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Survey reveals physical and mental problems among health workers during pandemic

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Poor physical and mental health was frequent among Brazilian health workers employed in the public sector during the COVID-19 pandemic, according to a study by researchers at the Federal University of São Carlos (UFSCar) in São Paulo state, Brazil. The study showed that 86% reported burnout and 81% suffered from stress. They slept badly, experienced depression and complained of aches and pains. On the other hand, most said they were happy to provide meaningful services to society.

The study is still in progress. An analysis of the initial findings is reported in an article published in the journal Healthcare. The initiative as a whole is supported by FAPESP and is now in the final stage of data collection and analysis.

“The paper offers a snapshot of the situation, and we can’t blame the pandemic for all the problems we found, but we believe the particularly heavy effects of COVID-19 in Brazil contributed to these very negative results,” said Tatiana de Oliveira Sato, a professor of physical therapy at UFSCar’s School of Biological and Health Sciences (CCBS).

“Overwork, tough decisions and dramatic experiences all intensified because of the pandemic, affecting all health workers but especially those on the front line,” Sato said. Brazil has had more deaths of healthcare professionals from COVID-19 than any other country, according to the article.

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“The original idea for the survey arose just before the pandemic. Even outside the context of the pandemic, health workers have to deal with a heavy schedule and burden of responsibility. We wanted to assess the effects of all this on their physical and mental health. However, when the pandemic arrived, we decided to measure the impact of the public health emergency on the well-being of these workers,” Sato said.

Change of course

The researchers initially planned to interview volunteers on the job. They would all be health workers for the SUS, Brazil’s public health service, in São Carlos. However, the formalities required to prepare for the survey (permits, questionnaires, etc.) became irrelevant between late 2020 and early 2021, when the pandemic was raging across Brazil and vaccine rollout was still incipient.

“Instead, we created an online form and widened the search for respondents throughout the country,” Sato explained. “The criteria for inclusion were working for the SUS, being over 18, and being directly involved in patient care.”

The form was publicized via social media, emails and newspapers. It contained five questionnaires, each designed to quantify an aspect of the respondent’s life. They included the Copenhagen Psychosocial Questionnaire, the Pittsburgh Sleep Quality Index, the Nordic Musculoskeletal Questionnaire, and the Beck Depression Inventory.

The form was 10 pages long. “We reckoned it took 20-30 minutes to answer all the questions. The questionnaires were only included in the analysis if they were completely filled out,” Sato said. Local respondents also used equipment to measure the amount of physical activity for inclusion in the survey.

Eventually, 125 health workers took part in the study. The first stage of data collection lasted from June 2021 to April 2022. The data published so far constitutes a baseline and does not yet cover physical activity, but the project calls for four more steps to take place three, six, nine and 12 months after the first collection.

“We called this cohort HEROES. We thought a lot about the name because we didn’t want it to be taken as implying that health workers are superhuman and never get tired or dejected. The name is intended as a homage. We also wanted to call attention to the need to valorize health workers, who were disproportionately affected by the pandemic,” Sato said. Some 60 respondents participated in all stages.

Initial findings

The data presented in the article show a high prevalence of musculoskeletal symptoms: 64% reported neck pain, 62% shoulder pain, 58% upper back pain and 61% lower back pain.

For Sato, all this was certainly due largely to long hours, being on their feet most of the time, lifting patients and working flat out. “But mental stress can also trigger these kinds of pain because of the tension it creates in the body,” she noted.

The frequency of psychosocial problems is striking, according to the authors, with stress affecting 81% of the participants and 86% suffering burnout. Symptoms of mild depression were detected in 22%, moderate depression in 16% and severe depression in 8%. In addition, 74.4% said they slept badly.

It is still necessary to analyze the evolution of the indicators over time, however. According to Sato, prevalence levels tend to be lower in studies of other populations. For example, five meta-analyses mentioned in the article found burnout rates ranging from 25% to 37%, while nine such studies found that between 17% and 57% of the respective samples suffered from stress. These proportions are far lower than those reported in the study by the researchers at UFSCar.

