Risk Of COVID-19 Transmission Research Articles

Community health promotion and medical provision and impact on neonates (CHAMPION2) and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2): an update to the study protocol (v 11) for a cluster randomised trial in Madhya Pradesh, India

BackgroundThis update outlines amendments to the CHAMPION2/STRIPES2 cluster randomised trial protocol primarily made due to the COVID-19 pandemic and nationwide lockdown in India in 2020. These amendments were in line with national guidelines for health research during the COVID-19 pandemic.MethodsWe did not change the original trial design, eligibility, and outcomes. Amendments were introduced to minimise the risk of COVID-19 transmission and ensure safety and wellbeing of trial staff, participants, and other villagers. CHAMPION2 intervention: participatory learning and action (PLA) and fixed day service (FDS) meeting were revised to incorporate social distancing and hygiene precautions. During the COVID-19 pandemic, PLA participation was limited to pregnant women and birthing partners. STRIPES2 intervention: before/after-school classes were halted for a period and then modified temporarily (reducing class sizes, and/or changing meeting places) with hygiene and safe distancing practices introduced. Data collection: The research team gathered as much information as possible from participants by telephone. If the participant had no telephone or could not be contacted by telephone, data were collected in person. COVID-19 precautions: trial teams were trained on COVID-19 precautions and used personal protective equipment whilst in the villages for trial-related activities.After restarting the trial between June and September 2020 in a phased manner, some trial activities were suspended again in all the trial villages from April to June 2021 due to the second wave of COVID-19 cases and lockdown imposed in Satna, Madhya Pradesh. Trial timelines were also revised, with outcomes measured later than originally planned.Trial registrationClinical Trial Registry of India CTRI/2019/05/019296. Registered 23 May 2019.https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MzExOTg=&Enc=&userName=champion2.

Comparing lagged impacts of mobility changes and environmental factors on COVID-19 waves in rural and urban India: a Bayesian spatiotemporal modelling study.

Previous research in India has identified urbanisation, human mobility and population demographics as key variables associated with higher district level COVID-19 incidence. However, the spatiotemporal dynamics of mobility patterns in rural and urban areas in India, in conjunction with other drivers of COVID-19 transmission, have not been fully investigated. We explored travel networks within India during two pandemic waves using aggregated and anonymized weekly human movement datasets obtained from Google, and quantified changes in mobility before and during the pandemic compared with the mean baseline mobility for the 8-week time period at the beginning of 2020. We fit Bayesian spatiotemporal hierarchical models coupled with distributed lag non-linear models (DLNM) within the integrated nested Laplace approximate (INLA) package in R to examine the lag-response associations of drivers of COVID-19 transmission in urban, suburban, and rural districts in India during two pandemic waves in 2020-2021. Model results demonstrate that recovery of mobility to 99% that of pre-pandemic levels was associated with an increase in relative risk of COVID-19 transmission during the Delta wave of transmission. This increased mobility, coupled with reduced stringency in public intervention policy and the emergence of the Delta variant, were the main contributors to the high COVID-19 transmission peak in India in April 2021. During both pandemic waves in India, reduction in human mobility, higher stringency of interventions, and climate factors (temperature and precipitation) had 2-week lag-response impacts on the R t of COVID-19 transmission, with variations in drivers of COVID-19 transmission observed across urban, rural and suburban areas. With the increased likelihood of emergent novel infections and disease outbreaks under a changing global climate, providing a framework for understanding the lagged impact of spatiotemporal drivers of infection transmission will be crucial for informing interventions.

Infection Prevention Strategies for Otorhinolaryngology and Head-and-Neck Surgery During the COVID-19 Pandemic: A Systematic Review

Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has significantly impacted global healthcare systems, necessitating stringent infection control measures to safeguard patients and healthcare workers. Otorhinolaryngology and head-and-neck surgery, due to their close proximity to the respiratory tract and frequent aerosol-generating procedures, face elevated risks of COVID-19 transmission. Understanding infection control measures in these specialties is paramount to optimize safety protocols and mitigate transmission risks. Aim: The review aims to examine infection control measures in otorhinolaryngology and head-and-neck surgery during the COVID-19 pandemic, addressing specific risks, effectiveness of safety measures, adaptations to evolving knowledge, implementation challenges, and future directions for research and policy. Review Summary: A systematic literature search was conducted from December 2019 to present, focusing on infection control practices in these specialties during the pandemic. Studies addressing infection control measures, risks, and adaptations in otorhinolaryngology and head-and-neck surgery were included. Key findings were synthesized qualitatively, emphasizing trends, common themes, and discrepancies in data. Future Implications: Insights from the review provide actionable guidance for optimizing infection control measures in otorhinolaryngology and head-and-neck surgery, enhancing safety for patients and healthcare providers during current and future pandemics. Areas for future research include ongoing surveillance, adaptation of protocols, and development of innovative safety strategies. Clinical Policy and Development: Recommendations include comprehensive use of personal protective equipment, modifications to patient handling and surgical procedures, telemedicine integration, and adherence to strict infection control protocols. These measures aim to minimize COVID-19 transmission risks while maintaining essential healthcare services. Keywords: COVID-19, Otorhinolaryngology, Head-And-Neck Surgery, Infection Control, Aerosol-Generating Procedures

Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Asymptomatic Healthcare Workers of Dezful Ganjavian Hospital, Southwest Iran

Background: The 21st century has seen the emergence of the COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Objectives: Given the elevated risk of COVID-19 transmission among healthcare workers, our objective was to assess the seroprevalence of anti-SARS-CoV-2 antibodies in asymptomatic healthcare workers at Dezful Ganjavian Hospital in 2021. Methods: A total of 276 participants were included in this descriptive cross-sectional study. The study assessed the participants' medical history, including autoimmune diseases, corticosteroid administration, and underlying conditions. Additionally, the history of previous SARS-CoV-2 infection and exposure to COVID-19 patients was recorded. Results: The results showed that 32.6% of the participants had a history of previous SARS-CoV-2 infection. No significant associations were found between the previous infection history and variables such as sex, age, corticosteroid administration, autoimmune disease, or exposure to COVID-19 patients. However, a significant association was observed between the participants' history of COVID-19 and underlying conditions. Serum analysis revealed that 10.1% of the participants tested positive for IgG anti-SARS-CoV-2 antibodies, while 1.8% tested positive for IgM antibodies. A significant relationship was found between the presence of IgG antibodies and a history of previous SARS-CoV-2 infection. Similarly, all participants with IgM antibodies had a history of previous infection. Conclusions: The study findings indicate that a significant proportion of asymptomatic healthcare workers at Dezful Ganjavian Hospital have been previously exposed to SARS-CoV-2. These results can inform infection control measures and help protect both healthcare workers and patients in the hospital setting.

Moral Distress, Burnout, Turnover Intention, and Coping Strategies among Korean Nurses during the Late Stage of the COVID-19 Pandemic: A Mixed-Method Study

The COVID-19 pandemic has exacerbated the difficulties nurses face, resulting in higher turnover rates and workforce shortages. This study investigated the relationships between nurses’ moral distress, burnout, and turnover intention during the last stage of the COVID-19 pandemic. It also explored the coping strategies nurses use to mitigate moral distress. Utilizing a mixed-method approach, this study analyzed data from 307 nurses caring for patients with COVID-19 in acute care hospitals through an online survey conducted in November 2022. Our data analysis encompassed quantitative methods, including descriptive statistics and path analysis, using a generalized structural equation model. For the qualitative aspect, we examined open-ended responses from 246 nurses using inductive content analysis. The quantitative findings revealed that nurses’ moral distress had a significant direct effect on turnover intention. In addition, burnout significantly mediated the relationship between moral distress and turnover intention. Qualitative analyses contextualized the relationships uncovered in the quantitative analyses. The qualitative analysis identified various positive and negative coping strategies. Positive strategies included a commitment to minimize COVID-19 transmission risks, adopting a holistic approach amidst the challenges posed by the pandemic, voicing concerns for patient safety, engaging in continuous learning, and prioritizing self-care. Conversely, negative strategies involved adopting avoidance behaviors stemming from feelings of powerlessness and adopting a passive approach to one’s role. Notably, some participants shifted from positive to negative coping strategies because of institutional barriers and challenges. The findings underscore the importance for hospital administrators and nurse managers to acknowledge the impact of the pandemic-related challenges encountered by nurses and recognize the link among moral distress, burnout, and turnover intention. It highlights the essential role of organizational and managerial support in fostering effective coping strategies among nurses to address moral distress.

