Higher Risk Of COVID-19 Research Articles

Investigation of the Readability and Reliability of Online Health Information for Cancer Patients During the Coronavirus Pandemic.

For cancer patients undergoing treatment who may be at higher risk of COVID-19, access to high-quality online health information (OHI) may be of particular importance amidst a plethora of harmful medical misinformation online. Therefore, we assessed the readability and quality of OHI available for various cancer types and treatment modalities. Search phrases included “cancer radiation COVID,” “cancer surgery COVID,” “cancer chemotherapy COVID,” and “cancer type COVID,” for the fourteen most common cancer types (e.g., “prostate cancer COVID” and “breast cancer COVID”), yielding a total of 17 search phrases. The first 20 sources were recorded and analyzed for each keyword, yielding a total of 340 unique sources. For each of these sources, the approximate grade level required to comprehend the text was calculated as a mean of five validated readability scores; subsequently, for the first ten results of each search, the DISCERN tool was manually used to assess quality. Search terms were translated into Spanish and French, and a quality assessment using the Health on the Net Code (HONcode) accreditation was conducted. The median grade level readability for all sources was 13 (IQR 11–14). Median DISCERN scores for the 170 sources assessed were 55 out of 75, suggesting good quality. OHI with quality scores below the median DISCERN score had a median readability of 12.5 (IQR 11–14) grade reading level vs 14 (IQR 12–17) for those above the median DISCERN score (T-test P < 0.0001). Percentages of HONcode-accredited websites were 34.9%, 39.9%, and 38.6% for English, Spanish, and French OHI, respectively. We conclude that efforts are needed to make high-quality OHI available at the appropriate reading level for patients with cancer; such efforts may contribute to the alleviation of disparities in access to healthcare information.

Lactoferrin as Immune-Enhancement Strategy for SARS-CoV-2 Infection in Alzheimer's Disease Patients.

Coronavirus 2 (SARS-CoV2) (COVID-19) causes severe acute respiratory syndrome. Severe illness of COVID-19 largely occurs in older people and recent evidence indicates that demented patients have higher risk for COVID-19. Additionally, COVID-19 further enhances the vulnerability of older adults with cognitive damage. A balance between the immune and inflammatory response is necessary to control the infection. Thus, antimicrobial and anti-inflammatory drugs are hopeful therapeutic agents for the treatment of COVID-19. Accumulating evidence suggests that lactoferrin (Lf) is active against SARS-CoV-2, likely due to its potent antiviral and anti-inflammatory actions that ultimately improves immune system responses. Remarkably, salivary Lf levels are significantly reduced in different Alzheimer’s disease (AD) stages, which may reflect AD-related immunological disturbances, leading to reduced defense mechanisms against viral pathogens and an increase of the COVID-19 susceptibility. Overall, there is an urgent necessity to protect AD patients against COVID-19, decreasing the risk of viral infections. In this context, we propose bovine Lf (bLf) as a promising preventive therapeutic tool to minimize COVID-19 risk in patients with dementia or AD.

KNOWLEDGE, ATTITUDE AND PRACTICE ABOUT COVID-19 AND VACCINE ACCEPTANCE AMONG FAMILY PHYSICIAN IN AL-MADINAH

Background: COVID-19 vaccination is very important to get immunity agents new against SARS-CoV-2. Also, it’s important to know the knowledge and attitude and welling to get vaccination about covid-19 in family physicians cause the are the first line doctor and people get medical information from them so this why we chose this population to assess knowledge and willing to get vaccine. This study aims to assess family physician awareness about covid-19 and its vaccine in al Madinah and to explore the association between knowledge and awareness of covid-19 and acceptance to take its vaccine. The study also assessed the awareness of the covid-19 and the acceptance of covid-19 vaccine. Methodology: A cross-sectional study that was carried out in Al-Madinah. The study was done on family physicians in Al-Madinah. A self-administered questionnaire was used in previous publications in the English language, the questionnaire was done online. By sending the questionnaire by WhatsApp. Data was verified by hand and then was coded, entered, and analyzed using SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Official Data was presented using means and standard deviation and frequency number and percent according to the type of variable. The result will significant if p-value &lt;0.05. Results:The study included 152 participants, 57.9% were males and 42.1% were females. 61.2% aged between 25- 30 years old and 24.3% aged between 31- 40 years old. 59.9% of participants strongly agree that SARS-CoV-2 can be transmitted by respiratory droplets. 35.5% strongly agree that Symptoms of COVID-19 can be similar with those of seasonal flu. 52.6% strongly agree that COVID-19 cause serious illness and death. 56.6% of study participants wash their hands before and after contact with the patient/patient’s environment. 30.9% think there is an available specific drug therapy for COVID-19 while 99.3% think is an available vaccine for COVID-19. However, all study participants received vaccine against COVID-19. Only 63.2% think they have sufficient level of knowledge about CIVID-19 and 39.5% intend to take the 3rd dose of vaccine. Conclusion: Health care professionals are expected to be at high risk for COVID-19 because of contact with confirmed and suspected cases at the frontline. Family physicians in Saudi Arabia have moderate level of knowledge, attitude and practice towards COVID-19 vaccine.