Workplace climate

Other psychosocial factors were assessed via the Copenhagen questionnaire, with a large majority of respondents giving negative scores to the emotional demands of their work (75%), its pace and intensity (61%), and its unpredictability (47%). These were the psychosocial factors with the worst ratings in the survey.

The proportions who reported offensive behavior were also strikingly high: 15% said they had been the object of unwanted sexual attention or harassment, while 26% had been threatened, 17% bullied, and 9% physically assaulted.

“This is deplorable. All these numbers should be zero. Occurrences of this kind in any workplace are unacceptable,” Sato said. Sexual harassment was reported most by younger women, she noted. Threats of violence came mainly from patients and their relatives, while fellow workers were more often bullies than supervisors.

On the positive side, more than 90% said they believed their work was very meaningful and some 80% said they were committed to their work despite the stress.

Limitations and implications

For Sato, the relatively small number of respondents to the first form (125) and the even smaller number (about 60) remaining in the last stage of the survey were a limitation because they prevented extrapolation and analysis of data for other regions. “Nevertheless, the survey was valuable because of its depth,” she said.

The information obtained, she added, is sufficient to lobby top management of the SUS and the authorities for improvements to working conditions. Physically and mentally distressed professionals cannot always provide the best patient care.

“This has to lead to increased staffing, better pay, less exhausting hours and proper training,” Sato said. Simple matters such as providing training for staff on the best ways to lift and carry patients without injuring themselves could lead to significant improvements in musculoskeletal terms. Similarly, creation of support networks would help nursing and other staff cope with the emotional impact. “Health workers need a lot of support. They’re people, too,” she said.

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe


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Governments seek buyer as Quebec COVID-19 vaccine manufacturer Medicago set to close

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MONTREAL — The Quebec government says it’s looking to find a buyer for Medicago Inc., the Quebec-based COVID-19 vaccine manufacturer that will be shut down by parent company Mitsubishi Chemical.

Quebec Economy Minister Pierre Fitzgibbon said Friday the province has had preliminary talks with potential buyers in the pharmaceutical sector to keep Medicago’s expertise and skilled workforce in Quebec. He said both the Quebec and federal governments would be willing to put in money to secure a deal.

“We can’t operate it ourselves; the government will not be the main shareholder,” Fitzgibbon said. “But if there is a pharmaceutical company that considers it’s worth continuing, we’re ready to help.”

Mitsubishi Chemical said Thursday it would stop marketing the Medicago-produced Covifenz vaccine, which is plant-based and was approved by Health Canada one year ago for adults aged 18 to 64.

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The Japanese chemical company said it had been preparing to commercially produce the Covifenz vaccine but decided against doing so because of the “significant changes” in the COVID-19 vaccine environment. The company said it would dissolve Medicago because it is no longer “viable” to continue marketing its products.

“In light of significant changes to the COVID-19 vaccine landscape since the approval of Covifenz, and after a comprehensive review of the current global demand and market environment for COVID-19 vaccines and Medicago’s challenges in transitioning to commercial-scale production, the (company) has determined that it will not pursue the commercialization of Covifenz,” Mitsubishi Chemical said in a statement.

Following the announcement, Medicago issued a statement thanking its employees. “The Medicago team has pushed scientific boundaries and we know that they will continue to make incredible contributions to innovation and biopharmaceutical’s sector.”

Canada invested $173 million in Medicago in 2020 to support development of the Covifenz vaccine and help Medicago expand its production facility in Quebec City.

On Thursday, Innovation, Science and Industry Minister François-Philippe Champagne told reporters the federal government is in “solution mode.”

“Our first order of business is really to try to find a partner who can help us preserve the jobs, preserve the technology and the intellectual property,” Champagne said.

The minister acknowledged that mRNA vaccine technology for COVID-19 became dominant as it “seemed to be most effective.”

But Medicago’s plant-based vaccine was still “promising,” Champagne said.

“Everyone agreed that the plant-based vaccine could very well help in a future pandemic,” Champagne said.

Speaking to reporters on Montreal’s South Shore Friday, Fitzgibbon said the company informed the province at the end of December it intended to pull the plug on Medicago.

