H5N1

Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic

Via PLOS Medicine: Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic: A population-based cohort study in Ontario, Canada. The abstract:

Background  

The Coronavirus Disease 2019 (COVID–19) pandemic has exacerbated mental health challenges among physicians and non–physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non–physicians, before and during the COVID–19 pandemic.  

Methods and findings  

We conducted a population–based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario’s universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non–physicians. We compared the first 18 months of the COVID–19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID–19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in–person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses.  

Pre–pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non–physicians.  

During the first 18 months of the COVID–19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person–years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non–physicians (615.5 pre versus 675.9 during per 1,000 person–years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non–physicians during the first 18 months of the pandemic.  

Limitations include residual confounding between physician and non–physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access.   

Conclusions  

The first 18 months of the COVID–19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non–physicians. These findings suggest physicians may have had larger negative mental health during COVID–19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness.

Chile: Health ministry reports first human case of H5N1, in north of country

I believe this is the first case of human H5N1 contracted in the Americas. Via La Nación: Minsal informa primer caso humano de gripe aviar en el norte del país.[Health ministry report first human case of avian flu in the north of the country] The full report, with my translation:

El Ministerio de Salud (Minsal) informó la tarde de este miércoles el primer caso en Chile de gripe aviar en humanos, reportado en el norte del país. 

The Ministry of health reported Tuesday afternoon on the first case in Chile of avian flu in a human, reported in the north of the country.

La persona enferma corresponde a un hombre de 53 años afectado por un cuadro de influenza grave. El paciente se encuentra estable dentro de su gravedad. 

The person is a 53-year-old man with a case of severe influenza. The patient is in serious but stable condtion.

Se indicó que se activaron los protocolos sanitarios establecidos para el manejo de esta enfermedad y se tomaron los exámenes correspondientes para su análisis por el Instituto de Salud Pública (ISP), que confirmó que se trata de influenza aviar. 

The ministry said it had activated health protocols established for control of the disease; tests were analyzed by the Institute of Public Health, which confirmed the disease was avian flu.

Se investiga la fuente de contacto y si existen antecedentes de otros afectados en el entorno del paciente. 

The source of the infection in being investigated, as well as the possibility of others' infection among the patient's contacts.

El virus H5N1 o gripe aviar es un virus que se puede transmitir desde aves o mamíferos marinos al ser humano, pero no se conocen casos de contagios de humano a humano. 

The H5N1 virus, or avian flu, can be transmitted from birds or infected marine mammals to humans, but human-to-human cases are unknown.

El Ministerio de Salud hace un llamado a la ciudadanía a no manipular aves o mamíferos enfermos o muertos e insta a los trabajadores avícolas a seguir los protocolos de seguridad correspondientes y a vacunarse contra la influenza estacional.

The Ministry of Health asked the public not to handle or touch birds of marine mammals, whether sick or dead, and asked workers in the poultry industry to follow the appropriate safety protocols and to obtaain a vaccination against seasonly influenza.

Tanzania confirms first-ever outbreak of Marburg Virus Disease

Via WHO AFRO: Tanzania confirms first-ever outbreak of Marburg Virus Disease.

Brazzaville/Dar es Salaam – Tanzania today confirmed its first-ever cases of Marburg Virus Disease after laboratory tests were carried out following reports of cases and deaths in the country’s north-west Kagera region.  

Tanzania’s National Public Health Laboratory analysed samples to determine the cause of illness after eight people developed symptoms including fever, vomiting, bleeding and renal failure. Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.  

“The efforts by Tanzania’s health authorities to establish the cause of the disease is a clear indication of the determination to effectively respond to the outbreak. We are working with the government to rapidly scale up control measures to halt the spread of the virus and end the outbreak as soon as possible,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.  

WHO is supporting the Ministry of Health to deploy an emergency team to Kagera to carry out further epidemiological investigations. The emergency team will focus on active case finding in the community and local health care facilities to identify more contacts and provide them with appropriate care.  

While Tanzania has never previously recorded a Marburg case, it has had to respond to other health emergencies including COVID-19, cholera and dengue within the past three years. A strategic risk assessment conducted by WHO in September 2022 showed that the country is at high to very high risk for infectious diseases outbreaks.   

