In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett reports on some recent research findings and new releases.
The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study
Liu, Q, The Lancet, 29 April 2020
A study exploring the experiences of healthcare workers during the COVID-19 epidemic in China has described their feelings of a sense of duty to fight against the novel coronavirus, even though they previously had no experience working in infectious diseases.
The healthcare workers included in this qualitative study were nurses and physicians who, prior to COVID-19, worked in fields of oncology, neurosurgery and anaesthesia.
They were interviewed via phone between 10 and 15 February about their experiences working in COVID-19 dedicated hospitals during the beginning stages of the outbreak in Hubei Province, China.
They described feeling completely responsible for the patients’ wellbeing, caring for them emotionally as well as medically in treating symptoms of the disease.
Three main themes were identified from the interviews:
- A responsibility to the patients’ wellbeing and a call to duty
- Challenges of working in the COVID-19 hospital wards
- Resilience amid the challenges
Challenges described by the healthcare workers include: working in new healthcare environments; being overwhelmed by the workload; working cautiously with protective equipment; anxiety about being infected and also about infecting others; engaging with the patients during the crisis; and witnessing a wide range of patient experiences.
One participant said:
When I talk with patients who are recovering, I am more relaxed because treatments are effective.
But when patients have a persistent fever without obvious improvement, or their condition deteriorates, I am very depressed when I enter their room.”
While undergoing these challenging work experiences, the healthcare workers noted many sources of support helped them through that time. These included logistical support from the hospital, peer support from colleagues and support from wider community members, many of whom donated food to the staff.
The healthcare workers also identified with a great sense of achievement. One said:
I am proud that I do not hesitate in the face of risks and danger.
My awareness of self-protection and communication skills have also improved.”
The findings, in particular regarding the challenges faced by healthcare workers, are not unexpected nor dissimilar to studies already published about the mental health of health-workers (see here and here), and provide an in-depth account of the main challenges faced by those working on the frontline of the COVID-19 pandemic.
The authors say a limitation of their study was their limited ability to build rapport with participants, as interviews had to be conducted over the phone due to physical distancing restrictions for COVID-19.
In summary, the findings indicate the hard work of healthcare workers in the COVID-19 pandemic and that strategies should be implemented to mitigate the logistical and emotional challenges faced by frontline workers.
Estimating the burden of SARS-CoV-2 in France
Salje, J, Science Mag, 13 May 2020
France, like many other countries around the world, has been greatly impacted by the COVID-19 pandemic. As of 7 May, France had reported 95,210 hospitalisations and 16,386 deaths in hospital from the novel coronavirus.
To obtain a better understanding of the level of immunity in the population, researchers used modelling, applied to hospital admission and death data, to estimate that 4.4% of the French population (approximately 2.8 million people) will have actually been infected with SARS-CoV-2 by 11 May.
Similar estimates were found in an antibody study in Spain, (not yet peer-reviewed), which estimated that five percent of the Spanish population (approximately 2.3 million people) had been infected with the novel coronavirus. This is far more than the 230,000 confirmed reported cases.
The French study found that the reproduction number dropped from 2.90, as it was prior to the country’s lockdown on 17 March, to 0.67 by 11 May, indicating that the lockdown helped slow the spread of SARS-CoV-2 infections in France.
The authors say France “would require around 65% of the population to be immune for the epidemic to be controlled by immunity alone”, strongly suggesting that herd immunity without a vaccine is not an effective way to manage the COVID-19 pandemic.
No limitations are identified in their study; however, as with modelling studies, their results should be interpreted as a guide only.
The study does highlight the impact that lockdown measures had on slowing the rate of SARS-CoV-2 infections, and, that as such a low proportion of the population has been infected, efficient control measures will need to be maintained as France, and other countries, ease their current restrictions.
Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020
Garazzino, S, Eurosurveillance, Preprint
Preliminary analysis of data in Italian children (17 years of age or younger) infected with SARS-CoV-2 indicate that children mostly experience positive clinical outcomes and have a low risk of death from the virus.
Of 168 children in this cohort who tested positive for the novel coronavirus, 65% were hospitalised. Nearly twenty percent (19.6%) of the cohort developed complications, including pneumonia and severe respiratory illness. Two children in the cohort needed to be admitted to intensive care and treated with ventilation; these two children were under 12 months of age. All children in this cohort fully recovered.
Nearly twenty percent of the children had comorbidities; but the hospitalisation rate was similar between them and the children that didn’t have comorbidities.
The study also found that almost all of the children (97.5%) were symptomatic, with fever (ranging from 37.5 to 39 degrees Celsius) the most common symptom (in 82.1% of the children). Cough (48.8%) and rhinitis (26.8%) were other common symptoms.
Hospital admission was more common in younger than older children. For example, 78.8% of those younger than 12 months were admitted to hospital, compared to 52.5% of the 11-17-year old children.