In May 2015, Quebec and Ottawa announced loans of $60 million and $8 million, respectively, for the construction of a complex in the Quebec City region to house Medicago’s activities.

“The challenge is not (getting the loan repaid), it’s how we can save the jobs, save this company,” Fitzgibbon said.

While Canada authorized Medicago’s vaccine in February 2022, it was rejected for emergency use by the World Health Organization in March because tobacco company Philip Morris was a minority shareholder in the company, contravening a policy adopted in 2005 by the United Nations agency.

Quebec City Mayor Bruno Marchand said on Twitter he was saddened by the closure of the company.

“My thoughts are with the families who learned some very sad news,” Marchand said Thursday evening. “We have to roll up our sleeves to keep all this expertise in the field of health innovation in Quebec City.”

This report by The Canadian Press was first published Feb. 3, 2023.

 

Sidhartha Banerjee, The Canadian Press

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Bird flu keeps spreading beyond birds. Scientists worry it signals a growing threat to humans, too

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As a deadly form of avian influenza continues ravaging bird populations around much of the world, scientists are tracking infections among other animals — including various types of mammals more closely related to humans.

Throughout the last year, Canadian and U.S. officials detected highly pathogenic H5N1 avian flu in a range of species, from bears to foxes. In January, France’s national reference laboratory announced that a cat suffered severe neurological symptoms from an infection in late 2022, with the virus showing genetic characteristics of adaptation to mammals.

Most concerning, multiple researchers said, was a large, recent outbreak on a Spanish mink farm.

Last October, farm workers began noticing a spike in deaths among the animals, with sick minks experiencing an array of dire symptoms like loss of appetite, excessive saliva, bloody snouts, tremors, and a lack of muscle control.

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The culprit wound up being H5N1, marking the first known instance of this kind of avian influenza infection among farmed minks in Europe, notes a study published in Eurosurveillance this month.

“Our findings also indicate that an onward transmission of the virus to other minks may have taken place in the affected farm,” the researchers wrote.

Eventually, the entire population of minks was either killed or culled — more than 50,000 animals in total.

That’s a major shift, after only sporadic cases among humans and other mammals over the last decade, according to Michelle Wille, a researcher at the University of Sydney who focuses on the dynamics of wild bird viruses.

“This outbreak signals the very real potential for the emergence of mammal-to-mammal transmission,” she said in email correspondence with CBC News.

It’s only one farm, and notably, none of the workers — who all wore face shields, masks, and disposable overalls — got infected.

But the concern now, said Toronto-based infectious disease specialist Dr. Isaac Bogoch, is if this virus mutates in a way that allows it to become increasingly transmissible between mammals, including humans, “it could have deadly consequences.”

“This is an infection that has epidemic and pandemic potential,” he said. “I don’t know if people recognize how big a deal this is.”

 

‘Explosive’ avian flu surge hits global bird populations

Global bird populations are being ravaged by a deadly strain of avian flu, wiping out flocks of domestic poultry and killing wild birds. Some researchers warn the virus could eventually evolve to better infect humans and potentially start a future pandemic.

H5N1 has high mortality rate

Among birds, the mortality rate of this strain of highly pathogenic avian influenza can be close to 100 per cent, causing devastation to both wild bird populations and poultry farms.

It’s also often deadly for other mammals, humans included.

The World Health Organization (WHO) has documented 240 cases of H5N1 avian influenza within four Western Pacific countries — including China, Cambodia, Laos, and Vietnam — over the last two decades. More than half of the infected individuals died.

Global WHO figures show more than 870 human cases were reported from 2003 to 2022, along with at least 450 deaths — a fatality rate of more than 50 per cent.

Bogoch said the reported death toll may be an overestimate, since not all infections may be detected, though it’s clear people can “get very, very sick from these infections.”

Most human infections also appeared to involve people having direct contact with infected birds. Real-world mink-to-mink transmission now firmly suggests H5N1 is now “poised to emerge in mammals,” Wille said — and while the outbreak in Spain may be the first reported instance of mammalian spread, it may not be the last.

