COVID-19 and Long Term Care

Collection of articles on COVID and LTC is available here

COVID-19 and Resident Care

Coronavirus Disease 19 (COVID-19) restrictions and loneliness among residents in long-term care communities: Data from the National Health and Aging Trends Study
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Hua CL, Thomas KS.
Journal of the American Medical Directors Association 2021/07.
Loneliness is associated with increased morbidity and mortality among older adults. Residents in long-term care (LTC) communities have higher rates of loneliness than community-dwelling individuals. Coronavirus Disease 19 (COVID-19) has disproportionately contributed to deaths in LTC communities, leading to measures to prevent the virus’s spread such as prohibiting visitors. Although potentially life-saving, these actions may have negative implications given that social isolation increases risk for loneliness. Anecdotal reports suggest that COVID-19 restrictions contribute to residents who have stopped eating and “given up”. However, to our knowledge, the relationship between COVID-19 restrictions and increased loneliness among residents in LTC communities has yet to be explored using nationally representative data. This report examines whether restrictive measures are associated with increased loneliness among older adults in LTC communities during the COVID-19 pandemic.

COVID-19 and long-term care facilities in Mexico: a debt that cannot be postponed
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Mena-Madrazo JA, Sosa-Tinoco E, Flores-Castro M, López-Ortega M, Gutiérrez-Robledo LM.
Gac Med Mex 2021;157(1):94-96.
Since the emergence of the COVID-19 pandemic, the most affected population group has been that of older people living in long-term care facilities (LTCFs), which has accumulated between 30 and 60 % of total number of deaths in the world. In Mexico, outbreaks have been reported in LTCFs of at least eight states. Various factors make this population group and LTCFs susceptible to COVID-1 outbreaks, mainly due to coexistence in common spaces, shared bedrooms and permanent physical contact with the personnel who work there, coupled with a lack of protocols and standards of care of mandatory observance, as well as personnel training limitations. There is evidence of the need to formally develop a National Care System that provides support to those in need of care and their families, and that includes LTCFs. In view of the challenges due to the lack of information and competencies in infection prevention and control at LTCFs, a group of experts, in collaboration with different public institutions, joined efforts with the purpose to update the guidelines in order to allow LTCFs face the pandemic and to contribute to the generation of said National Care System.

Quality Improvement

Application of the Haddon matrix to COVID-19 prevention and containment in nursing homes
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Fritch WM, Agnew J, Rosman L, Cadorette MA, Barnett DJ.
J Am Geriatr Soc 2021 Jul 8.
COVID-19 has exacted a disproportionate toll on the health of persons living in nursing homes. Healthcare providers and other decision-makers in those settings must refer to multiple evolving sources of guidance to coordinate care delivery in such a way as to minimize the introduction and spread of the causal virus, SARS-CoV-2. It is essential that guidance be presented in an accessible and usable format to facilitate its translation into evidence-based best practice. In this article, we propose the Haddon matrix as a tool well-suited to this task. The Haddon matrix is a conceptual model that organizes influencing factors into pre-event, event, and post-event phases, and into host, agent, and environment domains akin to the components of the epidemiologic triad. The Haddon matrix has previously been applied to topics relevant to the care of older persons, such as fall prevention, as well as to pandemic planning and response. Presented here is a novel application of the Haddon matrix to pandemic response in nursing homes, with practical applications for nursing home decision-makers in their efforts to prevent and contain COVID-19.