Similar findings were reported in a Chinese study and data from the US Centres for Disease Control and Prevention where children younger than 12 months had more severe cases of the virus.
Garrazino and colleagues suggest this may be due to infants being more susceptible to the virus, displaying more symptoms than other ages, and/or that families may be more likely to seek medical advice for infants than older children.
The average age of the children was five years, 56% were male and 67.3% of the children had at least one parent who had been confirmed with the virus.
The authors highlight some limitations in the study: it was a relatively small sample size; and they acknowledge it may be difficult to make comparisons to paediatric data from other countries if different ages are included in study populations.
While the findings indicate that most children who contract SARS-CoV-2 recover fully with minimal complications, the study highlights that children younger than 12 months account for a higher proportion of more severe cases than other paediatric age groups.
The most promising vaccines for COVID-19
Cunningham, A, Australian Academy of Science, 11 May 2020
To date, a successful vaccine hasn’t been created for any human coronavirus. Many people are working around the world on a vaccine against SARS-CoV-2, as one of the most significant ways to limit the spread of the novel coronavirus.
This rapid review found more than 100 vaccine candidates are currently in pre-clinical development stages; and as of 10 May 2020, there are 10 vaccines in human clinical trials, all using new types of technology and platforms.
An Australian vaccine candidate is forecast to be in human clinical trial stage by July 2020.
While 10 vaccines are currently in human clinical trials, the authors advise it is too early to tell which will be the most promising candidate as trials are not complete, and they have also not gone through safety or efficacy testing. It is also not known if the current candidates will be able to be mass produced.
To ensure a vaccine is safe for large populations, development should be robust and rigorous, a sometimes lengthy and expensive process.
Health inequity during the COVID-19 pandemic: a cry for ethical global leadership
Chiriboga, D, The Lancet, 15 May 2020
Amid widespread concerns about the unequal impact of COVID-19 among disadvantaged communities, an open letter to the United Nations was submitted on 21 April calling for global leadership in a bid to alleviate the socioeconomic and health impacts on the World’s most vulnerable populations.
Disadvantaged people have a greater risk of being infected with, and experiencing worse outcomes from SARS-CoV-2 as a result of the often-crowded conditions where they live and having limited access to essential health care.
The letter has been endorsed by public health, scientific, academic and healthcare professionals and co-signed by more than 120 groups, including the World Federation of Public Health Associations and World Federation of Critical Care Nurses, who propose that a Global Health Equity Task Force be created to ensure equitable access to medication, vaccines and equipment during the pandemic.
It is hoped the Task Force would encourage universal health-care systems to be developed and economic inequalities addressed for sustainable and global health equity.
COVID-19 – will this second phase be harder than the first?
Gerada & Walker, BMJ Blog, 13 May 2020
As countries now begin to enter the next phase of the COVID-19 pandemic after an influx of patients, many healthcare professionals in the UK are reported to be taking an opportunity to draw breath and reflect upon the experiences of the past few weeks.
Gerada and Walker, from NHS Practitioner Health in the UK, are hearing from healthcare professionals and others who approach their service that many don’t want to return to work as it was pre-COVID-19.
Doctors have been reported as appreciating the opportunity that the COVID-19 crisis afforded them to work as part of a team and have the ability to connect with colleagues, virtually, from around the world, all experiencing work in a similar situation.
As this blog post is written based on experiences of the authors in England, it may not be relevant for people in other parts of the world. However, it is likely that most people will be needing to adjust to a ‘new normal’ in the next phase of the COVID-19 pandemic.
The authors recommend these tips to help adjusting in that transition:
- Adjust your expectations, allow time (could be many months) for the transition, and don’t expect that things will go straight back to normal, if at all.
- Remain connected with your support networks and those close to you; this helps prevent mental health issues following a crisis.
- Be aware of the choices you make in how you spend your time, for example, in separating work from life. Make a note in your calendar to check in every 4-6 weeks to review how you’re going, and make changes
You can listen to a BMJ podcast with Dr Walker about how to cope with COVID fatigue here.
Other resources
Predicting a worse COVID-19 outcome
Zappala, C, Australian Medical Association, 8 May 2020
This paper summarises published literature and compiled the main risk factors, or predictors, for severe COVID-19 outcomes, a useful resource for clinicians identifying patients at risk.
WHO Academy and WHO Info Apps
World Health Organization, 13 May 2020
WHO has launched two mobile apps in the past week to provide up-to-date support and information about COVID-19 to health workers (WHO Academy) and general public (WHO Info).
They can both be downloaded from Apple Store (WHO Academy, WHO Info) and Google Play (WHO Academy, WHO Info).
15 minutes on health inequalities
MRC/CSO Social and Public Health Sciences Unit, The University of Glasgow
A new Podcast series on health inequalities is now available. The first two episodes are about health inequalities and COVID-19, available here.
World Pandemic Research Network
A global directory of scientific resources on societal and human impacts of COVID-19.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
COVID-19 Twitter lists
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