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Rapidly growing rate of infection among health workers during the current COVID-19 pandemic, is posing a serious challenge to global health systems. Lately, India is also witnessing an intensifying COVID-19 disease burden and its impact on health workers. This paper aims to discuss the challenges to health worker protection in India and the possible ways forward. Given the inadequate and unequally distributed healthcare workforce, it is highly essential for the country to strategize prompt measures for ensuring occupational health and safety of its health workers. Information for this paper were gathered by searching PubMed and Google Scholar databases using "COVID-19", "Infection Control", "Health worker", "India" as search keywords in different combinations. In addition, websites of Government of India, relevant UN agencies and leading news agencies were also searched manually for related reports and publications. India must take timely measures in rapid manufacturing and procurement of essential personal protective equipment (PPE) to ensure adequate stockpiling to meet the rising demands. Comprehensive and repeated training with sharply focussed content including usage of PPE kits as well as active surveillance of adherence to recommended protocol are critical in protecting health workers especially the primary care physicians and frontline health staff from the deadly COVID-19 infection. The provision of psychological and financial support for health workers and their families is absolutely critical in building trust and dedicated work efforts by the health workforce for a continuous fight against the deadly disease. [ABSTRACT FROM AUTHOR]

Telemedicine and related e-health facilities facilitate care from a distance through electronic information systems. COVID-19 pandemic is establishing telemedicine in the health care delivery system of countries. Telehealth is contributing significantly in health care delivery during the COVID-19 crisis. For mild-to-moderate symptoms of COVID-19 or any illness, telehealth services might represent a better, efficient way to receive initial care and perform triaging. Telemedicine also has a significant role in screening for COVID-19 symptoms and delivering routine needs and follow-up care. The large-scale adoption of telemedicine in public health care delivery is still not visible in low- and middle-income countries like India. Adoption by patients and healthcare professionals is limited and their concerns need to be addressed to ensure its utilization in future of the care continuum. In the current paper, we aim to review recent measures of Telemedicine adopted during the course of pandemic and its impact on public health in lower-middle income countries like India. [ABSTRACT FROM AUTHOR]

The disability viewpoint is fundamental for understanding and advancing social justice for everyone in the population. Despite this fact, it is regularly dismissed by public health experts and policymakers. Understanding of disability rights is central in an all-inclusive COVID-19 preparedness. This paper attempts to explore disability ethics in understanding structural discrimination, equitable practices, respect for disability culture and ways to safeguard health care professionals with disabilities in the coronavirus pandemic. In crisis standards of care, resource allocations must not be solely based on a disabled person's subjective quality of life. Health professionals should avoid stereotypes about an individual's disability to ration care. Triage protocol committees and disaster risk reduction working groups should explicitly recruit people with disabilities and chronic illnesses in their response strategies. Disability ethics can reform medical rationing by removing prejudices and safeguarding fair protection of the interests of all patients, including those with a disability. [ABSTRACT FROM AUTHOR]

Background: Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan. Materials and Methods: This is a health facility–based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff. Results: A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n = 44) of the participants. Women were significantly more likely to be affected than men (P = 0.0). Age (21–40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0). Conclusion: This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase. [ABSTRACT FROM AUTHOR]

Context: The COVID-19 vaccination drive globally was supposedly a game-changing event. However, the emerging variants of the virus and waning immunity over time posed new challenges for breakthrough infections. Standing at the frontline of defense against COVID-19, healthcare personnel (HCP) were vulnerable to such infections. Aims: This study estimates i) the vaccine breakthrough infections (VBI) among HCP following exposure to COVID-19 cases, and ii) the mean interval between the second dose of vaccine and laboratory-confirmed SARS-CoV-2 infection. Materials and Methods: A cross-sectional study was conducted including 385 HCP with a history of exposure to COVID-19 cases during January and February 2022. Demographic details and clinical and vaccination history were collected from the test forms and the Web-based hospital management system. Laboratory testing of COVID-19 was carried out by real-time RT-PCR test. Results: The majority of the HCP were males (262; 68.05%) and nurses (180; 46.75%) by occupation. Two doses of vaccines were received by 278 (87.7%) HCP. VBI was confirmed in 185 (66.55%) HCP. No significant difference in VBI between the COVAXIN and COVISHIELD recipients (P = 0.69) was observed. The interval between the second dose and confirmed SARS-CoV-2 infection was significantly higher (P < 0.00001) in COVAXIN recipients (median 228 days) than in COVISHIELD recipients (median 95 days). Conclusions: The incidence of VBI was very high among the HCP, but not statistically different among the COVAXIN and COVISHIELD-recipients. Waning immunity over time suggests boosting immunity with a third dose because of emerging variants. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic caused a huge impact on the healthcare system worldwide. With a spectrum of outcome ranging from mild symptoms to mortality, the experiences of patients admitted in isolation wards have not been documented. Objective: To explore the experience of COVID-19 patients during hospitalization during the early phase of pandemic. Materials and Methods: A qualitative study using in-depth interviews was conducted among 30 COVID positive patients admitted in COVID wards of a private medical college in Coimbatore, South India between May and June 2020. Qualitative data analysis was done using the seven steps of Colaizzi's descriptive phenomenological method. Results: The experiences of COVID-19 patients during their hospitalization were categorized into three themes. Firstly, their initial reaction to being diagnosed positive for COVID-19. Secondly, experience during hospitalization with regards to their mental health, treatment providers, caregivers (family and relatives) and other COVID patients admitted in the same ward. Lastly, perceived change in their quality of life after discharge. Conclusion: The study highlights that the psychological experiences of COVID-19 patients admitted to the hospital were heterogeneous. Therefore, primary care physicians should provide individualized psychological interventions based on the needs. Since many expressed fear on diagnosis and stigma of the disease, hence policy makers and health care providers should plan intervention for control and treatment without causing stigma to patients and their families. [ABSTRACT FROM AUTHOR]