Prevalence and Spread

Mitigating outbreaks in congregate settings by decreasing the size of the susceptible population [Pre-Print]
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Blumberg S, Lu P, Hoover CM, Lloyd-Smith JO, Kwan AT, Sears D, et al.
medRxiv 2021 Jul 7.
While many transmission models have been developed for community spread of respiratory pathogens, less attention has been given to modeling the interdependence of disease introduction and spread seen in congregate settings, such as prisons or nursing homes. As demonstrated by the explosive outbreaks of COVID-19 seen in congregate settings, the need for effective outbreak prevention and mitigation strategies for these settings is critical. Here we consider how interventions that decrease the size of the susceptible populations, such as vaccination or depopulation, impact the expected number of infections due to outbreaks. Introduction of disease into the resident population from the community is modeled as a branching process, while spread between residents is modeled via a compartmental model. Control is modeled as a proportional decrease in both the number of susceptible residents and the reproduction number. We find that vaccination or depopulation can have a greater than linear effect on anticipated infections. For example, assuming a reproduction number of 3.0 for density-dependent COVID-19 transmission, we find that reducing the size of the susceptible population by 20% reduced overall disease burden by 47%. We highlight the California state prison system as an example for how these findings provide a quantitative framework for implementing infection control in congregate settings. Additional applications of our modeling framework include optimizing the distribution of residents into independent residential units, and comparison of preemptive versus reactive vaccination strategies.

Bayesian inference of heterogeneous epidemic models: Application to COVID-19 spread accounting for long-term care facilities
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Chen P, Wu K, Ghattas O.
Comput Methods Appl Mech Eng 2021 Nov 1;385:114020.
We propose a high dimensional Bayesian inference framework for learning heterogeneous dynamics of a COVID-19 model, with a specific application to the dynamics and severity of COVID-19 inside and outside long-term care (LTC) facilities. We develop a heterogeneous compartmental model that accounts for the heterogeneity of the time-varying spread and severity of COVID-19 inside and outside LTC facilities, which is characterized by time-dependent stochastic processes and time-independent parameters in ∼  1500 dimensions after discretization. To infer these parameters, we use reported data on the number of confirmed, hospitalized, and deceased cases with suitable post-processing in both a deterministic inversion approach with appropriate regularization as a first step, followed by Bayesian inversion with proper prior distributions. To address the curse of dimensionality and the ill-posedness of the high-dimensional inference problem, we propose use of a dimension-independent projected Stein variational gradient descent method, and demonstrate the intrinsic low-dimensionality of the inverse problem. We present inference results with quantified uncertainties for both New Jersey and Texas, which experienced different epidemic phases and patterns. Moreover, we also present forecasting and validation results based on the empirical posterior samples of our inference for the future trajectory of COVID-19.

Comparison of hospitalized patients with COVID-19 who did and did not live in residential care facilities in Montréal: a retrospective case series
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Mah J, Lieu A, Palayew M, Alipour P, Kong LY, Song S, et al.
CMAJ Open 2021 Jul 13;9(3):E718-E727.
BACKGROUND: As in other jurisdictions, the demographics of people infected with SARS-CoV-2 changed in Quebec over the course of the first COVID-19 pandemic wave, and affected those living in residential care facilities (RCFs) disproportionately. We evaluated the association between clinical characteristics and outcomes of hospitalized patients with COVID-19, comparing those did or did not live in RCFs. METHODS: We conducted a retrospective case series of all consecutive adults (≥ 18 yr) admitted to the Jewish General Hospital in Montréal with laboratory-confirmed SARS-CoV-2 infection from Mar. 4 to June 30, 2020, with in-hospital follow-up until Aug. 6, 2020. We collected patient demographics, comorbidities and outcomes (i.e., admission to the intensive care unit, mechanical ventilation and death) from medical and laboratory records and compared patients who did or did not live in public and private RCFs. We evaluated factors associated with the risk of in-hospital death with a Cox proportional hazard model. RESULTS: In total, 656 patients were hospitalized between March and June 2020, including 303 patients who lived in RCFs and 353 patients who did not. The mean age was 72.9 (standard deviation 18.3) years (range 21 to 106 yr); 349 (53.2%) were female and 118 (18.0%) were admitted to the intensive care unit. The overall mortality rate was 23.8% (156/656), but was higher among patients living in RCFs (36.6% [111/303]) compared with those not living in RCFs (12.7% [45/353]). Increased risk of death was associated with age 80 years and older (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.35-4.24), male sex (HR 1.74, 95% CI 1.25-2.41), the presence of 4 or more comorbidities (HR 2.01, 95% CI 1.18-3.42) and living in an RCF (HR 1.62, 95% CI 1.09-2.39). INTERPRETATION: During the first wave of the COVID-19 epidemic in Montréal, more than one-third of RCF residents hospitalized with SARS-CoV-2 infection died during hospitalization. Policies and practices that prevent future outbreaks of SARS-CoV-2 infection in this setting must be implemented to prevent high mortality in this vulnerable population.