The rs8176740 T/A and rs512770 T/C Genetic Variants of the ABO Gene Increased the Risk of COVID-19, as well as the Plasma Concentration Platelets.

We conducted a case-control study in order to evaluate whether ABO gene polymorphisms were associated with a high risk of developing COVID-19 in a cohort of patients. Six ABO gene polymorphisms (rs651007 T/C, rs579459 T/C, rs495828 T/G, rs8176746 A/C, rs8176740 T/A, and rs512770 T/C) were determined using TaqMan genotyping assays in a group of 415 COVID-19 patients and 288 healthy controls. The distribution of rs651007 T/C, rs579459 T/C, rs495828 T/G, and rs8176746 A/C polymorphisms was similar in patients and healthy controls. Nonetheless, under co-dominant (OR = 1.89, pCCo-dominant = 6 × 10−6), recessive (OR = 1.98, pCRecessive = 1 × 10−4), and additive (OR = 1.36, pCAdditive = 3 × 10−3) models, the TT genotype of the rs8176740 T/A polymorphism increased the risk of developing COVID-19. In the same way, under co-dominant, recessive, and additive models, the TT genotype of the rs512770 T/C polymorphism was associated with a high risk of developing COVID-19 (OR = 1.87, pCCo-dominant = 2 × 10−3; OR = 1.87, pCRecessive = 5 × 10−4; and OR = 1.35, pCAdditive = 4 × 10−3, respectively). On the other hand, the GTC and GAT haplotypes were associated with a high risk of COVID-19 (OR = 5.45, pC = 1 × 10−6 and OR = 6.33, pC = 1 × 10−6, respectively). In addition, the rs8176740 TT genotype was associated with high-platelet plasma concentrations in patients with COVID-19. Our data suggested that the ABO rs512770 T/C and rs8176740 T/A polymorphisms increased the risk of developing COVID-19 and the plasma concentration of platelets.

Application of Health Belief Model for the assessment of COVID-19 preventive behavior and its determinants among students: A structural equation modeling analysis.

COVID-19 is a new pandemic that poses a threat to people globally. In Ethiopia, where classrooms are limited, students are at higher risk for COVID-19 unless they take consistent preventative actions. However, there is a lack of evidence in the study area regarding student compliance with COVID-19 preventive behavior (CPB) and its predictors. This study aimed to assess CPB and its predictors among students based on the perspective of the Health Belief Model (HBM). A school-based cross-sectional survey was conducted from November to December 2020 to evaluate the determinants of CPB among high school students using a self-administered structured questionnaire. 370 participants were selected using stratified simple random sampling. Descriptive statistics were used to summarize data, and partial least squares structural equation modeling (PLS-SEM) analyses to evaluate the measurement and structural models proposed by the HBM and to identify associations between HBM variables. A T-value of > 1.96 with 95% CI and a P-value of < 0.05 were used to declare the statistical significance of path coefficients. A total of 370 students participated with a response rate of 92%. The median (interquartile range) age of the participants (51.9% females) was 18 (2) years. Only 97 (26.2%), 121 (32.7%), and 108 (29.2%) of the students had good practice in keeping physical distance, frequent hand washing, and facemask use respectively. The HBM explained 43% of the variance in CPB. Perceived barrier (β = - 0.15, p < 0.001) and self-efficacy (β = 0.51, p <0.001) were significant predictors of student compliance to CPB. Moreover, the measurement model demonstrated that the instrument had acceptable reliability and validity. COVID-19 prevention practice is quite low among students. HBM demonstrated adequate predictive utility in predicting CPBs among students, where perceived barriers and self-efficacy emerged as significant predictors of CPBs. According to the findings of this study, theory-based behavioral change interventions are urgently required for students to improve their prevention practice. Furthermore, these interventions will be effective if they are designed to remove barriers to CPBs and improve students' self-efficacy in taking preventive measures.

