseases, including COVID-19, have a severe impact on child health globally. We investigated whether emergency medical service (EMS) calls are a bellwether for future COVID-19 caseloads. We elaborated on geographical hotspots and socioeconomic risk factors. Methods: All EMS calls for suspected infectious disease in the pediatric population (under 18 years of age) in Rhode Island between 1 March 2018 and 28 February 2022 were included in this quasi-experimental ecological study. The first of March 2020 was the beginning of the COVID-19 pandemic. We used the 2020 census tract and the most recent COVID-19 data. We investigated associations between pediatric EMS calls and positive COVID-19 tests with time series analysis and identified geographical clusters using local indicators of spatial association. Economic risk factors were examined using Poisson regression. Results: We included 980 pediatric ambulance calls. Calls during the omicron wave were significantly associated with increases in positive COVID-19 tests one week later (p < 0.001). Lower median household income (IRR 0.99, 95% CI [0.99, 0.99]; p < 0.001) and a higher child poverty rate (IRR 1.02, 95% CI [1.02, 1.02]; p < 0.001) were associated with increased EMS calls. Neighborhood hotspots changed over time. Conclusion: Ambulance calls might be a predictor for major surges of COVID-19 in children.

Effectiveness of Needle Tenotomy for Correction of Equinus in Clubfoot.

During the COVID-19 surge, due to a lack of operating room availability, we performed Achilles tendon tenotomy in clubfoot patients using a 16/18 gauge needle to avoid delay in their management. The procedures were performed on an outpatient basis. The current retrospective study aims to investigate the effectiveness of needle tenotomy for the correction of equinus in clubfoot at a minimum of one year of follow-up. Clinical records of all clubfoot patients that underwent needle tenotomy of Achilles tendon from March 2020 onwards with at least one year of follow-up were reviewed. We recorded Pirani scores and the equinus deformity at the initial presentation, after Achilles tendon tenotomy, and at the final follow-up. We also recorded any procedure-related complications following the Achilles tendon tenotomy. We compared dorsiflexion after final cast removal and after one year of follow-up. A total of 26 clubfeet in 14 patients underwent needle tenotomy of the Achilles tendon and completed one year of follow-up. Ankle dorsiflexion was achievable in all patients and the mean dorsiflexion of 27.4 degrees. The average Pirani score after tenotomy at final cast removal was 0.16, while the mean dorsiflexion at final cast removal was 24.2 degrees (p = .00084).No tenotomy procedure-related complications were noted. Percutaneous needle tenotomy of the Achilles tendon is a simple, safe, and effective technique for equinus correction in clubfoot. Considering the less invasive nature of the procedure, it can be done as a short procedure on an outpatient basis and has a limited risk of hemorrhage and other wound-related complications.

Trauma Incidence During the New Jersey COVID-19 Stay-At-Home Order: A Multicenter Study

IntroductionGiven the early surge of COVID-19 in New Jersey (NJ), a statewide executive order (EO) to stay-at-home was instituted on March 22, 2020. We hypothesized that the EO would result in a decreased number of trauma admissions, length of stay, and resources utilized in trauma patients at NJ trauma centers. MethodsIn an institutional review board-approved, retrospective, multicenter study, trauma registries at three level one trauma centers in NJ were queried from March 22 to June 14 in 2020 and compared to the same timeframe the year prior. Epidemiological and clinical data were obtained including demographics, select preexisting conditions, mechanism of injury, injury severity score, resources utilized, and outcomes. Results1859 trauma patients were evaluated during the EO versus 2201 the year prior. During the EO, trauma patients were less likely to be transferred from another hospital (21% versus 29% P < 0.05), more likely to have a penetrating mechanism (16% versus 12% P < 0.05), were equally likely to require a procedure (P = 0.44) and had similar injury severity score (5 [interquartile range [IQR] 1-9] versus 5 [IQR 1-9], P = 0.73). There was no significant difference in ventilator days (0 [IQR 0-1] versus 0 [IQR 0-2] P = 0.08), intensive care unit days (2 [IQR 0-4] versus 2 [IQR 0-3] P = 0.99), or length of stay (2 [IQR 1-5] versus 2 [IQR 1-6] P = 0.73). Patients were more likely to be sent home than to rehabilitation or long-term acute care hospital during the EO (81% versus 78%, P = 0.02). ConclusionsThe 2020 COVID-19 EO was associated with a significantly different epidemiology with a higher rate of penetrating injury during the EO, and similar volume of injured patients evaluated.