Impact Of Visitation And Cohorting Policies To Shield Residents From Covid-19 Spread In Care Homes: An Agent-based Model: Controlling COVID-19 in care homes
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Nguyen MLKN, Howick PS, McLafferty MD, Anderson MGH, Pravinkumar DSJ, Van Der Meer DR, et al.
Am J Infect Control 2021 Jul 7.
BACKGROUND: This study examines the impact of visitation and cohorting policies as well as the care home population size upon the spread of COVID-19 and the risk of outbreak occurrence in this setting. METHODS: Agent-based modelling Results: The likelihood of the presence of an outbreak in a care home is associated with the care home population size. Cohorting of residents and staff into smaller, self-contained units reduces the spread of COVID-19. Restricting the number of visitors to the care home to shield its residents does not significantly impact the cumulative number of infected residents and risk of outbreak occurrence in most scenarios. Only when the community prevalence where staff live is considerably lower than the prevalence where visitors live (the former prevalence is less than or equal to 30% of the latter), relaxing visitation increases predicted infections much more significantly than it does in other scenarios. Maintaining a low infection probability per resident-visitor contact helps reduce the effect of allowing more visitors into care homes. CONCLUSIONS: Our model predictions suggest that cohorting is effective in controlling the spread of COVID-19 in care homes. However, according to predictions shielding residents in care homes is not as effective as predicted in a number of studies that have modelled shielding of vulnerable population in the wider communities.

Duration of SARS-CoV-2 shedding: A population-based, Canadian study
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Phillips SP, Wei X, Kwong JC, Gubbay J, Schwartz KL, Majury A, et al.
PLoS One 2021 Jun 17;16(6):e0252217.
INTRODUCTION: There is an evidence gap regarding the duration of SARS-CoV-2 shedding and of its variability across different care settings and by age, sex, income, and co-morbidities. Such evidence is part of understanding of infectivity and reinfection. We examine direct measures of viral shedding using a linked population-based health administrative dataset. METHODS: Laboratory and sociodemographic databases for Ontario, Canada were linked to identify those testing positive (RT-PCR) between Jan. 15 and April 30, 2020 who underwent subsequent testing by May 31, 2020. To maximise use of available data, we computed two shedding duration estimates defined as the time between initial positive and most recent positive (documented shedding) or second of two negative tests (documented resolution). We also report multivariable results using quantile regression to examine subgroup differences. RESULTS: In Ontario, of the 16,595 who tested positive before April 30, 2020, 6604 had sufficient subsequent testing to allow shedding duration calculation. Documented shedding median duration calculated in 4,889 (29% of 16,595) patients was 19 days (IQR 12-28). Documented resolution median duration calculated in 3,219 (19% of the 16,595) patients was 25 days (IQR 18-34). Long-term care residents had 3-5 day longer shedding durations using both definitions. Shorter documented shedding durations of 2-4 days were observed in those living in higher income neighbourhoods. Shorter documented resolution durations of 2-3 days were observed at the 25th% of the distribution in those aged 20-49. Only 11.5% of those with definitive negative test results reverted to negative status by day 14. CONCLUSIONS: Viral shedding continued well beyond 14 days among this large subset of a population-based group with COVID-19, and longer still for long-term care residents and those living in less affluent neighborhoods. Our findings do not speak to duration of infectivity but are useful for understanding the expected duration of RT-PCR positivity and for identifying reinfection.