“The lessons learnt, and progress made during other recent outbreaks should stand the country in good stead as it confronts this latest challenge,” said Dr Moeti. “We will continue to work closely with the national health authorities to save lives.”  

Marburg virus disease is highly virulent and causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.  

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves likelihood of survival.

Chinese doctors and nurses reportedly told to work while infected as Covid surges

Via The Guardian: Chinese doctors and nurses reportedly told to work while infected as Covid surges. Excerpt:

Chinese doctors and nurses are being told to keep working even when infected with Covid-19, staff and residents reported, as the virus rips through the population in the wake of eased restrictions.  

Some hospitals in Beijing have up to 80% of their staff infected, but many of them are still required to work due to staff shortages, a doctor in a large public hospital in Beijing told Reuters, adding he had spoken to his peers at other big hospitals in the capital.  

All operations and surgeries had been cancelled at his hospital unless the patient was “dying tomorrow”, he said, declining to be named due to the sensitivity of the subject.  

A senior World Health Organization official said on Wednesday that China’s flare-up started “long before” restrictions were lifted, but since the sudden shift in policy major cities in Beijing appear to have experienced a huge surge in cases of Covid-19. Authorities have said it is “impossible” to measure, since most people are not being tested.  

“The explosion of cases in China had started long before any easing of the zero-Covid policy,” WHO emergencies chief Michael Ryan said on Wednesday. “There’s a narrative that, in some way, China lifted the restrictions and all of a sudden, the disease is out of control,” he added at the UN health agency’s headquarters in Geneva.  

“The disease was spreading intensively because the control measures in themselves were not stopping the disease.”  

In Sichuan, a doctor surnamed Li told Reuters that their tertiary hospital was “overwhelmed with patients”.  

“There are 700, 800 people with fever coming every day,” Li said. “We are running out of medicine stocks for fever and cold. A few nurses at the fever clinic were tested positive, there aren’t any special protective measures for hospital staff and I believe many of us will soon get infected.”  

Claims of rampant infections among hospital staff are also spreading across social media. One Chongqing resident said primary care in their city had “imploded”.  

“80% of the newly admitted patients in our small third-level respiratory department in a remote city are positive,” they wrote on Weibo.  

“From December 8, when the first positive patient was allowed to be admitted, to today, December 13, at least half of the medical staff in our department were infected. At the beginning the infected were allowed to go home to rest, but now as long as it is not very serious symptoms, they are not allowed to go home.”

Bilateral pneumonia outbreak in Tucumán, Argentina

Thanks to Giuseppe Michieli for tagging me in a tweet about this news release from the Ministry of Public Health in the province of Tucumán, Argentina: El ministerio de Salud Pública informó sobre la situación sanitaria del brote de neumonía bilateral (Ministry of Public Health reports on the health situation of the outbreak of bilateral pneumonia). Excerpt from the Google translation, lightly edited:

In a new press conference, the head of the Health Portfolio, Dr. Luis Medina Ruiz, reported the death of a 70-year-old patient and the identification of 3 employees of the sanatorium experiencing the same outbreak.

In this regard, the minister announced: “The sanatorium informed us of the death of a 70-year-old patient who was hospitalized there, we needed the family to know first to be able to communicate it. In addition, we identified 3 more employees of the private agent who began with symptoms around August 20 to 23 (that is, they correspond to the same outbreak and place of contagion in principle). That is why at this moment 3 more people are added to the 6 initial patients”.

Regarding the 70-year-old patient who died today, the minister stated: “She was hospitalized and she underwent surgery for a gallbladder problem. She was re-operated twice. From then on, an infectious pulmonary disease took place, the date of which coincides with the onset of symptoms in the other patients, around August 20. Although it is not yet clear which came first, at first she was considered patient zero, but she is under study based on the deepening of the analyses that are being carried out”.

