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      Occupational COVID-19 Prevention among Congolese Healthcare Workers: Knowledge, Practices, PPE Compliance, and Safety Imperatives

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          Abstract

          The SARS-CoV-2 (COVID-19) pandemic has had a tremendous impact on the functionality of health systems and world affairs. We assessed knowledge, attitudes, and practices (KAPs) of healthcare workers (HCWs) in the Democratic Republic of the Congo (DRC). This was a cross-sectional study conducted in 23 referral hospitals located in three towns of the DRC (Lubumbashi, Kamina, Mbuji-Mayi). In total, 613 HCWs were surveyed using the World Health Organization’s (WHO’s) “Exposure Risk Assessment in the Context of COVID-19” questionnaire. Participants included medical doctors (27.2%) and other categories of HCWs (72.8%). The mean age was 40.3 ± 11.7 years. Over 80% (range: 83–96%) of respondents had sufficient knowledge on each of the three domains: COVID-19 symptoms, disease transmission, and patient care approach. However, attitudes and practices scores were relatively low. Only 27.7% of HCWs were willing to receive a COVID-19 vaccine when it is available, whereas 55% of HCWs complied with good practices; 49.4% wore masks consistently and, surprisingly, only 54.9% used personal protective equipment (PPE) consistently at work and during contact with patients. Knowledge level was positively associated with the use of social media as a primary source of COVID-19-related information and the category of residence, with HCWs from towns already affected by the COVID-19 epidemic being more likely to have positive attitudes (adjusted OR, 1.64; 95%CI, 1.32–2.20) and comply with good practices (aOR, 2.79; 95%CI, 1.93-4.06). This study showed that most Congolese HCWs had sufficient knowledge on COVID-19, whereas the majority did not comply with consistent PPE use. The government of the DRC should urgently take major steps in capacity building for HCWs in outbreak preparedness and supplying hospitals with PPE.

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          Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

          Summary Background A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were successively reported in Wuhan, China. We aimed to describe the CT findings across different timepoints throughout the disease course. Methods Patients with COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who were admitted to one of two hospitals in Wuhan and who underwent serial chest CT scans were retrospectively enrolled. Patients were grouped on the basis of the interval between symptom onset and the first CT scan: group 1 (subclinical patients; scans done before symptom onset), group 2 (scans done ≤1 week after symptom onset), group 3 (>1 week to 2 weeks), and group 4 (>2 weeks to 3 weeks). Imaging features and their distribution were analysed and compared across the four groups. Findings 81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years (SD 11·0). The mean number of involved lung segments was 10·5 (SD 6·4) overall, 2·8 (3·3) in group 1, 11·1 (5·4) in group 2, 13·0 (5·7) in group 3, and 12·1 (5·9) in group 4. The predominant pattern of abnormality observed was bilateral (64 [79%] patients), peripheral (44 [54%]), ill-defined (66 [81%]), and ground-glass opacification (53 [65%]), mainly involving the right lower lobes (225 [27%] of 849 affected segments). In group 1 (n=15), the predominant pattern was unilateral (nine [60%]) and multifocal (eight [53%]) ground-glass opacities (14 [93%]). Lesions quickly evolved to bilateral (19 [90%]), diffuse (11 [52%]) ground-glass opacity predominance (17 [81%]) in group 2 (n=21). Thereafter, the prevalence of ground-glass opacities continued to decrease (17 [57%] of 30 patients in group 3, and five [33%] of 15 in group 4), and consolidation and mixed patterns became more frequent (12 [40%] in group 3, eight [53%] in group 4). Interpretation COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1–3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia. Funding None.
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            Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

            New England Journal of Medicine
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              Public responses to the novel 2019 coronavirus (2019‐nCoV) in Japan: Mental health consequences and target populations