Association between Covid-19 surge and emergency department patient flow and experience

BackgroundPreparations for Covid-19 in the Netherlands included hospital reconfigurations to increase capacity for the expected surge at the emergency department (ED). We describe patients’ ED length of stay (LOS), crowding and experiences of patients with respiratory complaints during the first Covid-19 peak. MethodsRetrospective analysis of demand, ED LOS, crowding, and a patient experience survey during a 12-week period in 2020 and similar periods in 2018 and 2019. Crowding levels were calculated using the National ED OverCrowding Scale. ResultsThe number of patients with respiratory complaints increased significantly, while total ED numbers were unchanged. Although presentation during the Covid-19 peak and needing hospital admission were associated with a longer ED LOS in patients with respiratory complaints, significantly less crowding occurred compared with the 2018 and 2019 periods. Increased ED LOS was associated with lower patient experience scores. ConclusionAdvanced warning and its associated preparation within the hospital and the community prevented significant delays in ED throughput during the first Covid-19 peak.

Value of a confidential COVID-19 helpline for nursing home staff

We hosted a confidential helpline to address concerns about COVID-19 prevention among staff in 12 nursing homes in Orange County, California. We fielded 301 inquiries from April 2021-April 2022, most commonly involving questions about vaccines (40%), nursing home COVID-19 prevention (28%), SARS-CoV-2 variants (18%), symptom reporting (10%), and home and community COVID-19 prevention (5%). During COVID-19 surges, staff dominantly expressed fear, anger, and exhaustion. During nadirs, sentiment shifted towards optimism and acceptance.

Changes in Population Health-Related Behaviors During a COVID-19 Surge: A Natural Experiment.

The study of impact of lockdowns on individual health-related behaviors has produced divergent results. To identify patterns of change in multiple health-related behaviors analyzed as a whole, and their individual determinants. Between March and August 2020, we collected data on smoking, alcohol, physical activity, weight, and sleep in a population-based cohort from Catalonia who had available pre-pandemic data. We performed multiple correspondence and cluster analyses to identify patterns of change in health-related behaviors and built multivariable multinomial logistic regressions to identify determinants of behavioral change. In 10,032 participants (59% female, mean (SD) age 55 (8) years), 8,606 individuals (86%) modified their behavior during the lockdown. We identified five patterns of behavioral change that were heterogeneous and directed both towards worsening and improvement in diverse combinations. Patterns ranged from "global worsening" (2,063 participants, 21%) characterized by increases in smoking, alcohol consumption, and weight, and decreases in physical activity levels and sleep time, to "improvement" (2,548 participants, 25%) characterized by increases in physical activity levels, decreases in weight and alcohol consumption, and both increases and decreases in sleep time. Being female, of older age, teleworking, having a higher education level, assuming caregiving responsibilities, and being more exposed to pandemic news were associated with changing behavior (all p < .05), but did not discriminate between favorable or unfavorable changes. Most of the population experienced changes in health-related behavior during lockdowns. Determinants of behavior modification were not explicitly associated with the direction of changes but allowed the identification of older, teleworking, and highly educated women who assumed caregiving responsibilities at home as susceptible population groups more vulnerable to lockdowns.

Immunomodulators in Mechanically Ventilated Patients With COVID-19: Lessons Learned From Underpowered Trials.

Immunomodulators in Mechanically Ventilated Patients With COVID-19: Lessons Learned From Underpowered Trials.