At the same time he added: “We informed about the 3 identified employees. One of them is a 40-year-old pharmacy assistant and she was hospitalized a few days ago in a public hospital with a fever. In the active search that we are carrying out, especially in health personnel, we detected that it is a person who has non-severe bilateral pneumonia with an oxygen requirement under study. The other person is a 44-year-old nurse; she is at her home and we are following her evolution, since her clinical condition does not warrant hospitalization. The third case is a 30-year-old nurse with comorbidities, who was admitted to hospital this morning. His symptoms began around the same days and on the date he was present to be evaluated, at which time we decided to hospitalize him."

Following this line, the official explained that these three people have bilateral pneumonia as a clinical characteristic and have in common the origin of the focus, the epidemiological link with the 6 initial patients. The criterion of incorporating them as suspected patients to the outbreak in principle is based on the employment relationship with the sanatorium, bilateral pneumonia and that with all the study panels its etiology has not yet been found.

“Last night and this morning we had information from the Malbrán Institute and so far all the studies that we had as negative -for Covid, Hantavirus and some strains of Legionella- are also giving negative results there. We continue to carry out the research protocol for blood cultures, sputum cultures, urine cultures and all the viruses and bacteria that we have available in the province. We are in direct communication with Minister Carla Vizzotti, who is available, as well as all the epidemiology and infectious disease teams of the Nation, we are working as a large medical board in which we all participate with the information we have, there are hypotheses of the etiology that are being put on the table, although what we have specifically is the common origin and evolution of the disease”, he added.

Will COVID force public health to confront America's epic inequality?

Via Nature, an important article by Amy Maxmen: Will COVID force public health to confront America's epic inequality? Excerpt:

On a hazy day in November, Hardeep Singh received a text message from the COVID-19 testing system at Foster Farms poultry company saying that his mother had tested positive for the coronavirus.  

He got the alert because his mother, a 63-year-old line worker at one of the company’s meat-packing plants in California’s San Joaquin Valley, doesn’t speak English and doesn’t own a smartphone.  

Singh couldn’t reach her as she continued to handle chicken parts alongside her co-workers. Her supervisors didn’t tell her, either. In fact, they assigned her more shifts for the week.  

Singh broke the news to her that evening, and convinced her not to return to work, where she might spread the infection to others. But he couldn’t reach anyone at the company for another five days, to ask whether she qualified for paid time off while she isolated.  

Singh’s mother ended up being among the more than 400 employees at the plant who were diagnosed with COVID-19 last year, and one of about 90,000 cases linked to food-production facilities and farm work across the United States. Because the sector feeds Americans and powers part of the US economy, agricultural workers such as Singh’s mother have been considered essential workers during the COVID-19 pandemic.  

That important role comes at a cost. One study1 found that food and agricultural workers in California had an almost 40% increased risk of dying last year, compared with the state’s general population. And within that imbalance lies another contrast. Latinx food and agriculture workers experienced a nearly 60% increase in deaths compared with previous years; the increase for white workers was just 16%.  

The reasons for such disparities, say public-health researchers, include discrimination, low wages, limited labour protections and inadequate access to health care, affordable housing and education. These are some of the ‘social determinants of health’, a concept that has been around for at least 150 years, but which has gained recognition during the pandemic.

Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada

Via medRxiv: Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada. This could have serious implications for healthcare systems around the world. The abstract:

Importance Most adults with COVID-19 do not require hospitalization, but the subsequent risk of post-COVID condition, including associated psychological and cognitive dysfunction, remains poorly understood among non-hospitalized versus hospitalized cases.  

Objective To assess the prevalence and duration of post-COVID condition, including physical, psychological and cognitive symptoms.  

Design Case series and case-control study between December 2020 and May 2021  

Setting Healthcare workers in Quebec, Canada  

Participants Eligible cases were symptomatic healthcare workers with PCR-confirmed COVID-19 between July 2020 and May 2021. Among 17,717 contacted cases, 6061 (34%) participated. A random sample of symptomatic healthcare workers with negative PCR result between November 2020 and May 2021 served as controls. Among 11,498 contacted controls, 4390 (38%) participated.  

Exposures In multivariable models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared self-reported cognitive dysfunctions (difficulty concentrating; difficulty organizing oneself; forgetfulness; loss of necessary items) among cases with post-COVID condition to controls, adjusting for psychological distress and fatigue.  

