H5N1

Individual and work factors associated with psychosocial health of registered nurses during the Covid-19 pandemic

Via the Journal of Occupational and Environmental Medicine: Individual and Work Factors Associated with Psychosocial Health of Registered Nurses During the Covid-19 Pandemic. The abstract:

Objective:   

To describe the initial influence of the Covid-19 pandemic on U.S. nurses’ psychosocial health, and to identify factors associated with poor psychosocial health outcomes.  

Methods:   

We conducted a convergent (QUAN+qual) mixed methods study. From June-August 2020, we administered surveys (N=629) and conducted semi-structured interviews (N = 34) among nurses working across healthcare settings in 18 states. We developed separate multivariable logistic regression models for three psychosocial outcomes (anxiety, depressive symptoms, insomnia). We used content analysis to process and analyze qualitative data, and integrated results in the final analysis step.  

Results:   

Nurses reported high rates of depressive symptoms (22%), anxiety (52%), and insomnia (55%). Disturbances to sleep were both a contributing factor to, and an outcome of, poor psychosocial health.  

Conclusions:   

Evidence-based interventions addressing work stress and sleep, and proactive monitoring of nurses’ psychosocial health by employers are urgently needed.

Russia reports over 100,000 daily Covid-19 cases for first time

Via The Moscow Times: Russia Reports Over 100,000 Daily Covid-19 Cases For First Time. Somehow this does not seem like the right time to invade Ukraine.

Russia reported more than 100,000 daily coronavirus cases for the first time on on Saturday as the country weathers a surge of infections driven by the highly contagious Omicron variant.   

A government Covid-19 portal registered 113,122 new cases over 24 hours, nearly double the number of daily infections just a week ago.   

The number of cases across Russia continues to rise sharply, with Omicron accounting for the majority of cases.   

Following a strict but brief national lockdown at the beginning of the pandemic, Russia has held back on curbs hoping instead to protect its struggling economy.

But with four vaccines widely available for months, Russians remain reluctant to get jabbed with just under half of the population fully vaccinated.   

Russia's government figures have reported 330,111 deaths from Covid-19 since the start of the pandemic — the highest death toll in Europe.  

However those figures are contradicted by statistics agency Rosstat, which counts Covid deaths under a broader definition and says the overall death toll is close to double the official number.  

On Friday, Rosstat said that Russia's population declined by more than a million people last year, a historic drop not seen since the collapse of the Soviet Union. 

Close relatives of MERS-CoV in bats use ACE2 as their functional receptors

Thanks to Doug McB for alerting me to this development, reported on bioRxiv: Close relatives of MERS-CoV in bats use ACE2 as their functional receptors. The abstract:

Middle East Respiratory Syndrome coronavirus (MERS-CoV) and several bat coronaviruses employ Dipeptidyl peptidase-4 (DPP4) as their functional receptors. However, the receptor for NeoCoV, the closest MERS-CoV relative yet discovered in bats, remains enigmatic. 

In this study, we unexpectedly found that NeoCoV and its close relative, PDF-2180-CoV, can efficiently use some types of bat Angiotensin-converting enzyme 2 (ACE2) and, less favorably, human ACE2 for entry. The two viruses use their spikes' S1 subunit carboxyl-terminal domains (S1-CTD) for high-affinity and species-specific ACE2 binding. Cryo-electron microscopy analysis revealed a novel coronavirus-ACE2 binding interface and a protein-glycan interaction, distinct from other known ACE2-using viruses. 

We identified a molecular determinant close to the viral binding interface that restricts human ACE2 from supporting NeoCoV infection, especially around residue Asp338. Conversely, NeoCoV efficiently infects human ACE2 expressing cells after a T510F mutation on the receptor-binding motif (RBM). Notably, the infection could not be cross-neutralized by antibodies targeting SARS-CoV-2 or MERS-CoV. 

Our study demonstrates the first case of ACE2 usage in MERS-related viruses, shedding light on a potential bio-safety threat of the human emergence of an ACE2 using 'MERS-CoV-2' with both high fatality and transmission rate.

China’s zero-Covid policy is a pandemic waiting to happen

An op-ed in The New York Times: China’s Zero-Covid Policy Is a Pandemic Waiting to Happen. Much as I respect Drs. Emanuel and Osterholm, I'm nervous about their use of terms like "have to live with it" and "endemic." They sound at this point like acceptance of high mortality and morbidity rates, which will be endured much more by working-class people and people of colour. Excerpt:

As the Winter Olympics approach and some 3,000 athletes, their retinues and the media converge in and around Beijing, the Chinese government has gone to extraordinary lengths to prevent the 24th version of the games from becoming a Covid super spreading event. 

Though athletes and coaches will be required to be vaccinated, they will face severe restrictions. Those who receive a medical exemption from vaccination are being required to quarantine for 21 days after entering the country. Even the vaccinated will have to present two negative tests. Olympic participants must submit to daily Covid tests and will be restricted to an Olympic bubble where they will be confined to prevent spread to the local population.  

These extreme measures are in line with China’s zero-Covid policy. President Xi Jinping and his government seem to believe that the country can be sealed off until the virus is eradicated around the world.  