COVID-19 Outbreak Associated with a SARS-CoV-2 P.1 Lineage in a Long-Term Care Home after Implementation of a Vaccination Program – Ontario, April-May 2021
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Williams C, Al-Bargash D, Macalintal C, Stuart R, Seth A, Latham J, et al.
Clin Infect Dis 2021 Jul 8.
In a P.1 COVID-19 outbreak in long-term-care, vaccine effectiveness against SARS-CoV-2 infection was 52.5% (95%CI 26.9-69.8%) in residents and 62.2% (95%CI, 2.3-88.3%) in staff. VE against severe illness was 78.6% (95%CI 47.9-91.2) in residents. Two of 19 vaccinated resident cases died. Outbreak management required both vaccination and infection control measures.

Administration and Organization

From Cruddiness to Catastrophe: COVID-19 and Long-term Care in Ontario
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Badone E.
Med Anthropol 2021 Jul;40(5):389-403.
Over 80% of Canadian COVID-19 first wave deaths occurred in long-term care homes. Focussing on Ontario, I trace the antecedents of the COVID-19 crisis in long-term care and document experiences of frontline staff and family members of residents during the pandemic. Following Povinelli, I argue that the marginalization of both residents and workers in Ontario’s long-term care system over two decades has eroded possibilities for recognition of their personhood. I also question broader societal attitudes toward aging, disability and death that make possible the abandonment of the frail elderly.

Larger Nursing Home Staff Size Linked To Higher Number Of COVID-19 Cases In 2020
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McGarry BE, Gandhi AD, Grabowski DC, Barnett ML.
Health Aff (Millwood) 2021 Jul 14:101377hlthaff202100323.
Staff in skilled nursing facilities (SNFs) are essential health care workers, yet they can also be a source of COVID-19 transmission. We used detailed staffing data to examine the relationship between a novel measure of staff size (that is, the number of unique employees working daily), conventional measures of staffing quality, and COVID-19 outcomes among SNFs in the United States without confirmed COVID-19 cases by June 2020. By the end of September 2020, sample SNFs in the lowest quartile of staff size had 6.2 resident cases and 0.9 deaths per 100 beds, compared with 11.9 resident cases and 2.1 deaths per 100 beds among facilities in the highest quartile. Staff size, including staff members not involved in resident care, was strongly associated with SNFs’ COVID-19 outcomes, even after facility size was accounted for. Conventional staffing quality measures, including direct care staff-to-resident ratios and skill mix, were not significant predictors of COVID-19 cases or deaths. Reducing the number of unique staff members without decreasing direct care hours, such as by relying on full-time rather than part-time staff, could help prevent outbreaks.

COVID-19 preparedness in aged care: A qualitative study exploring residential aged care facility managers experiences planning for a pandemic
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Sunner C, Giles M, Parker V, Kable A, Foureur M.
J Clin Nurs 2021 Jul 12.
AIMS AND OBJECTIVES: The study aims to understand the changing context of RACFs and the role of RACF managers in preparing to confront the COVID-19 pandemic and to provide insights into how the use of visual telehealth consultation might be incorporated to assist with managing whatever might arise. DESIGN: An interpretive descriptive study design was employed, and data were collected using semi-structured interviews conducted via telephone or videoconference. Purposive recruitment targeted clinical managers responsible for the COVID-19 response in RACFs. METHODS: RACF clinical managers were invited to discuss their responses to COVID-19 including the management of RACF and staff. Semi-structured interviews explored the COVID-19-related challenges, the response to these challenges and how telehealth might assist in overcoming some of these challenges. This study followed Thorne’s (2008) three-stage process of interpretive description. The COREQ checklist was used in preparing this manuscript. RESULTS: Two main themes were identified. The first theme ‘keeping people safe’ was comprised of three subthemes; fear and uncertainty, managing the risks and retaining and recruiting staff. The second theme was ‘keeping people connected’, had two subthemes; being disconnected and isolated and embracing technology. CONCLUSION: Findings from this study provide valuable insight into understanding the context and the challenges for RACFs and the staff as they attempt to keep residents safe and connected with healthcare providers and the outside world. RELEVANCE TO CLINICAL PRACTICE: Understanding the experiences of RACF managers in preparing to respond to the pandemic will better inform practice development in aged care in particular the use of telehealth and safe practices during COVID-19. Increased awareness of the challenges faced by RACFs during a pandemic provides policymakers with valuable insights for future planning of pandemic responses.