Spatial Interaction Analysis of Infectious Disease Import and Export between Regions

Human travel plays a crucial role in the spread of infectious disease between regions. Travel of infected individuals from one region to another can transport a virus to places that were previously unaffected or may accelerate the spread of disease in places where the disease is not yet well established. We develop and apply models and metrics to analyze the role of inter-regional travel relative to the spread of disease, drawing from data on COVID-19 in the United States. To better understand how transportation affects disease transmission, we established a multi-regional time-varying compartmental disease model with spatial interaction. The compartmental model was integrated with statistical estimates of travel between regions. From the integrated model, we derived a transmission import index to assess the risk of COVID-19 transmission between states. Based on the index, we determined states with high risk for disease spreading to other states at the scale of months, and we analyzed how the index changed over time during 2020. Our model provides a tool for policymakers to evaluate the influence of travel between regions on disease transmission in support of strategies for epidemic control.

Modeling the Impact of Air Pollution and Meteorological Variables on COVID-19 Transmission in Western Cape, South Africa

Understanding the factors that influence COVID-19 transmission is essential in assessing and mitigating the spread of the pandemic. This study focuses on modeling the impact of air pollution and meteorological parameters on the risk of COVID-19 transmission in Western Cape Province, South Africa. The data used in this study consist of air pollution parameters, meteorological variables, and COVID-19 incidence observed for 262 days from April 26, 2020, to January 12, 2021. Lagged data were prepared for modeling based on a 6-day incubation period for COVID-19 disease. Based on the overdispersion property of the incidence, negative binomial (NB) and generalised Poisson (GP) regression models were fitted. Stepwise regression was used to select the significant predictors in both models based on the Akaike information criterion (AIC). The residuals of both NB and GB regression models were autocorrelated. An autoregressive integrated moving average (ARIMA) model was fitted to the residuals of both models. ARIMA (7, 1, 5) was fitted to the residuals of the NB model while ARIMA (1, 1, 6) was fitted for the residuals of the GP model. NB + ARIMA (7, 1, 5) and GP + ARIMA (1, 1, 6) models were tested for performance using root mean square error (RSME). GP + ARIMA (1, 1, 6) was selected as the optimal model. The results from the optimal model suggest that minimum temperature, ambient relative humidity, ambient wind speed, PM2.5, and NO2 at various lags are positively associated with COVID-19 incidence while maximum relative humidity, minimum relative humidity, solar radiation, maximum temperature, NO, PM load, PM10, SO2, and NOX at various lags have a negative association with COVID-19 incidence. Ambient wind direction and temperature showed a nonsignificant association with COVID-19 at all lags. This study suggests that meteorological and pollution parameters play a vital independent role in the transmission of the SARS-CoV-2 virus.

Inhomogeneous log-Gaussian Cox processes with piecewise constant covariates: a case study in modeling of COVID-19 transmission risk in East Java

Inhomogeneous log-Gaussian Cox processes with piecewise constant covariates: a case study in modeling of COVID-19 transmission risk in East Java

COVID-19 case management in primary dental care settings in Yorkshire and the Humber.

Introduction Emerging guidance during the COVID-19 pandemic aimed to minimise transmission risk within dental settings. This service evaluation provides an overview of reported cases of COVID-19 among primary dental care staff within Yorkshire and the Humber.Methods Data for COVID-19 cases reported within dental practices between November 2020 and August 2021 were extracted from the Public Health England, Health Protection Zone database and summarised using descriptive statistics.Results In total, 421 cases across 223 dental practices were reported, with 221 close contacts and 77 outbreaks identified. Cases/contacts were highest among dental nurses (51/49%). Household and community (42/22%) were the most frequently reported sources of transmission, with the majority of staff-to-staff contacts (60%) occurring in communal/non-clinical areas.Discussion There was a low number of reported COVID-19 cases/contacts among dental professionals, with most cases suspected to have acquired the infection from outside of the dental setting. The majority of personal protective equipment breaches occurred within communal/non-clinical areas. When infection prevention and control guidance was followed, there were no incidences of staff or patients becoming contacts or cases.Conclusion With adherence to strict protocols, the risk of COVID-19 transmission in the dental setting was low within the context of this review. The evaluation highlighted the importance of collaborative working during the pandemic.