225 An acute decline in utilisation of the obstetric and gynaecology emergency service during The COVID-19 Pandemic in MALTA

Introduction: The COVID-19 pandemic has disrupted health services worldwide. Quarantine laws and a perception of the high risk of COVID-19 in hospitals has led to a substantial drop in the number of patients presenting to the Emergency Department. The aim of this study was to assess the utilisation of the obstetric and gynaecology emergency services during the COVID-19 pandemic and compare these numbers to pre-pandemic emergency attendances. Design: Population-based study. Methodology: We reviewed the total number of attendees to the Gynae Admission Room at Mater Dei Hospital during the months of March to December 2019 (pre-pandemic) and March to December 2020 (COVID-19 pandemic).

Has the COVID-19 lockdown wreaked havoc on diet and lifestyle choices?

Background: The COVID-19 pandemic induced nationwide lockdown affected the 1.3 billion population of India. Home confinement and isolation have caused sudden lifestyle and dietary changes. A healthy diet is crucial in this period. Studies have shown that subjects with severe obesity and smokers are at higher risk of COVID-19. Such studies can help advocate nutritional interventions to support the health status of people. Hence this study aims to investigate the impacts of COVID-19 lockdowns on dietary behavior and lifestyle habits of adults.Methods: This is a cross sectional study done in Chengalpattu district with a sample size of 150 adults. Two-stage random sampling was done and a semi structured, self-administered online questionnaire was used. IBM statistical package for the social sciences (SPSS) v.21 was used for analyses.Results: In this study 46% people reported snacking more during the COVID-19 lockdown. An increase in alcohol consumption was seen in 14.6% and 45% smokers experienced a rise in smoking frequency. There was a 2.6% decrease in the number of people spending time for physical fitness during lockdown and the perception of weight gain was observed in 46.7% of respondents. Sleep duration seemed to have improved in the lockdown with 64.7% people sleeping for 7-9 hours during lockdown, compared to only 40.7% people before lockdown.Conclusions: The current study found that there was a negative impact of lockdown on the dietary habits and lifestyle choices of the people. Hence it is important to advocate appropriate nutritional interventions and create awareness among people about healthy diet and lifestyle choices during these the COVID-19 pandemic.

Impact of environmental and individual factors on COVID-19 mortality in children and adolescents in Mexico: An observational study

BackgroundDuring the Covid-19 pandemic, children and adolescents faced poverty, potentially dying from preventable causes, or missing out essential vaccines. The aim of this study was to assess potential environmental and individual factors associated to COVID-19 mortality in children and adolescents in Mexico.MethodsThis cross-sectional study analysed the official data of 131,001 children under 10 years of age and adolescents between 10 and 19 years of age with COVID-19 disease, in Mexico. Participants were diagnosticated between March 2020 and June 13, 2021. The environmental variables such as malnutrition, vaccination coverage and social lag index were evaluated at the state level. Multilevel models were fitted to evaluate the association between environmental and individual factors and COVID-19 mortality.FindingsA total of 773 (0.6%) children and adolescents died due to COVID-19. Younger age (OR = 0.878, 95%CI: 0.869-0.888), diabetes (OR = 3.898, 95%CI: 2.596-5.851), immunosuppression (OR = 5.410, 95%CI: 4.088-7.158), obesity (OR = 1.876, 95%CI: 1.397-2.521), hypertension (OR = 1.906, 95%CI: 1.239-2.932), cardiovascular disease (OR = 2.288, 95%CI: 1.482-3.531), and chronic kidney disease (OR = 13.250, 95%CI: 9.066-19.350) were associated with mortality. COVID-19 mortality was directly associated with social lag index and malnutrition (ORvery high = 2.939, 95%CI: 1.111-7.775, and OR = 1.390, 95%CI: 1.073-1.802, respectively), and inversely associated with population density (OR = 0.374, 95%CI: 0.204-0.688). Finally, children and adolescents living in areas with a higher percentage of people with incomplete education (OR = 1.045, 95%CI: 1.011-1.081), of children of school age of 6–14 years who do not attend school (OR = 1.266, 95%CI: 1.032-1.554), and of illiterate population aged 15 and over (OR = 1.086, 95%CI: 0.999-1.179) were associated with a higher risk of COVID-19 mortality.InterpretationMalnutrition, social lag index and population density are key factors to understand COVID-19 mortality in children and adolescents. Also, age and pre-existing comorbidities were also associated with worse COVID-19 prognosis.FundingNo funding was secured for this study.