              In December 2019, cases of life‐threatening pneumonia were reported in Wuhan, China. A novel coronavirus (2019‐nCoV) was identified as the source of infection. The number of reported cases has rapidly increased in Wuhan as well as other Chinese cities. The virus has also been identified in other parts of the world. On 30 January 2020, the World Health Organization (WHO) declared this disease a ‘public health emergency of international concern.’ As of 3 February 2020, the Chinese government had reported 17 205 confirmed cases in Mainland China, and the WHO had reported 146 confirmed cases in 23 countries outside China.1 The virus has not been contained within Wuhan, and other major cities in China are likely to experience localized outbreaks. Foreign cities with close transport links to China could also become outbreak epicenters without careful public health interventions.2 In Japan, economic impacts and social disruptions have been reported. Several Japanese individuals who were on Japanese‐government‐chartered airplanes from Wuhan to Japan were reported as coronavirus‐positive. Also, human‐to‐human transmission was confirmed in Nara Prefecture on 28 January 2020. Since then, the public has shown anxiety‐related behaviors and there has been a significant shortage of masks and antiseptics in drug stores.3 The economic impact has been substantial. Stock prices have dropped in China and Japan, and other parts of the world are also showing some synchronous decline. As of 3 February 2020, no one had died directly from coronavirus infection in Japan. Tragically, however, a 37‐year‐old government worker who had been in charge of isolated returnees died from apparent suicide.4 This is not the first time that the Japanese people have experienced imperceptible‐agent emergencies – often dubbed as ‘CBRNE’ (i.e., chemical, biological, radiological, nuclear, and high‐yield explosives). Japan has endured two atomic bombings in 1945, the sarin gas attacks in 1995, the H1N1 influenza pandemic in 2009, and the Fukushima nuclear accident in 2011: all of which carried fear and risk associated with unseen agents. All of these events provoked social disruption.5, 6 Overwhelming and sensational news headlines and images added anxiety and fear to these situations and fostered rumors and hyped information as individuals filled in the absence of information with rumors. The affected people were subject to societal rejection, discrimination, and stigmatization. Fukushima survivors tend to attribute physical changes to the event (regardless of actual exposure) and have decreased perceived health, which is associated with decreased life expectancy.7, 8 Fear of the unknown raises anxiety levels in healthy individuals as well as those with preexisting mental health conditions. For example, studies of the 2001 anthrax letter attacks in the USA showed long‐term mental health adversities as well as lowered health perception of the infected employees and responders.9 Public fear manifests as discrimination, stigmatization, and scapegoating of specific populations, authorities, and scientists.10 As we write this letter, the coronavirus emergency is rapidly evolving. Nonetheless, we can more or less predict expected mental/physical health consequences and the most vulnerable populations. First, peoples' emotional responses will likely include extreme fear and uncertainty. Moreover, negative societal behaviors will be often driven by fear and distorted perceptions of risk. These experiences might evolve to include a broad range of public mental health concerns, including distress reactions (insomnia, anger, extreme fear of illness even in those not exposed), health risk behaviors (increased use of alcohol and tobacco, social isolation), mental health disorders (post‐traumatic stress disorder, anxiety disorders, depression, somatization), and lowered perceived health. It is essential for mental health professionals to provide necessary support to those exposed and to those who deliver care. Second, particular effort must be directed to vulnerable populations, which include: (i) the infected and ill patients, their families, and colleagues; (ii) Chinese individuals and communities; (iii) individuals with pre‐existing mental/physical conditions; and, last but not least, (iv) health‐care and aid workers, especially nurses and physicians working directly with ill or quarantined persons. If nothing else, the death of the government quarantine worker must remind us to recognize the extent of psychological stress associated with imperceptible agent emergencies and to give paramount weight to the integrity and rights of vulnerable populations. Disclosure statement The authors declare no conflicts of interest. Supporting information File S1 Online health information sources for the novel coronavirus (2019‐nCoV). Click here for additional data file.
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                Author and article information

                Journal
                Trop Med Infect Dis
                Trop Med Infect Dis
                tropicalmed
                Tropical Medicine and Infectious Disease
                MDPI
                2414-6366
                30 December 2020
                March 2021
                : 6
                : 1
                : 6
                Affiliations
                [1 ]Department of Public Health, Faculty of Medicine, University of Kamina, Kamina 279, Democratic Republic of the Congo; michelnzaji@ 123456yahoo.fr (N.M.-K.); leonkab@ 123456hotmail.com (N.L.-K.); guillaumengoiemwamba@ 123456gmail.com (G.N.-M.); eliekilolongoyumba@ 123456gmail.com (E.K.-N.); bwanaignace@ 123456yahoo.fr (I.B.-K.); oscarluboya@ 123456yahoo.fr (N.O.-L.)
                [2 ]Department of Public Health, Kagawa University Faculty of Medicine, Miki-cho 761-0793, Japan; mahfuz@ 123456med.kagawa-u.ac.jp (A.H.S.-M.); akitsu@ 123456med.kagawa-u.ac.jp (A.M.); oda@ 123456med.kagawa-u.ac.jp (K.K.); ymashima@ 123456med.kagawa-u.ac.jp (Y.M.); sharks@ 123456med.kagawa-u.ac.jp (T.H.)
                [3 ]Department of Public Health, Technical Medical College (ISTM), Lubumbashi 4748, Democratic Republic of the Congo; astridkatumbo081@ 123456gmail.com (A.K.-M.); oliviermukuku@ 123456yahoo.fr (O.M.); ngoyijean0@ 123456gmail.com (J.N.-M.); kafutshidora@ 123456yahoo.com (D.K.-M.)
                [4 ]Department of Epidemiology and Public Health, Technical Medical College (ITSM) of Mbuji-Mayi, Mbuji-Mayi 1244, Democratic Republic of the Congo; banzadeca2@ 123456gmail.com (D.B.B.-N.); dcmkabila@ 123456gmail.com (D.K.-M.); balelamarieclaire@ 123456gmail.com (M.-C.B.-K.); kanyikikatala@ 123456gmail.com (M.K.-K.)
                [5 ]Faculty of Medicine: University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
                Author notes
                [* ]Correspondence: ngatu@ 123456med.kagawa-u.ac.jp or doc.rogerngatu@ 123456gmail.com ; Tel.: +81-90-9778-2097
                Author information
                https://orcid.org/0000-0003-3843-654X
                https://orcid.org/0000-0001-6902-7023
                https://orcid.org/0000-0003-2411-7070
                Article
                tropicalmed-06-00006
                10.3390/tropicalmed6010006
                7838953
                33396599
                dab8bf2e-3e28-48f7-a6e8-be59975666d0
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 November 2020
                : 24 December 2020
                Categories
                Article

                covid-19,democratic republic of the congo,health care workers,infection prevention,personal protective equipment

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