Impact of COVID-19 on volume of elective and nonelective ventral hernia repair

BackgroundThe significant decrease in elective surgery during the COVID-19 pandemic prompted fears that there would be an increase in emergency or urgent operations for certain disease states. The impact of COVID-19 on ventral hernia repair is unknown. This study aimed to compare volumes of elective and nonelective ventral hernia repairs performed pre–COVID-19 with those performed during the COVID-19 pandemic. MethodsAn analysis of a prospective database from 8 hospitals capturing patient admissions with the International Classification of Diseases, Tenth Revision Procedure Coding System for ventral hernia repair from January 2017 through June 2021 were included. During, COVID-19 was defined as on or after March 2020. ResultsComparing 3,558 ventral hernia repairs pre–COVID-19 with 1,228 during COVID-19, there was a significant decrease in the mean number of elective ventral hernia repairs per month during COVID-19 (pre–COVID-19: 61 ± 5 vs during COVID-19 19: 39 ± 11; P < .001), and this persisted after excluding the initial 3-month COVID-19 surge (61 ± 5 vs 42 ± 9; P < .001). There were fewer nonelective cases during the initial 3-month COVID-19 surge (32 ± 9 vs 24 ± 4; P = .031), but, excluding the initial surge, there was no difference in nonelective volume (32 ± 9 vs 33 ± 8; P = .560).During COVID-19, patients had lower rates of congestive heart failure (elective: 9.0% vs 6.6%; P = .0047; nonelective: 17.7% vs 11.6%; P < .001) and chronic obstructive pulmonary disease (elective: 13.7% vs 10.2%; P = .017; nonelective: 17.9% vs 12.0%; P < .001) and underwent fewer component separations (10.2% vs 6.4%; P ≤ .001). Intensive care unit admissions decreased for elective ventral hernia repairs (7.7% vs 5.0%; P = .016). Length of stay, cost, and readmission were similar between groups. ConclusionElective ventral hernia repair volume decreased during COVID-19 whereas nonelective ventral hernia repairs transiently decreased before returning to baseline. During COVID-19, patients appeared to be lower risk and less complex. The possible impact of the more complex patients delaying surgery is yet to be seen.

Allogeneic Stem Cell Cryopreservation Is Associated with Equivalent Survival and Relapse Rates with Lower Rate of Severe Chronic Gvhd

The ongoing COVID-19 pandemic continues to raise challenges for safe administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT). From March to August 2020, unrelated donor (URD) peripheral blood stem cell (PBSC) products were shipped to central national hubs and cryopreserved either at the site of collection or infusion, a shift from the traditional practice of infusing fresh stem cells. The National Marrow Donor Program (NMDP) instituted this mandate due to uncertainty around international transportation of stem cells as well as a fail-safe to prevent interruptions to a planned transplant if a donor contracted COVID-19 after the recipient started conditioning chemotherapy. We previously published our single institution experience demonstrating equivalent short-term clinical outcomes (overall survival [OS], progression free survival [PFS], relapse, and non-relapse mortality [NRM]) between adult recipients of fresh vs cryopreserved allogeneic stem cells (median follow up time 16 months [fresh] vs 8 months [cryopreserved]) (PMID: 34581754). We also demonstrated lower T-cell chimerism at day 30 and 100 after receipt of cryopreserved grafts. There is a paucity of data evaluating longer term outcomes of patients receiving cryopreserved stem cells compared to fresh. Currently there is variability among donation and transplant centers around the practice of cryopreservation prior to allo-HSCT. With ongoing surges of COVID-19 and evolution of new variants, the risk of donors or recipients contracting COVID-19 leading to delays or disruptions in planned allo-HSCT remains high. In January 2022 with the rise of the Omicron variant of COVID-19, the NMDP reinstated the cryopreservation recommendation. Anecdotal reports indicate multiple recent instances of a planned URD testing positive for COVID-19 after conditioning chemotherapy had started but before stem cell harvest, raising the potential for severe deleterious outcomes in the intended transplant recipient. Given the unremitting COVID-19 surges three years into the pandemic and continued uncertainty around longer-term survival and relapse rates of allo-HSCT using cryopreserved stem cells, we reanalyzed our prior cohort and added 116 additional patients (40 cryopreserved, 76 fresh) with at least 1-year follow up for a total of 141 and 279 patients receiving cryopreserved versus fresh (respectively) URD PBSCs between January 1, 2019, and July 31, 2021. The cohorts had similar baseline characteristics including donor/recipient age/sex, disease, and conditioning regimen/intensity. Patients receiving cryopreserved cells were more likely to receive post-transplant cyclophosphamide as part of the graft versus host disease (GVHD) prophylaxis regimen (24% vs 15%, p=0.015). Median follow-up time among survivors in this cohort was 22 months (range, 4-41 months). Two-year OS was not different in patients receiving fresh versus cryopreserved stem cells (63% vs 63%, p=0.73) (Figure 1A). Two-year PFS was also similar (57% for fresh, 52% for cryopreserved, p=0.27) (Figure 1A). Relapse (36% vs 30%, p=0.17) and NRM (12% vs 13%, p=0.79) at two years were comparable between patients receiving fresh versus cryopreserved stem cells (Figure 1B). In total, 8 patients died of COVID-19 in this cohort (4 fresh, 3 cryopreserved). Cumulative incidence of moderate/severe chronic GVHD (cGVHD) was higher in patients receiving fresh stem cells versus cryopreserved (24% vs 9%, p=0.0003). Whereas cryopreservation was associated with lower T-cell chimerism early after transplant, by 1-year post-transplant, T-cell chimerism was not different (2% vs 5% of fresh vs cryopreserved patients with T-cell chimerism <75% at 1 year, p=0.14). However, Day 30 T-cell chimerism <75% was associated with a reduction in OS and PFS regardless of cryopreservation of stem cells (data not shown). As the COVID-19 pandemic continues with frequent surges in case numbers and rapid viral evolution, the risk for interruptions in life-saving allo-HSCT therapies remains high. Our data show that allo-HSCT with cryopreserved URD PBSCs results in similar OS, PFS, relapse rates, and NRM at 2 years post-transplantation. We found that cryopreservation is associated with lower 1-year cumulative incidence of moderate/severe cGVHD without compromise in OS. While this is an intriguing finding, larger multicenter analyses are needed to confirm these observations. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