Vaccination against COVID-19: Factors That Influence Vaccine Hesitancy among an Ethnically Diverse Community in the UK.

The UK’s minority ethnic population, despite being at higher risk of COVID-19 and experiencing poorer health outcomes, continue to have lower uptake of the COVID-19 vaccine compared with their white British counterparts. Given the importance of the vaccination programme in improving health outcomes, this research sought to examine the influential factors that impact the decision to accept the COVID-19 vaccination among an ethnically diverse community. A total of 1058 residents from Luton, UK, a large town with an ethnically diverse population, completed a community survey. Questions centred around uptake or individuals’ intentions to accept the offer of COVID-19 vaccination alongside demographics, knowledge, and views on the vaccine. A binary logistic regression analysis was conducted to determine the most significant predictors of vaccine hesitancy, while respondents’ reasons for not getting vaccinated were identified using qualitative content analysis. Findings revealed that age and ethnicity were the only sociodemographic factors to predict vaccine hesitancy. Knowledge of symptoms and transmission routes, alongside ensuring information about COVID-19 was objectively sourced, were all identified as protective factors against vaccine hesitancy. Qualitative analysis revealed that ‘lack of trust in government/authorities’ and ‘concern of the speed of vaccine development’ were the most common reasons for non-uptake. This research reinforces the importance of age, ethnicity, and knowledge as influential factors in predicting vaccine hesitancy. Further, this study uncovers some of the barriers of uptake that can be utilised in developing promotional campaigns to reduce vaccine hesitancy in certain sections of the diverse UK population.

Prevalence of Burnout, Depression, Anxiety, Stress, and Hopelessness Among Healthcare Workers in COVID-19 Pandemic in Turkey.

BackgroundThis study’s aim was to reveal the burnout, depression, anxiety, stress, and hopelessness levels of HCWs in the pandemic period.MethodsThe cross-sectional study was carried out with 1015 HCWs, between September 1 and October 1, 2021, in Turkey. Maslach Burnout Inventory, Beck Hopelessness Scale, and Depression Anxiety Stress Scale-21 (DASS-21) were used.ResultsOf the HCWs, 56.7% had moderate/high emotional exhaustion (EE), 35.8% had moderate/high depersonalization (D), 58.0% had low personal accomplishment (PA), 34.9% had high depression, 31.9% had high anxiety, 15.4% had high stress, and 33.3% had moderate/severe hopelessness. Risk factors for EE were working in a public hospital, increased workload intensity, decreased income, and difficulty in procuring personal protective equipment (PPE). Risk factors for D were having a male gender, being under the age of 40, being a physician, working in a public hospital, and difficulty in procuring PPE. Risk factors for depression were being under the age of 40, having contact with COVID-19 patients, and decreased income. Risk factors for anxiety were having a female gender, being under the age of 40, working in a public hospital, having a chronic disease, having contact with COVID-19 patients, and having individuals at high risk for COVID-19 at home. Risk factors for hopelessness were having a female gender, being a physician, and increased income.ConclusionThe negative effects of the pandemic, which has been going on for over a year and a half, on the mental health of HCWs were high.

Obesity, Hypovitaminosis D, and COVID-19: the Bermuda Triangle in Public Health.

Purpose of ReviewThe COVID-19 pandemic has challenged public health to a significant extent by markedly increasing morbidity and mortality. Evidence suggests that obesity and hypovitaminosis D constitute important risk factors for SARS-CoV-2 infection, severity of disease, and poor outcomes. Due to their high prevalence globally, obesity and hypovitaminosis D are considered pandemics. This review presents current epidemiologic and genetic data linking obesity, hypovitaminosis D, and COVID-19, highlighting the importance of the convergence of three pandemics and their impact on public health. We also briefly summarize potential mechanisms that could explain these links.Recent FindingsEpidemiologic data have shown that obesity is an independent risk factor for COVID-19, severe disease and death, and genetic evidence has suggested a causal association between obesity-related traits and COVID-19 susceptibility and severity. Additionally, obesity is independently associated with hypovitaminosis D, which is highly prevalent in subjects with obesity. Hypovitaminosis D is independently associated with a higher risk for COVID-19, severity, hospitalization, infectious complications, acute respiratory distress syndrome, and poor outcomes. However, genome-wide association studies have not revealed any causal association between vitamin D levels and the risk for COVID-19, while there is no robust evidence for a beneficial role of vitamin D supplementation in the prevention and treatment of COVID-19.SummaryIn the context of the ongoing COVID-19 pandemic, the epidemiologic impact of obesity and hypovitaminosis D is emphasized. Efforts to increase public awareness and reinforce preventive and therapeutic measures against obesity and hypovitaminosis D are strongly required.