Impact on LTC Workers

‘I wouldn’t choose this work again’: Perspectives and experiences of care aides in long-term residential care
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Booi L, Sixsmith J, Chaudhury H, O’Connor D, Young M, Sixsmith A.
J Adv Nurs 2021 Jul 7.
AIMS: To provide insight into the everyday realities facing care aides working in long-term residential care (LTRC), and how they perceive their role in society. DESIGN: A qualitative ethnographic case study. METHODS: Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi-structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. RESULTS: The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections – which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. CONCLUSION: Care aides remain an unsupported workforce that is essential to the provision of high-quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. IMPACT: What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.

Evaluation of the Mental Health of Care Home Staff in the Covid-19 Era. What price did care home workers pay for standing by their patients?
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Martín J, Padierna Á, Villanueva A, Quintana JM.
Int J Geriatr Psychiatry 2021 Jul 11.
BACKGROUND: The characteristics of this pandemic increase the potential psychological impact on care homes workers (CHWs). The aims of this study were to analyze the mental health and health-related quality of life (HRQoL) of a broad sample of CHWs in Spain and to identify potential factors that have a significant effect on their mental health and HRQoL. METHOD: This descriptive study comprised 210 CHWs who completed the Generalized Anxiety Disorder 7-item Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, the Insomnia Severity Index, and the Health-related Quality of Life Questionnaire. Sociodemographic and clinical data in relation to COVID-19 were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were applied to identify factors associated with mental health and HRQoL. RESULTS: 86.19% of participants were female; 86.67% were aged under 55 years; 11% were physicians and 64.19% were nurses or auxiliaries; 77.62% have themselves tested positive for Covid-19, and 67.94% of CHWs have directly treated patients with Covid-19. 49.28% had clinical depression; over half (58.57%) had clinical anxiety; 70.95% had clinical stress; and 28.57% had clinical insomnia. Increased use of tranquilizers/sedatives appears to be an explanatory variable of suffering greater anxiety, depression, stress and insomnia, and of having a worse HRQoL amongst our CHWs. CONCLUSIONS: Our study confirms that symptomatology of anxiety, depression, stress, insomnia and HRQoL were affected amongst CHWs during the Covid-19 pandemic. This article is protected by copyright. All rights reserved.

Working in a Dutch nursing home during the COVID-19 pandemic: Experiences and lessons learned
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Rutten JER, Backhaus R, Ph Hamers J, Verbeek H.
Nurs Open 2021 Jul 6.
AIMS: To gain insight into how direct care staff in Dutch nursing homes experienced work during the COVID-19 pandemic. DESIGN: A qualitative study consisting of semi-structured, face-to-face focus groups was conducted using “the active dialogue approach”. METHODS: Participants (n = 29) were care staff from four care teams at Dutch nursing homes. Teams were selected based on the number of COVID-19 infections amongst residents. Data were analysed with conventional content analysis. RESULTS: Themes emerging from the data were the loss of (daily) working structure, interference between work and private life for direct care staff, the importance of social support by the team and a leader, and the effects on relationship-centred care of the measures. Results offer concrete implications for similar situations in the future: psychological support on-site; autonomy in daily work of care staff; an active role of a manger on the work floor and the importance of relationship-centred care.

Impact on Health Care Workers

Posttraumatic stress disorder in nurses caring for patients with COVID-19
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Hill R.
Nursing 2021 Jul 1;51(7):52-56.
Little is known about the psychological impact of trauma from pandemics such as the COVID-19 pandemic. This article explores a descriptive study on the impact of COVID-19 and the prevalence of posttraumatic stress disorder among RNs caring for patients with COVID-19. This descriptive cross-sectional study assessed active RNs at two acute care hospitals in north Louisiana in June 2020. Convenience sampling was conducted on volunteer participants, targeting those who worked full time. The participants were asked to identify their daily level of exposure to patients with COVID-19 as either “greater than 75%” or “less than 25%” of their patient load, or indicate that they had “no exposure” to these patients. Based on their answers, respondents were sorted into “high-exposure,” “low-exposure,” and “no exposure” categories.