QLTI-18. LIQUID BIOPSY: CLINICALLY INTEGRATED RESEARCH IN THE MODERN PANDEMIC ERA

Abstract The COVID-19 pandemic forced a redesign of clinical research to adapt to an ever-changing situation while minimizing patient and provider risks and preserving scientific discovery. During the initial surge of COVID-19, elective healthcare services and non-critical research operations were halted. These changes inspired dispersed health care operations and streamlined clinical research. The first wave of COVID-19 hit Detroit, Michigan, in March 2020, consuming Henry Ford Health (HFH), in COVID-19 emergency care. HFH has a clinically integrated liquid biopsy (LB) program where enrolled patients provide an LB sample via venipuncture within 7 days of each MRI, typically in the clinic at the point-of-care. Prior to COVID-19, 183 neuro-oncology patients were actively providing LB samples in clinic with a mean of 29.9 specimens monthly. Institutional COVID-19 restrictions on non-critical interactions resulted in months were nearly all outpatient encounters utilized telemedicine and decentralized testing off-site from research operations. This halted LB procurement to 4.55 specimens monthly during early pandemic months. To reduce patient-provider exposure, LB specimens were then procured with the venipuncture for MRI which streamlined LB operations and improved the patient experience. After this change, LB specimen procurement returned to near pre-pandemic levels with a mean of 28.1 monthly specimens, despite a significant population utilizing video visits and imaging at satellite or non-HFH centers. The pandemic forced adaptations to patient encounters that have changed how healthcare is delivered, resulting in parallel changes in research that must be considered in the design of future studies.

Decreasing the Nursing Documentation Burden During the Covid-19 Surge

During the Covid-19 pandemic, nurses requested a clean, streamlined, intuitive view of the adult nursing assessment(s) within the electronic medical record (EMR). We created a more efficient method during a national disaster to reduce duplicative efforts and allow additional time with patients. This project was added as part of the Clinically Led EMR Optimization (CLEO) strategy to eliminate unnecessary EMR assessment data elements in the adult medical-surgical and critical care areas. This was completed in a 5-month period and decreased 20% of the data points entered by nursing. 433 data points were excluded or relocated to achieve the desired result.

Abstract 14599: Survival From Sudden Cardiac Arrest During the COVID-19 Pandemic: Two-Year Prospective Evaluation in a Large US Community

Background: Early experience in the COVID-19 pandemic indicated higher rates of out-of-hospital sudden cardiac arrest (SCA) and worse outcomes. There is little data from subsequent surges of Delta and Omicron variants. Hypothesis: All surges in the COVID-19 pandemic affected SCA incidence and outcomes. Methods: In Ventura County CA (pop. 848,112), all SCA cases with likely cardiac etiology and resuscitation attempted by emergency medical services (EMS) were prospectively identified (2015-). Comparisons were conducted between two years of the pandemic period (Feb 1, 2020-Jan 31, 2022) and the corresponding 2y pre-pandemic period (2018-2020) and during COVID surges (&gt;3000 COVID cases / month in the county) vs. non-surge times during the pandemic (&lt;3000 cases / month). COVID monthly incidence was obtained from US CDC data (Fig. red curve). Results: Pre-pandemic there were 671 SCA cases (40/100,000, mean age 70.9 yrs, 63% male) with an increase in the pandemic period (p&lt;0.001) to 894 cases (53/100,000, mean age 69.6 yrs, 65% male). During the pandemic there was significant reduction in SCA survival (16.4% to 9.1%, p &lt;0.001). Survival decreased consistently with each COVID surge. The mean SCA survival during surges (Fig. blue curve) was significantly lower than pre-pandemic (6.3% vs 16.4% dotted blue curve, p &lt;0.001) as well as during non-surge periods (6.3% vs 11.4%, p=0.008). Comparing pre-pandemic to COVID surge periods, the proportion of SCA calls with ambulance response time &lt; 4 min declined from 27.1% to 9.4% (p&lt;0.001) as did the proportion of SCAs with shockable rhythm (26.2% to 18.6%, p=0.004), and bystander CPR (56.9% to 47.9%, p=0.004). Conclusion: SCA rates continue to be higher during the COVID-19 pandemic with persisting significant reductions in survival outcomes at 2y, that are exaggerated during each surge. These findings have implications for ongoing community public health and EMS response planning during the pandemic.