Dynamic evolution of an SVEIR model with variants and non-pharmaceutical interventions for controlling COVID-19

The epidemiological characteristics and distributions of two epidemics in Fujian Province of Southeast China were attributed to the complex interactions among variant, host, and non-pharmaceutical interventions (NPIs). All reported cases in the Putian epidemic (September 8–October 2, 2021, Delta variant B.1.617.2) and Fuzhou epidemic (October 22–November 18, 2022, Omicron variant BA.5.2) were classified by sex, age group, occupation, and location in this study. Using surveillance data from the Fujian Provincial Center for Disease Control and Prevention, we established a virus-oriented SVEIR (Susceptible–Vaccinated–Exposed–Infected–Recovered) model to investigate the dynamic evolution features of these two variants and the effects of NPIs. The optimal simulations were carried out with variants and scenario investigations. The scenario investigations showed that NPIs significantly reduced the transmission risk and infection scales of COVID-19, and that the Omicron variant was more infectious than the Delta variant. Moreover, the dynamic investigations revealed the increasing tendencies from Delta to Omicron, such as the basic reproduction number, infection rate, percentage of high-risk cases, and the growth rate. Decreasing tendencies were also identified, such as the average recovery period, the awareness delay, and the percentage of symptomatic cases. This study highlighted that NPIs played critical roles in successfully containing the two epidemics. Such interventions are strongly recommended to public health policymakers.

COVID-19 Vaccine Knowledge, Attitude, and Acceptance in Students of Tertiary Institutions in Central Nigeria

INTRODUCTION/BACKGROUND: On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. Nigeria, among African nations, has borne the highest burden of COVID-19 reporting 163,498 cases and 2,058 fatalities. Institutions of higher learning possess certain characteristics that can increase the risk of COVID-19 transmission within their campuses. These features include a sizable student population, high population density, and frequent student interactions. As a result, it is imperative to implement protective measures to mitigate the virus’s spread on campus. 
 
 AIM/OBJECTIVE: This research aimed to explore the connection between the knowledge, attitudes, and acceptance of COVID-19 vaccines among students in tertiary institutions located in Central Nigeria. 
 
 METHODOLOGY: An anonymous online survey was conducted among Nigerian students, gathering information related to their demographics, as well as assessing their knowledge, attitudes, and willingness to accept vaccines in the post-COVID-19 era. The collected data were subjected to analysis through descriptive and inferential statistics.
 
 RESULTS: Out of the 400 participants included in the survey, 140 (35.0%) reported having already received a COVID-19 vaccine, while 144 (36.0%) expressed an intention to be vaccinated. The analysis indicated that there is a positive yet very weak correlation between attitudes towards COVID-19 vaccination and the intention to get vaccinated (r = −0.023, N = 365, p < 0.01). Conversely, knowledge regarding COVID-19 vaccines demonstrated a significant positive correlation with the intent to be vaccinated (r = 0.222, N = 367, p < 0.01). 
 
 CONCLUSION: In conclusion, this study underscores the importance of students’ knowledge and attitudes regarding vaccines in shaping their acceptance of COVID-19 vaccines. The results emphasize the critical necessity of providing comprehensive information on COVID-19 vaccines to address concerns related to unforeseen side effects, mitigate general mistrust in vaccine benefits, and alleviate apprehensions about the profitability of pharmaceutical companies.

Contact patterns between index patients and their close contacts and assessing risk for COVID-19 transmission during different exposure time windows: a large retrospective observational study of 450 770 close contacts in Shanghai

IntroductionTo characterise age-mixing patterns among index cases and contacts of COVID-19, and explore when patients are most infectious during the disease process.MethodsThis study examined all initial 90 885 confirmed index...

A self-controlled case series study to measure the risk of SARS-CoV-2 infection associated with attendance at sporting and cultural events: the UK Events Research Programme events

BackgroundIn 2021, whilst societies were emerging from major social restrictions during the SARS-CoV-2 pandemic, the UK government instigated an Events Research Programme to examine the risk of COVID-19 transmission from attendance at cultural events and explore ways to enable people to attend a range of events whilst minimising risk of transmission. We aimed to measure any impact on risk of COVID-19 transmission from attendance at events held at or close to commercially viable capacity using routinely collected data.MethodsData were obtained on attendees at Phase 3 Events Research Programme events, for which some infection risk mitigation measures were in place (i.e. evidence of vaccination or a negative lateral flow test). Attendance data were linked with COVID-19 test result data from the UK Test and Trace system. Using a self-controlled case series design, we measured the within person incidence rate ratio for testing positive for COVID-19, comparing the rate in days 3 to 9 following event attendance (high risk period) with days 1 and 2 and 10–16 (baseline period). Rate ratios were adjusted for estimates of underlying regional COVID-19 prevalence to account for population level fluctuations in infection risk, and events were grouped into broadly similar types.ResultsFrom attendance data available for 188,851 attendees, 3357 people tested positive for COVID-19 during the observation period. After accounting for total testing trends over the period, incidence rate ratios and 95% confidence intervals for positive tests were 1.16 (0.53–2.57) for indoor seated events, 1.12 (0.95–1.30) for mainly outdoor seated events, 0.65 (0.51–0.83) for mainly outdoor partially seated events, and 1.70 (1.52–1.89) for mainly outdoor unseated multi-day events.ConclusionsFor the majority of event types studied in the third phase of the UK Events Research Programme, we found no evidence of an increased risk of COVID-19 transmission associated with event attendance. However, we found a 70% increased risk of infection associated with attendance at mainly outdoor unseated multi-day events. We have also demonstrated a novel use for self-controlled case series methodology in monitoring infection risk associated with event attendance.