“A virus which has evolved on a mink farm and subsequently infects farm workers exposed to infected animals is a highly plausible route for the emergence of a virus capable of human-to-human transmission to emerge,” she warned.

Louise Moncla, an assistant professor of pathobiology at the University of Pennsylvania school of veterinary medicine, explained that having an “intermediary host” is a common mechanism through which viruses adapt to new host species.

“And so what’s concerning about this is that this is exactly the kind of scenario you would expect to see that could lead to this type of adaptation, that could allow these viruses to replicate better in other mammals — like us.”

Government workers wear protective gear to collect poultry for slaughter during an outbreak of avian influenza on the Ivory Coast. More than 70 countries have reported cases this year, according to the World Organisation for Animal Health.
Government workers wear protective gear to collect poultry for slaughter during an outbreak of avian influenza on the Ivory Coast. More than 70 countries reported cases in 2022, according to the World Organisation for Animal Health. (Legnan Koula/EPA-EFE)

Surveillance, vaccines both needed

What’s more reassuring is the ongoing development of influenza vaccines, giving humanity a head start on the well-known threat posed by bird flu.

Wille noted the earlier spread of H7N9, another avian influenza strain which caused hundreds of human cases in the early 2010s, prompted similar concern that the virus would acquire the mutations needed for ongoing human-to-human transmission.

“However, a very aggressive and successful poultry vaccination campaign ultimately stopped all human cases,” she added.

But while several H5N1 avian influenza vaccines have been produced, including one manufactured in Canada, there’s no option approved for public use in this country.

To ward off the potential threat this strain poses to human health, Bogoch said ongoing surveillance and vaccine production needs to remain top-of-mind for both policy makers and vaccine manufacturers.

Dr. Jan Hajek, an infectious diseases physician at Vancouver General Hospital, also questioned whether it’s time to wind down global mink farming, given the spread of various viruses, from avian influenza to SARS-CoV-2, the virus behind COVID-19.

“We’re closely related to minks and ferrets, in terms of influenza risks … if it’s propagating to minks, and killing minks, it’s worrisome to us,” he said.

In 2021, B.C. officials announced an end to mink farming across the province, saying the farms can be reservoirs for viruses and represent an ongoing danger to public health. All mink farm operations must be shut down, with all of the pelts sold, by April 2025.

However, other provinces — and plenty of countries — do intend to keep their mink farms operating.

“Is it responsible to have these kinds of farming conditions where these types of events can occur?” questioned Moncla. “If we’re going to keep having these types of farms, what can we do to make this safer?”

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6,654 students facing suspension due to out-of-date immunization records

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The Windsor-Essex County Health Unit (WECHU) has issued about 6,654 suspension orders to students who do not meet immunization requirements.

WECHU completed a review of all elementary student immunization records in December and more than 12,000 students received a notice.

These students were either overdue for one or more vaccines required to attend school, or their immunization records were not updated with the health unit.

“While many of these vaccines are normally administered by primary health care providers, parents and guardians of children who received their vaccines from their health care provider still need to report this information to the health unit,” said a WECHU news release.

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The Immunization of School Pupils Act (ISPA) (1990), Section 11, Subsections (1) and (2) requires public health units to maintain and review vaccine records for every student attending school and to enforce a school suspension for incomplete immunization information. As the next step of the ISPA enforcement process, orders were mailed out to students that do not meet this requirement.

WECHU said this is the final notice.

The suspension order notifies parents and guardians that immunization records must be updated to the WECHU by Thursday, March 16, at 6 p.m. or their child will be suspended for up to 20 days from school, starting Monday, March 20, 2023. Once parents and guardians provide the missing immunization information to the WECHU, the student is removed from the suspension list and can attend school again.

Under the ISPA , children can be exempted from immunization for medical reasons or due to conscience or religious belief.

Families can book immunization appointments with their health care provider and are reminded to update their child’s immunization records online at immune.wechu.org.

Catch-up immunization clinics are also being offered at the WECHU Windsor and Leamington offices and will continue until the end of March. Families can book an appointment at a WECHU clinic by visiting wechu.org/getimmunized or by calling the WECHU at 519-960-0231.

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