But that goal is unattainable with the highly transmissible Omicron variant and has set the nation up for disaster. The coronavirus is not going to disappear — the world will have to live with it. Making matters worse, China’s vaccines are much less effective against Omicron. And the Chinese health care system simply is not equipped to care for millions of people sickened by the virus.  

Yes, China has weathered the pandemic well so far. Even with about four times the population of the United States, China has had fewer than 140,000 confirmed Covid cases and fewer than 6,000 deaths since January 2020, according to the World Health Organization. A vast majority of factories continued to operate. Early in the pandemic, China added thousands of hospital beds to its health care system in days.  

All of this seems like an enormous success when compared with the messy and often chaotic response to the virus in the United States, where more than 860,000 people have died and some 2,000 more die each day. Many hospitals are under siege. The economy has been disrupted.  

But this may very well be the future China is facing. Its pursuit of zero Covid will prove to be a huge mistake. The policy has left it wholly unprepared for what will become endemic Covid.

New report calls for global action plan to address nursing workforce crisis and prevent an avoidable healthcare disaster

Via the International Council of Nurses: New report calls for global action plan to address nursing workforce crisis and prevent an avoidable healthcare disaster. Excerpt:

A new report has revealed how the COVID-19 pandemic has made the fragile state of the global nursing workforce much worse, putting the World Health Organization’s (WHO) aim of Universal Health Coverage at serious risk. It suggests up to 13 million more nurses will be required over the next decade, the equivalent of almost half of the world’s current 28 million-strong workforce.  

International Council of Nurses (ICN) Chief Executive Officer Howard Catton, who co-authored the report, said the findings underlined the severity of the shortages:  

“We knew the situation was fragile because of the persistent historical underfunding of nursing around the world, but with the latest information about nurse vacancies, their rates of intention to leave, and staff sickness rates, it must now be recognised as a global crisis.  

"We already had a shortage of six million nurses at the start of the pandemic, but with the immense and relentless pressure of responding to COVID and the Omicron variant, and an avalanche of resignations and retirements anticipated, the world will need to recruit and retain up to 13 million nurses over the next decade.  

"The WHO’s International Year of the Nurse and Midwife in 2020 and last year’s International Year of the Health Care Worker were an important starting point in recognising the true value of nurses and other health workers, but it simply was not enough. This is a global health crisis, and it requires a fully funded and actionable ten-year plan to support and strengthen nurses and the health and care workforce to deliver health for all.”  

The report, published today by the International Centre for Nurse Migration in partnership with CGFNS and ICN, provides a blueprint for what needs to be done at the national and international level to guide nursing workforce planning globally. It says countries should commit to prioritising nurses for vaccinations, provide safe staffing levels, expand their domestic nurse education systems, increase the attractiveness of nursing careers for women and men, adhere to ethical international recruitment standards, and monitor countries’ ability to be self-sufficient to meet their nursing workforce requirements.  

CGFNS International Inc. President and Chief Executive Officer Dr Franklin A. Shaffer, another co-author of the report, added:  

“We can anticipate that there will be a migration tsunami as more than ever before, countries around the world turn to the international nursing supply to meet their workforce needs. The pre-existing unequal distribution of nurses around the world will be exacerbated by large-scale international recruitment to high-income countries as they look for a ‘quick fix’ solution to solving their nursing shortages, which will only widen inequalities in access to healthcare globally.”

Global Health Security Index: We haven't learned a damn thing

The Global Health Security Index came in for some deserved ridicule in 2020 when it declared the US health system as the best-prepared for a pandemic. But its latest report heaps scorn back on almost everyone, especially wealthy nations. As we stumble into the third year of this pandemic, such failure to prepare is inexcusable. An excerpt from its latest Report & Data:

Overall Finding

Although many countries were able to quickly develop capacities to address COVID-19, all countries remain dangerously unprepared for meeting future epidemic and pandemic threats. A great opportunity exists, however, to make new capacities more durable to further long-term gains in preparedness.

Additional Findings

Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness. 

• The overall average score for national-level financing is 35.2 out of 100.  

• 90 countries have not fulfilled their full commitment to contribute to the WHO; of those, 14 are high-income countries.  

• 66 countries have not identified special emergency public financing mechanisms and funds that the country can access in the face of a public health emergency; of those, 32 are high-income countries.  

• 155 countries have not allocated nonemergency national funds within the past three years to improve their capacity to address epidemic threats; among those, only two low-income countries have evidence of allocated funds.  

• The average score for national financing for epidemic preparedness is 21 out of 100; low-income countries have an average score of 7 out of 100.  

• Financing for emergency response has a global average score of 66.  

• High-income countries have the lowest average score of 46; low-income countries have the highest average, with 93.  

• Only four countries (Eritrea, Indonesia, Liberia, and Timor-Leste) have a JEE or NAPHS that describes specific funding from the national budget to address previously identified gaps.  

• High-income and upper-middle-income countries receive the lowest scores for financing when reviewed under the JEE and OIE Performance of Veterinary Services (PVS) Pathway assessments and related to financing for emergency response.  

• The average score for financing under the JEE and PVS report is 1 out of 100; this score reflects the provisions for funding IHR implementation through the national budget or other mechanisms.