Challenges to the Provision of Services for Sexual and Intimate Partner Violence in Canada During the COVID-19 Pandemic: Results of a Nationwide Web-Based Survey.

The COVID-19 pandemic increased women's vulnerability to intimate partner and sexual violence (IPV/SV), as well as challenging organizations' ability to respond. This research is based on a 2021 nationwide survey about the impacts of COVID-19 on IPV/SV services across Canada. Nationwide, organizations adopted several measures to reduce the risk of COVID-19 transmission, including scaling back services, reducing or stopping their volunteers, and reducing the number of in-shelter clients. Organizations detailed several financial challenges including increased costs and cancelation of fundraising events. Organizations also reported many staffing challenges, from increased workloads to staff leaves of absence due to childcare responsibilities, mental health reasons, or contracting COVID-19. Policies ensuring adequate financial support to IPV/SV services in nonemergency times could help minimize disruption to service delivery during crisis situations.

Telehealth use in maternity care during a pandemic: A lot of bad, some good and possibility

BackgroundTo reduce transmission risk during the COVID-19 pandemic, ‘telehealth’ (health care delivered via telephone/video-conferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives’ perspectives regarding telehealth use. MethodsA qualitative study was conducted in Australia during 2020–2021 using two data sources from the Birth in the Time of COVID-19 (BITTOC) study: i) interviews and ii) surveys (open-text responses). Content analysis was utilised to analyse the data and explore telehealth from the perspective of midwives and women accessing maternity care services. In-depth interviews were conducted with 20 women and 16 midwives. Survey responses were provided from 687 midwives and 2525 women who were pregnant or gave birth in 2021, generating 212 and 812 comments respectively. FindingsTelehealth delivery was variable nationally and undertaken primarily by telephone/videoconferencing. Perceived benefits included: reduced COVID-19 transmission risk, increased flexibility, convenience and cost efficiency. However, women described inadequate assessment, and negative impacts on communication and rapport development. Midwives had similar concerns and also reported technological challenges. ConclusionDuring the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services, but is not a suitable replacement to traditional face-to-face maternity care.

Correlation of public mobility and Covid-19 incidence in Indonesia during six phases of restriction policy implementation

Public mobility is considered one of the factors thought to impact the transmission of SARS-CoV2. The Indonesian government has imposed six mobility restriction policies since the beginning of the COVID-19 pandemic to cope this situation, however there has been no comprehensive evaluation of this program. This study aimed to examine the correlation between mobility and the incidence of COVID-19 during the implementation of this policy in Indonesia. Secondary data on public mobility, acquired through the Google Community Mobility Reports, and data on COVID-19 new cases, recorded on the COVID Task Force website, were utilized from 2 March 2020 to 20 July 2021.The analysis in this study was carried out using the Pearson correlation test with an alternative Spearman correlation test. The result reported a positive correlation between COVID-19 cases and mobility in certain places, such as in Grocery Store and Transit Station (r = 0.75; p-value <0.001; r = 0.62 p-value <0.001) while there was negative correlation in residential area (r= - 0.276 p-value < 0.001). Public mobility is found to be correlated with an increase in COVID-19 cases during the six phases of restriction policy implementation. In conclusion, regulating public mobility is important to minimize the risk of COVID-19 transmission.