Emergency Medicine Physician Stressors, Needs, and Wellness Resources During the Acute Phase of the COVID-19 Pandemic in New York City

Recent literature suggests that frontline physicians of the COVID-19 pandemic experienced increased stress and psychological burden. This study aimed to evaluate specific stressors, needs, and wellness resources used by emergency medicine (EM) faculty at an academic medical center during the first surge of COVID-19 in New York City to inform best practices to support EM physician wellness. Preliminary data suggest that job-enabling and peer support-centered wellness resources should be prioritized as key elements of a physician wellness strategy.

Seroprevalence of SARS CoV-2 among children after the second surge (June 2021) in a rural district of South India: Findings and lessons from a population-based survey.

To determine the seroprevalence of SARS COV 2 among children in the Bangalore Rural district. We conducted a cross-sectional study after the second surge of COVID-19 from 14 June to 13 July 2021 and recruited 412 children through house to house visits from four villages in a rural district. We administered a questionnaire to collect demographics and details of COVID-19 infection and used the ABCHEK Antibody Card test (NuLifecare,India) which is an ICMR approved test for detecting antibodies (IgG & IgM) by immunochromatography using the finger prick method. We used Statistical Package for the Social Sciences version 20.0 for analysis. Our participants had an age group ranging from 11 months to 18 years. There was an almost equal distribution of boys (48.3%) and girls (51.7%). We estimated seroprevalence of 45.9% (95% CI: 41-50.8) among children. Seroprevalence was significantly associated with a history of symptoms suggestive of COVID-19 in the past, the seropositive status of the parents, and any other family members being tested positive. Age and gender of the child, education and occupation of the parents were not associated with the seropositivity status of the child. Seroprevalence of COVID-19 among children corresponds to adult seroprevalence during the same time interval. This knowledge can be of practical application where adult prevalence is documented. Unvaccinated children in low-resource settings need special attention with respect to monitoring for new mutations as well as managing endemic needs.

Utilizing a Medical Ship in the COVID-19 Response in Fiji

Background/Introduction:Fiji consists of 110 populated islands over an area of 2,600,000 square kilometers and is prone to disasters such as tropical cyclones.1 To increase national capacity to respond to disasters and outbreak, the Fijian government, under the commissioning of Ministry of Transport and with technical guidance from the Ministry of Health, designed a medical ship called the MV Veivueti. During Fiji’s COVID-19 surge, MV Veivueti was utilized to provide operative health services during the surge in COVID-19 patients at other health facilities.2Objectives:To describe FEMAT’s COVID-19 response utilizing the medical ship, MV Veivueti, in Fiji’s Pacific island setting.Method/Description:MV Veivueti has been used on multiple disaster responses, however the COVID-19 surge in mid-2021 was the first time the vessel was used during an outbreak to allow for the continuation of surgeries when other health facilities were overwhelmed with COVID-19 patients. The medical ship is staffed with a comprehensive team from Fiji’s EMT - FEMAT - including surgeons, pediatricians, obstetricians, a dentist, nurses, and other medical staff.Results/Outcomes:From May 5 through July 6, 2021, a 12-member medical team staffed the medical ship 24-hours a day, providing primarily operative management of cases that were referred from health facilities. COVID-19 screening and IPC measures were in place and a clear patient flow was designed for patient transferred to health care facilities.Conclusion:The use of the MV Veivueti helped ensure continuity of critical health services during the peak of the Delta VOC outbreak in the Fiji Islands.