NHS staff mental health status in the active phase of the COVID-19 era: a staff survey in a large London hospital
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Ike ID, Durand-Hill M, Elmusharaf E, Asemota N, Silva E, White E, et al.
Gen Psychiatr 2021 Mar 19;34(2):e100368-2020-100368. eCollection 2021.
BACKGROUND: Experiencing a pandemic can be very unsettling and may have a negative impact on the mental health of frontline healthcare workers (HCWs). This may have serious consequences for the overall well-being of HCWs, which in turn may adversely affect patient safety and the productivity of the institution. AIMS: We designed a study to assess the prevalence of generalised anxiety disorder (GAD), depression and work-related stress experienced by the National Health Service staff in a large tertiary London hospital treating patients with COVID-19 during the current active phase of the COVID-19 era. METHODS: An anonymous survey was designed with demographic data and three questionnaires. The Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 were used to assess anxiety and depression, respectively. The Health and Safety Executive Management Standards Indicator Tool was used to assess work-related stress. Staff from multiple specialties embracing cardiothoracic surgery, cardiology, respiratory medicine, endocrinology, oncology, imaging, anaesthesia and intensive care at our hospital were asked to complete the questionnaire between 25 May and 15 June 2020. RESULTS: A total of 302 staff members (106 males and 196 females) completed the survey. The overall prevalence of GAD and depression was 41.4% and 42.7%, respectively. The prevalence of GAD and depression was significantly higher in females than in males and was statistically significant. Nurses were four times more likely to report moderate to severe levels of anxiety and depression as compared with doctors. Work-related stress was also observed to be prevalent in our surveyed population with the following standards: relationships, role, control and change showing a need for improvement. CONCLUSIONS: Our study presents early evidence suggestive of a high prevalence of GAD, depression and work-related stress in HCWs. It is imperative that coherent strategies are implemented to improve the healthcare work environment during this pandemic and mitigate further injury to the mental health status of the healthcare population.

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study
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Roberts T, Daniels J, Hulme W, Hirst R, Horner D, Lyttle MD, et al.
BMJ Open 2021 Jul 9;11(7):e049680-2021-049680.
OBJECTIVES: The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. DESIGN: A prospective online three-part longitudinal survey. SETTING: Acute hospitals in the UK and Ireland. PARTICIPANTS: Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020. PRIMARY OUTCOME MEASURES: Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised. RESULTS: The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R(2)=0.06) and trauma (R(2)=0.10). CONCLUSION: Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care. TRIAL REGISTRATION NUMBER: ISRCTN10666798.

Moderating Roles of Resilience and Social Support on Psychiatric and Practice Outcomes in Nurses Working During the COVID-19 Pandemic
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Schierberl Scherr AE, Ayotte BJ, Kellogg MB.
SAGE Open Nurs 2021 Jun 14;7:23779608211024213.
INTRODUCTION: Staff and equipment shortages and an easily transmissible virus make working in the COVID-19 pandemic demanding physically and psychologically. Nurses on the frontlines are particularly vulnerable to the adversity of working under these conditions, particularly with regard to mental health. Thus, understanding risk and protective factors for this vulnerable and essential group is critical for identifying potential targets of interventions. We had two aims for the current study: (a) to examine work functioning and symptoms of depression, anxiety, and posttraumatic stress (PTSD) among nurses who did and did not care for patients with COVID-19; and (b) to determine if resilience and social support moderate these relationships. METHODS: For three weeks in July 2020, nurses across the United States were invited to participate in an online survey collecting data on demographics, resilience, social support, and screening measures of depression, PTSD, anxiety, and distracted practice. Data were analyzed using descriptive statistics and hierarchical regression for each outcome measure. CONCLUSIONS: Our findings support a growing body of research reporting that nurses are experiencing mental health sequelae during the COVID-19 pandemic, especially those providing direct care to patients with the virus. We found that compared to nurses who did not care for patients with COVID-19, those who did reported increased symptoms of PTSD, depression, and anxiety. A novel contribution is our finding that nurses providing direct COVID-19 care also experienced increased levels of distracted practice, a behavioral measure of distraction linking to a potential impact on patient care. We also found that resilience and social support acted as moderators of some of these relationships. Fostering resilience and social support may help buffer the effects of providing care to patients with COVID-19 and could potentially decrease nurse vulnerability to developing psychological symptoms and impairment on the job.