The Most Vulnerable Children Faced Unique Risks During COVID-19: How Agencies Communicated with Communities on Parenting in Low Resource and Humanitarian Settings

Evidence suggests that children in low resource and humanitarian settings experienced added mental health burdens and violence in the home during the SARS-CoV-2 (COVID-19) pandemic, which may have affected their health and development. For humanitarian response agencies, conducting child protection services during this pandemic had been constrained by safety concerns related to the risk of COVID-19 transmission, and logistical issues aligned with social and public health measures. This paper describes how agencies responded to the identified risks children face, integrating remote risk communication and community engagement approaches and safe in-person dialogues with parents and caregivers into child protection interventions to educate about the disease and prevention, encourage a positive parenting environment and mitigate negative effects on children. United Nations (UN) agencies and non-government organizations (NGOs) must reflect on these different approaches and share lessons learned and best practices internally and at an inter-agency level to support evidence-based responses for future epidemics and pandemics.

Development and use of a directed acyclic graph (DAG) for conceptual framework and study protocol development exploring relationships between dwelling characteristics and household transmission of COVID-19 – England, 2020

BackgroundHousehold settings are high risk for COVID-19 transmission. Understanding transmission factors associated with environmental dwelling characteristics is important in informing public health and building design recommendations. We aimed to develop a directed acyclic graph (DAG) to inform a novel analytical study examining the effect of dwelling environmental characteristics on household transmission of COVID-19. MethodsKey demographic, behavioural and environmental dwelling characteristics were identified by a multidisciplinary team. Using the DAG to visually display risk factors, and using expert knowledge of available datasets we reached a consensus on the factors included and directionality of relationships to build the final conceptual framework. Factors were displayed as nodes and relationships as pathways. ResultsOf 34 potential factors, 16 were included in the DAG, with 13 causal and three biasing pathways. Three variables were not measurable using retrospective datasets. The DAG enabled us to select data sources for the pilot study period and to inform the analysis plan. Key exposure nodes were energy efficiency or dwelling age; dwelling type or number of storeys; and dwelling size. We determined direct and proxy confounders which we could adjust for, potential interactions terms we could test in model building, and co-linear variables to omit in the same model. ConclusionsThe DAG helped identify key variables and datasets. It prioritised key nodes and pathways to formalise complex relationships between variables. It was pivotal in identifying unobserved variables, confounders, co-linearity and potential interactions. It has supported data selection and design of a retrospective pilot study analysis plan.

Filling the Gaps in the Pandemic Response: Impact of COVID-19 on Telehealth in the Military Health System.

Introduction: As a result of the COVID-19 pandemic, telehealth use became widespread, allowing for continued health care while minimizing COVID-19 transmission risk for patients and providers. This rapid scale-up highlighted shortcomings of the current telehealth infrastructure in many health systems. We aimed to identify and address gaps in the United States Military Health System (MHS) response to the COVID-19 pandemic related to the implementation and utilization of telehealth. Methods: We conducted semistructured key informant interviews of MHS stakeholders, including policymakers, program managers, and health care providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo. Results: We interviewed 28 key informants. Several themes emerged from the interviews and were categorized into four defined areas of obstacles to the effective utilization of telehealth: administrative, technical, organizational, and quality issues. While respondents had positive perceptions of telehealth, issues such as billing, licensure portability, network connectivity and technology, and ability to monitor health outcomes represent major barriers in the current system, preventing the potential for further expansion. Conclusions: While the shift to telehealth during the COVID-19 pandemic demonstrated robust potential within the MHS, it highlighted shortcomings that impair the utility and expansion of telehealth on a level comparable to that of other large health systems. Future focus should be directed toward generating and implementing actionable recommendations that target these identified challenges in the MHS.

THE RISK OF TRANSMISSION OF COVID-19, COMMUNITY STIGMA, THE AVAILABILITY OF PPE AS A STRESS TRIGGER FOR HEALTH WORKERS

In the midst of the Covid-19 pandemic, the role of health workers is very important. The high risk of transmission causes stress for them. The aim of the research is to empirically determine the influence of the risk of Covid-19 transmission, public stigma, and the availability of PPE on the stress of health workers in hospitals. Using a quantitative approach, the cross section with a sample of 122 was tested with multinomial logistic regressions. Univariate results show that the risk of transmission is low, public stigma is moderate, PPE availability is high and stress is moderate. The results of the bivariate analysis show that the risk of Covid-19 transmission has a positive effect, community stigma has a positive effect, and the availability of PPE has a positive effect on health worker stress, all of which are significant. Multivariate analysis results indicate that all independent variables have a significant effect on health worker stress. The risk variable for transmitting Covid-19 is the most dominant. Screening for the risk of Covid-19 transmission, complete personal protective equipment, and positive stigma can provide health workers with a sense of security so that the risk of stress can be minimized.