Analyzing the spatio-temporal directions of air pollutants for the initial wave of Covid-19 epidemic over Bangladesh: Application of satellite imageries and Google Earth Engine

One of the most critical issues for city viability and global health is air quality. The shutdown interval for the COVID-19 outbreaks has turned into an ecological experiment, allowing researchers to explore the influence of human/industrial operations on air quality. In this study, we have observed and examined the spatial pattern of air pollutants, specifically CO, NO2, SO2, O3 as well as AOD Over Bangladesh. For that reason, the timeline was chosen from March 2019 to October 2020 (before and during the first surge of COVID-19). The full analysis has been performed in Google Earth Engine (GEE). The findings showed that, CO, SO2, and AOD levels dropped significantly, but SO2 dropped slowly and O3 levels were similar, with marginally greater quantities in some areas during the lockdown than in 2019. During the shutdown, the association involving airborne pollutants and weather parameters (temperature and rainfall) revealed that rainfall and temperature were directly associated with air pollutants. COVID-19 mortality had a high positive connection with NO2 (R2 = 0.145; r = 0.38) and AOD (R2 = 0.17; r = 0.412). It is also found that various air impurities concentration has a strong relationship with Covid death. It would help the policymakers and officials to gain a better understanding of the sources of atmospheric emissions to develop a substantial proof of short- and long-term mitigation ways to enhance air quality and reduce the associated disease and disability burden.

Recovering from COVID-19: lessons learnt from an intensive secondary care follow-up service

In response to the first COVID-19 surge in 2020, secondary care outpatient services were rapidly reconfigured to provide specialist review for disease sequelae. At our institution, comprising hospitals across three sites in London, we initially implemented a COVID-19 follow-up pathway that was in line with expert opinion at the time but more intensive than initial clinical guidelines suggested. We retrospectively evaluated the resource requirements for this service, which supported 526 patients from April 2020 to October 2020. At the 6-week review, 193/403 (47.9%) patients reported persistent breathlessness, 46/336 (13.7%) desaturated on exercise testing, 167/403 (41.4%) were discharged from COVID-19-related secondary care services and 190/403 (47.1%) needed 12-week follow-up. At the 12-week review, 113/309 (36.6%) patients reported persistent breathlessness, 30/266 (11.3%) desaturated on exercise testing and 150/309 (48.5%) were discharged from COVID-19-related secondary care services. Referrals were generated to multiple medical specialties, particularly respiratory subspecialties. Our analysis allowed us to justify rationalising and streamlining provisions for subsequent COVID-19 waves while reassured that opportunities for early intervention were not being missed.

Rift Valley Fever Outbreak during COVID-19 Surge, Uganda, 2021.

Rift Valley fever, endemic or emerging throughout most of Africa, causes considerable risk to human and animal health. We report 7 confirmed Rift Valley fever cases, 1 fatal, in Kiruhura District, Uganda, during 2021. Our findings highlight the importance of continued viral hemorrhagic fever surveillance, despite challenges associated with the COVID-19 pandemic.

COVID-19 surge readiness: use cases demonstrating how hospitals leveraged digital identity access management for infection control and pandemic response

BackgroundSurging volumes of patients with COVID-19 and the high infectiousness of SARS-CoV-2 challenged hospital infection control/safety, staffing, care delivery and operations as few crises have. Imperatives to ensure security of...

Psychological Impact of Covid-19 Surge among Healthcare Workers in Primary, Secondary and Tertiary Care Settings in Cross River State, Nigeria

Introduction: This study investigates the psychological impact of COVID-19 surge and the community spread among healthcare workers (HCWs) in the three tiers of health care delivery system in CRS. Materials and Methods: Descriptive cross-sectional design was adopted for this study. Total population sampling technique guided the recruitment of 776 consenting healthcare workers from one tertiary, one secondary and three randomly selected primary healthcare centres in the state. A well validated researcher developed, adapted and modified 21-item Depression, Anxiety and Stress Scale (DASS-21) online questionnaire with a Cronbach’s alpha coefficient reliability of 0.76, used for data collection. Result: Majority of the respondents were nurses 460 (63.3%) and the mean age was 37.3. The incidence of depression, anxiety, stress and overall psychological problems were 288 (37.1%), 375 (48.3%) 316 (40.7%) and 402 (51.8%). The overall psychological problems were higher in females 331 (58.0%) than in males 71 (34.6%) (PR=1.67). Compared with HCWs who do not have personal contact with patients, HCWs who have personal contact with patients had a higher prevalence of psychological problems (PR=1.83). Conclusion: COVID-19 pandemic has negative psychological impacts on HCWs, and having a pre-existing medical condition increases the risk of impact. Word count: 194 words