Serum levels of C-reactive protein and ferritin in COVID-19 patients infected with Toxoplasma gondii.

During infection, T. gondii disseminates by the circulatory system and establishes chronic infection in several organs. Almost third of humans, immunosuppressed individuals such as HIV/AIDS patients, cancer patients, and organ transplant recipients are exposed to toxoplasmosis. Therefore, the study aimed to investigate the possibility that Toxoplasma infection could be a risk factor for COVID-19 patients and its possible correlation with C-reactive protein and ferritin. Overall 220 patients referred to the Al Furat General Hospital, Baghdad, Iraq were enrolled from 2020-2021. All serum samples were tested for T. gondii immunoglobulins (IgG and IgM) antibodies, C-reactive protein and ferritin levels. In patients with COVID-19, the results revealed a high positivity percentage for anti-Toxoplasma IgG. In COVID-19 patients infected with T. gondii, the C-reactive protein and ferritin levels were higher than the controls. The ferritin level was high in COVID-19 patients infected with toxoplasmosis compare with COVID-19 patient without toxoplasmosis in different gender and age while the level of CRP had no significant differences in COVID-19 patient with or without toxoplasmosis. These finding suggest that the incidental rate of toxoplasmosis could be considered as an indication to the high risk of COVID-19.

Household Food Insecurity Scores are Higher among Adults Infected with COVID-19: A Cross-Sectional Online Study among an Iranian Population

Introduction: Food insecurity has negative impacts on health, including the function of the immune system. The association between food insecurity and COVID-19 infection rates has not been fully understood. This study aimed to examine whether food-insecure households are more vulnerable to COVID-19 infection. Materials and Methods: This online cross-sectional study was conducted on 2,871 Iranian adults (31 provinces), from August to September 2020. Demographic and socio-economic information was collected using a questionnaire. The Household Food Insecurity Access Scale (HFIAS) was used for assessing household food insecurity. The data analysis was performed by SPSS.22, using Chi-square test, ANOVA test, and Multinomial Logistic Regression Model. Results: The findings indicated that healthcare personnel were at higher risk of COVID-19 (CI = 1.90, 7.05; OR = 3.66; P &lt; 0.001). It was also shown that HFIAS scores were significantly higher among infected people compared to non-infected (CI = 1.00, 1.05; OR = 1.03; P &lt; 0.05). Women were at lower risk of infection compared to men (CI = 0.41, 0.87; OR = 0.60; P &lt; 0.05). Conclusions: Based on the results, in addition to long-term policies to improve food security, policymakers are recommended to implement short-term policies to reduce the vulnerability of the community to COVID-19 virus.

Longitudinal Analysis of Antibody Responses to the mRNA BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis: A 6-Month Follow-Up.

Background: Patients on hemodialysis (HD) are at higher risk for COVID-19, overall are poor responders to vaccines, and were prioritized in the Portuguese vaccination campaign.Objective: This work aimed at evaluating in HD patients the immunogenicity of BTN162b2 after the two doses induction phase, the persistence of specific antibodies along time, and factors predicting these outcomes.Methods: We performed a prospective, 6-month long longitudinal cohort analysis of 156 HD patients scheduled to receive BTN162b2. ELISA quantified anti-spike IgG, IgM, and IgA levels in sera were collected every 3 weeks during the induction phase (t0 before vaccine; t1, d21 post first dose; and t2 d21 post second dose), and every 3–4 months during the waning phase (t3, d140, and t4, d180 post first dose). The age-matched control cohort was similarly analyzed from t0 to t2.Results: Upon exclusion of participants identified as previously exposed to SARS-CoV-2, seroconversion at t1 was lower in patients than controls (29 and 50%, respectively, p = 0.0014), while the second vaccine dose served as a boost in both cohorts (91 and 95% positivity, respectively, at t2, p = 0.2463). Lower response in patients than controls at t1 was a singularity of the participants ≤ 70 years (p = 2.01 × 10−05), associated with immunosuppressive therapies (p = 0.013), but not with lack of responsiveness to hepatitis B. Anti-spike IgG, IgM, and IgA levels decreased at t3, with IgG levels further waning at t4 and resulting in >30% seronegativity. Anti-spike IgG levels at t1 and t4 were correlated (ρ = 0.65, p < 2.2 × 10−16).Conclusions: While most HD patients seroconvert upon 2 doses of BNT162b2 vaccination, anti-spike antibodies levels wane over the following 4 months, leading to early seroreversion in a sizeable fraction of the patients. These findings warrant close monitoring of COVID-19 infection in vaccinated HD patients, and advocate for further studies following reinforced vaccination schedules.