Outcomes Post-COVID condition was defined by symptoms persisting ≥4 weeks or ≥12 weeks after COVID-19 onset.  

Results Four-week and 12-week post-COVID condition prevalences of 46% (2,746/5,943) and 40% (653/1,746), respectively, were observed among non-hospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex and age were associated with higher risk.  

A substantial proportion of non-hospitalized cases with 4-week post-COVID condition often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%) and loss of necessary items (10%), with no decline at 12 weeks. All four aspects of cognitive dysfunction were 2.2 to 3.0 times more prevalent among cases with post-COVID condition than in controls, but also independently associated with psychological distress and fatigue.  

Conclusions and relevance Post-COVID condition may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many healthcare workers infected since the beginning of the COVID-19 pandemic, the ongoing implications for quality healthcare delivery could be profound should cognitive dysfunction and other severe post-COVID symptoms persist in a professionally-disabling way over the longer term.  

Question How common and long-lasting are the physical, psychological and cognitive effects of post-COVID condition in healthcare workers, both hospitalized and non-hospitalized?  

Findings The prevalence of post-COVID condition was 46% at 4 weeks and 40% at 12 weeks among non-hospitalized cases and 76% and 68% among hospitalized cases. One third of non-hospitalized healthcare workers with post-COVID condition reported cognitive impairment, which was independently associated with persistent physical symptoms, but also psychological distress and fatigue.  

Meaning Persistent cognitive and other professionally-disabling sequelae of COVID-19 in essential workers could have critical implications for quality healthcare delivery during and after the pandemic.

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.

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.”

How America's ICUs are dealing with another Christmas of death and distress

Via The New York Times: How America's ICUs Are Dealing with Another Christmas of Death and Distress. Excerpt:

INDIANAPOLIS — Of all the Covid patients that Ronda Stevenson is treating over Christmas, there’s one she cannot stop thinking about. He has been hospitalized for 10 months, and in all that time his 7-year-old daughter has never once been allowed to visit, prohibited from the hospital by age restrictions that keep families separated. Situations like this are bringing even veteran health care workers to tears.  

Ms. Stevenson, an intensive care unit nurse at Eskenazi Health in Indianapolis for the past seven years, cries as she talks about her patients and their families, making clear the grinding toll of the pandemic on already exhausted hospital work forces.  

“We’re pretty short-staffed,” Ms. Stevenson said. She added: “It’s getting harder.”  

Instead of taking holiday vacations this weekend, workers at strained hospitals across the nation are working 16-hour shifts. Some have been on the job every day for weeks. Festive meals have been replaced with protein bars and sports drinks.  

This Christmas weekend, with the United States facing another surge of illness stoked by a proportion of the population that remains unvaccinated, frontline workers are again sacrificing time at home with family to tend to Covid patients. In Indiana, which has among the highest rates of hospitalization and lowest rates of vaccination in the country, the situation is especially acute.

“A lot of people, including myself, had scheduled time off but are now being asked to come in and pick up shifts to cover for one another and meet the increased demands of patient care,” said Dr. Graham Carlos, the executive medical director at Eskenazi, which is at capacity and has had a backlog of patients in the emergency room.  

He worries that it will only get worse. “If the numbers continue as they are, a tidal wave of infections is going to hit hospital systems, putting us in dire straits,” he said.  

Nearly two years into a pandemic that shows no sign of abating, doctors, nurses and other frontline workers have already faced the emotional toll of mass death in their hospitals. They have endured the frustration of pleading with the public to take precautions only to watch outbreaks unfold as people ignored the call for help. They have suffered the moral distress of not being able to give patients the ideal level of care.  

But this season, there is a new strain on the system: Many workers who persisted through the first year of the pandemic have departed jobs because of burnout and anxiety. And with the Omicron variant pushing case numbers up dramatically, the caregivers who remain are getting infections, too, straining staff levels in unpredictable ways.

“This is the worst I’ve ever seen it,” said Maureen May, a nurse with 37 years of experience who serves as president of the Pennsylvania Association of Staff Nurses and Allied Professionals. She canceled her own holiday plans to pick up a shift on Christmas Day so that a co-worker could have time away.