Mental health outcomes of ICU and non-ICU healthcare workers during the COVID-19 outbreak: a cross-sectional study
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Wozniak H, Benzakour L, Moullec G, Buetti N, Nguyen A, Corbaz S, et al.
Ann Intensive Care 2021 Jul 10;11(1):106-021-00900-x.
BACKGROUND: Intensive care workers are known for their stressful work environment and for a high prevalence of mental health outcomes. The aim of this study was to evaluate the mental health, well-being and changes in lifestyle among intensive care unit (ICU) healthcare workers (HCW) during the first wave of the COVID-19 pandemic and to compare these results with those of HCW in other hospital units. Another objective was to understand which associated factors aggravate their mental health during the COVID-19 outbreak. METHODS: This cross-sectional survey collected socio-demographic data, lifestyle changes and mental health evaluations as assessed by the Generalized Anxiety Disorder 7 items (GAD-7), the Patient Health Questionnaire 9 items (PHQ-9), the Peritraumatic Distress Inventory (PDI) and the World Health Organization Well-Being Index (WHO-5) from the 28th May to 7th July 2020. The study was carried out at Geneva University Hospitals, a group of eight public hospitals in Switzerland. ICU HCW were analyzed for mental health outcomes and lifestyles changes and then compared to non-ICU HCW. A series of linear regression analyses were performed to assess factors associated with mental health scores. RESULTS: A total of 3461 HCW were included in the study, with 352 ICU HCW. Among ICU HCW, 145 (41%) showed low well-being, 162 (46%) symptoms of anxiety, 163 (46%) symptoms of depression and 76 (22%) had peritraumatic distress. The mean scores of GAD-7, PHQ-9 and WHO-5 were worse in ICU HCW than in non-ICU HCW (p < 0.01). Working in the ICU rather than in other departments resulted in a change of eating habits, sleeping patterns and alcohol consumption (p < 0.01). Being a woman, the fear of catching and transmitting COVID-19, anxiety of working with COVID-19 patients, work overload, eating and sleeping disorders as well as increased alcohol consumption were associated with worse mental health outcomes. CONCLUSION: This study confirms the suspicion of a high prevalence of anxiety, depression, peritraumatic distress and low well-being during the first COVID-19 wave among HCW, especially among ICU HCW. This allows for the identification of associated risk factors. Long-term psychological follow-up should be considered for HCW.

Stressors Among Chinese Frontline Health Care Workers Exposed to COVID-19 and Associated Mental Health Outcomes
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Zhang X, Sun J, Sun M, Wang J, Li Y, Wu L, et al.
J Psychosoc Nurs Ment Health Serv 2021 Jul 1:1-6.
The current study aimed to identify the main stressors inherent to caring for patients with coronavirus disease 2019 (COVID-19) and associated mental health outcomes among frontline health care workers. Data were collected via an online questionnaire from 651 frontline health care workers providing direct medical services for patients with suspected or confirmed COVID-19. Participants reported the stressors inherent to caring for patients with COVID-19, including depression, anxiety, and insomnia. Data were analyzed using descriptive statistics and multivariable logistic regression analysis. The most common stressors were “Worry about being negligent and endangering coworkers” (76.2%), “Worry about getting infected” (74.7%), and “Protective gear causing physical discomfort” (73.6%). “Conflict between duty and safety” and “Protective gear causing physical discomfort” were linked to high risk of depression, anxiety, and insomnia. Findings suggest that frontline health care workers may develop adverse mental health outcomes in the face of certain stressors, requiring targeted interventions. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].