Depression, Anxiety and Associated Factors among Frontline Hospital Healthcare Workers in the Fourth Wave of COVID-19: Empirical Findings from Vietnam.

(1) Background: This study aims to assess the magnitude of, and factors associated with, depression and anxiety among Vietnamese frontline hospital healthcare workers in the fourth wave of COVID-19; (2) Methods: A hospital based cross-sectional study was carried out within two weeks, October 2020, at a central COVID-19 treatment hospital. Depression and anxiety were measured with PHQ-9 and GAD-7, respectively. Bivariate and multivariate logistic regression analysis were applied to recognize variables related to depression and anxiety, respectively; (3) Results: Among 208 frontline hospital healthcare workers, overall prevalence of depressive symptoms, anxiety symptoms, and both symptoms of depression and anxiety was 38.94%, 25.48% and 24.04%, respectively, in healthcare workers. In a reduced model after using multivariate stepwise logistic regression, age (OR = 0.9, p = 0.001), marital status (OR = 7.84, p = 0.027), profession (OR = 0.39, p = 0.028), having experienced traumatic stress following a work event (OR = 46.24, p < 0.001), feeling at very high risk for COVID-19 (OR = 0.02, p < 0.04), and affected by workplace conditions (OR = 5.36, p < 0.001) were associated with the symptoms of depression. With regard to symptoms of anxiety, single status (OR: 12.18, p = 0.002), being medical technician (OR: 68.89, p < 0.001), alcohol use (OR: 6.83, p = 0.014), using pain relief medications (OR: 25.50, p = 0.047), having experienced traumatic stress following a family event (OR: 130.32, p = 0.001), having experienced traumatic stress following a work event (OR: 181.55, p = 0.002), reporting at very high risk for COVID-19 (OR: 29.64, p = 0.011), treating moderate (OR: 6.46, p = 0.038) and severe (OR: 18.96, p = 0.004) COVID-19 patients, and being significantly affected by the community (OR: 6.33, p = 0.003) were increased risk factors for the symptoms of anxiety. Meanwhile, those living with 4–5 people (OR: 0.15, p = 0.011), specializing in infectious disease (OR: 0.13, p = 0.044)/resuscitation and emergency medicine (OR: 0.04, p = 0.046), and having knowledge preparation before participating in COVID-19 (OR: 0.008, p = 0.014) were less associated with the symptoms of anxiety; (4) Conclusions: There was a relatively high prevalence among Vietnamese hospital healthcare workers exhibiting symptoms of depression and anxiety during the ongoing pandemic. Greater attention to training in psychological skills should be suggested for those belonging to a younger age group, being single/widowed/divorced, treating moderate and severe COVID-19 patients, feeling at very high risk for COVID-19, being significantly affected a lot the community or workplace conditions, or experiencing traumatic stress following a family/work event in the past week.

Genetically Predicted Higher Educational Attainment Decreases the Risk of COVID-19 Susceptibility and Severity: A Mendelian Randomization Study.

Background: Prior observational studies indicated that lower educational attainment (EA) is associated with higher COVID-19 risk, while these findings were vulnerable to bias from confounding factors. We aimed to clarify the causal effect of EA on COVID-19 susceptibility, hospitalization, and severity using Mendelian randomization (MR).Methods: We identified genetic instruments for EA from a large genome-wide association study (GWAS) (n = 1,131,881). Summary statistics for COVID-19 susceptibility (112,612 cases and 2,474,079 controls), hospitalization (24,274 cases and 2,061,529 controls), and severity (8,779 cases and 1,001,875 controls) were obtained from the COVID-19 Host Genetics Initiative. We used the single-variable MR (SVMR) and the multivariable MR (MVMR) controlling intelligence, income, body mass index, vigorous physical activity, sedentary behavior, smoking, and alcohol consumption to estimate the total and direct effects of EA on COVID-19 outcomes. Inverse variance weighted was the primary analysis method. All the statistical analyses were performed using R software.Results: Results from the SVMR showed that genetically predicted higher EA was correlated with a lower risk of COVID-19 susceptibility [odds ratio (OR) 0.86, 95% CI 0.84–0.89], hospitalization (OR 0.67, 95% CI 0.62–0.73), and severity (OR 0.67, 95% CI 0.58–0.79). EA still maintained its effects in most of the MVMR.Conclusion: Educational attainment is a predictor for susceptibility, hospitalization, and severity of COVID-19 disease. Population with lower EA should be provided with a higher prioritization to public health resources to decrease the morbidity and mortality of COVID-19.

Associated Factors with Perceived Fear of COVID-19 among Vietnamese Hospital Healthcare Workers during Fourth Wave of the COVID-19 Pandemic: Policy Implications for Interconnected and Social- and Personal-Based Health Support.

(1) Background: The present study measures the fear of COVID-19 among hospital healthcare workers and identifies several factors associated with increasing fear of COVID-19. (2) Methods: A cross-sectional, hospital-based survey was conducted on healthcare workforce recruited from the National Hospital of Tropical Diseases from 1 October 2021 and 20 October 2021. We selected the participants who have been directly involved in diagnosing, treating, or providing nursing care to patients with COVID-19. The primary data was collected via sending the invitation directly to the participants, utilizing structured self-completed questionnaires. The seven-item fear of COVID-19 scale was used to measure the data. The responses of 208 hospital healthcare workers were included in the final analysis. (3) Results: Total score of COVID-19 fear was 19.62 (SD = 5.22). The COVID-19 fear score of 7 items ranged from 2.38 (SD = 0.83) to 3.21 (SD = 0.96). The lowest and highest scores were the item ‘My hands become clammy when I think about Corona’ and the item ‘I am most afraid of corona’ was the highest, respectively. Linear regression of the COVID-19 fear showed that the factors positively correlated with the fear of COVID-19 among hospital healthcare workers were: being influenced by the community (p = 0.001), feeling at very high risk of COVID-19 (p = 0.03), and experiencing traumatic stress with an academic event (p = 0.042). (4) Conclusions: Although these findings merit further elaboration, these preliminary findings suggest relatively great fear of the COVID-19 pandemic among Vietnamese hospital healthcare workers and that social and personal connections are necessary for maintaining the mental wellbeing.

428. Assessing the Confidence, Knowledge and Preferences of Hospital Staff with Regards to Personal Protective Equipment (PPE) Practices During the COVID-19 Pandemic

BackgroundEffective use of personal protective equipment (PPE) by hospital staff is critical to prevent transmission of COVID-19. This study examines hospital staff confidence in and knowledge of effective PPE use, and their preferences for learning about PPE practices.MethodsThree isolation precautions signs were created for use in the care of those with or under investigation for COVID-19 infection: first, a special respiratory precautions sign designed by infection control; and next, two signs outlining proper donning and doffing practices – one created internally with the support of health literacy, and another developed with a design firm (IDEO) using principles of human-centered design (Figure 1). All signs were used for ≥ 10 weeks prior to distribution of a questionnaire (REDCap) to clinical and non-clinical hospital staff. Those who had not worked on hospital units during the pandemic (after March 15, 2020) were excluded. The 38-item survey was sent by supervisors over email between July 14-31, 2020, and examined demographics, confidence in and knowledge of PPE best practices, and preferences for each precaution sign with regards to trustworthiness, ease of following, informative content, and clarity of image/layout. Responses were reported using descriptive statistics. A non-parametric test of trends compared staff preferences across signs. Logistic regression examined the association between answering all knowledge-based questions correctly and staff role and confidence in PPE practices (Stata). ResultsOf the 531 respondents, 461 were eligible for inclusion. The majority were female, white, and not high risk for COVID-19 (Table 1). Most were confident about PPE use, correctly answered questions examining knowledge of PPE best practices, and found PPE signage helpful (Table 2). Staff preferred the professionally designed sign for informative content (p< 0.01) and clear imagery/layout (p=0.01) (Table 3). Confidence in PPE practices and physician or nurse roles were associated with answering all knowledge-based questions correctly (p< 0.001 and p=0.04, respectively). ConclusionIn a convenience sample of hospital staff, most were confident and knowledgeable about PPE use, found PPE signage helpful, and preferred professionally designed signs.Disclosures All Authors: No reported disclosures

98. COVID-19 Vaccine Breakthrough Hospitalizations and Deaths in the Veterans Health Administration

BackgroundA COVID-19 vaccine breakthrough infection is defined as SARS-CoV-2 RNA or antigen detected ≥ 14 days after completion of a final vaccine dose. CDC’s May 25 MMWR report of 10,262 vaccine breakthrough infections in the U.S. is likely an underestimate. Herein, we report Veterans Health Administration (VHA) breakthrough cases, focusing on hospitalizations and deaths.MethodsWe extracted COVID-19 vaccine breakthrough infections tested between 1/19/2021 and 4/30/2021 from the VHA Corporate Data Warehouse (including screening tests). We reviewed medical records of cases who died and/or were hospitalized within 14 days of SARS-CoV-2 positive test for clinician documentation of conditions deemed high risk for COVID-19 and to confirm hospitalization or death was related to COVID-19. SARS-CoV-2 whole genome sequencing (Clear Labs platform) and antigen testing (Abbott BinaxNOW) from available patient samples were performed and Pangolin lineage determined.Results1,142 COVID-19 vaccine breakthrough infections were identified. 357/1,142 (31.3%) were hospitalized and/or died. 1,085 (95%) were male (Table 1), and median age was 72.5 years (74 years for hospitalized/deceased patients). COVID-19 infection contributed to hospitalization and/or death in 139 (38.9%) cases. The remaining 218 (61.1%) were hospitalized or died of causes apparently unrelated to COVID-19. Smoking and heart conditions were seen most frequently among hospitalized/deceased breakthrough cases (Table 2). Variant B.1.1.7 was predominant, present in 17/27 (63%) total samples sequenced, and 13/21 (61.9%) hospitalized/deceased. (Table 3). Of 21 sequenced hospitalized/deceased cases, SARS-CoV-2 antigen positivity was present in 11 (52.4%). ConclusionCompared to CDC reported breakthrough infections, VHA cases were more male, older, and hospitalized/died at higher frequency. Further study is needed to determine the contribution of specific underlying conditions, COVID-19 vaccine formulations and variants on hospitalization and death among COVID-19 vaccine breakthrough infections. Sequencing efforts for breakthrough cases should be intensified, particularly for those presenting with more severe infections.Disclosures All Authors: No reported disclosures

Acceptance of COVID-19 vaccine and associated factors among health professionals working in Hospitals of South Gondar Zone, Northwest Ethiopia

ABSTRACT Background Health-care professions are among the highly exposed group of population affected by COVID-19 pandemic and identified as the target population to get vaccination against the spread of the infection. However, vaccine reluctance is still high, which may negatively affect the efforts to prevent the spread of the infection. Hence, this study was aimed to assess acceptance of COVID-19 vaccine and associated factors among health professionals working in Hospitals of South Gondar Zone, Northwest Ethiopia. Methods Institutional-based cross-sectional study was performed among 422 health professionals working in Hospitals of South Gondar Zone, Northwest Ethiopia, from March 1 to 30, 2021. Study participants were selected through simple random sampling techniques. Data were collected through a self-administered questionnaire. Multivariable logistic regression analysis was performed to identified factors associated with acceptance of COVID-19 vaccine with a p-value < 0.05 at 95% CI considered as statistically significant. Result Overall, 45.3% of health professionals accepted COVID-19 vaccine. Age (AOR: 2.55; 95% CI: 1.32–4.92), being male (AOR: 1.729; 95% CI: 1.32–2.34), had higher risk of COVID-19 (AOR: 1.74, 95% CI: 1.00–3.02), and positive attitude (AOR: 3.26, 95% CI: 2.14–4.96) were found to be statistically significant with the acceptance of COVID-19 vaccine. Conclusion The acceptance of COVID-19 vaccine among health professionals was significantly low. Participant’s age, sex, high risk of COVID-19, and attitude toward COVID-19 vaccine were significantly associated with vaccine acceptance. Therefore, the government with respective stakeholders should emphasize addressing the concern of the health professionals and increase attitudes regarding COVID-19 vaccine to scale up vaccine acceptance.