Health economics has long been neglected as a subset of the larger discipline of Economics and Finance. However, this could not be further from the truth. There is a large body of researchers and professionals alike that are of the consensus that extensive studying and working upon Healthcare Economics can help us avert the situation that arose in the wake of the recent COVID-19 pandemic. Applying the core principles of Health Economics to a situation like that would help avert bad outcomes. In this article, the authors begin by defining and establishing the concepts of Health Economics and then building on them. We further explain the concepts in light of the Indian Economy and Healthcare Sector and how it has seen unprecedented growth in the last decade. Furthermore, we touch on the various diseases that put the most strain on the healthcare infrastructure and what we can do to make the situation better. We also shed light on how the COVID-19 pandemic affected the Health Economics in the Indian setting and go on to elaborate how India managed to tackle it. Finally, we elaborate on what steps we can take, as researchers and healthcare professionals, to make it easier for the common man to get access to better and more economical healthcare. We determine the importance and effectiveness of data collection and processing and also how to make better research attempts to study, evaluate and process that said data. The onus falls on the academic and the healthcare professional to ensure that the true meaning of Health Economics is not reduced to a mere numbers game, but is something which is truly subjective and for the benefit of the masses. [ABSTRACT FROM AUTHOR]

Introduction: Telemedicine has emerged as an essential interface between health care providers and patients during the pandemic. The present study was done to assess this technology's level of acceptance and satisfaction amongst the patients. Methods: We did a retrospective study amongst patients >18 years (n = 300) who had availed telemedicine services in different departments of a tertiary care hospital between May and August 2020. The patients were interviewed telephonically using a pre-tested semi-structured tool that collected information about the socio-demographic and clinical characteristics of the patients, and satisfaction was measured on a 5-point Likert Scale. Results: Fifty-five percent patients received teleconsultation via a telephone call, while the others preferred video calling services on WhatsApp messenger. Overall, more than 97% of the clients depicted satisfaction with the telemedicine services in three major domains: registration/appointment services, consultation with the doctor and post-consultation services. Some of the common feedback included difficulty in getting medicine using the scanned copy of prescription slip generated by the hospital, problems faced in reimbursement of the bills, long waiting period, and poor quality of video calls due to slow internet. Conclusion: Telemedicine proved to be an efficient means of communication for many patients during the pandemic. Though patient satisfaction was high with the services received by them, timely assessment of the problems encountered in the implementation of telemedicine services will help evolve the services not just during the pandemic but even after that. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals are particularly more vulnerable to Covid-19 pandemic infection, since they are on the front lines. The relatively high morbidity and mortality among healthcare workers all over the world because of Covid-19 is a major cause of concern. Objectives: To explore the awareness of the healthcare workers in primary care settings regarding COVID-19 as well as the role of personnel protective equipment (PPE) as protective measures and to discover any defects for further intervention. Material and Methods: Cross-sectional study design was carried out in the Al-Baha Region, Southwest of Saudi Arabia. It included a representative random sample of healthcare workers working at primary health care (PHC) centers belonging to the Ministry of Health. A self-administered valid questionnaire was utilized in the present study, which included three main parts: demographic data of the healthcare workers; questions to assess their knowledge about the current COVID-19 pandemic (four multiple choice questions); and questions to assess knowledge about personal protective measures and hand hygiene (ten questions). Results: The study included 451 participants. The age of more than half of the participants (51.7%) ranged between 31 and 45 years. Females represented 53.2% of them. Physicians, nurses, and pharmacists represented 36.1%, 24.2%, and 23.3% of the participants, respectively. History of attending infection control training activity in the previous 12 months was reported by 38.1% of the participants. Overall, 74.5% and 19.1% of the participants expressed a poor level of knowledge regarding the current COVID-19 pandemic and PPE/personal hygiene, respectively. Older healthcare workers (HCWs) (> 45 years), non-Saudi nationals, dentists, moderately experienced healthcare workers (6–10 years), and those who attended infection control training courses were more knowledgeable about the current COVID-19 pandemic and its self-protective measures compared to others. Conclusion: Most of the primary healthcare staff in the Al-Baha Region expressed a poor level of knowledge about the current COVID-19 pandemic and a moderate level regarding PPE and personal hygiene. Some indicators for poor knowledge were identified. [ABSTRACT FROM AUTHOR]

Introduction: Till date, there is no particular medicine that has shown minimum impact on COVID-19 cases and mortality and prevention by vaccination remains the only option. Objective: This study aims to explore knowledge, attitude, and practices of healthcare workers (HCWs) toward COVID-19 vaccine. Material and Methods: This is a cross-sectional study done on HCWs. Both online (Google forms) and offline, the study questionnaire was distributed. The questionnaire was validated and consisted of knowledge, attitude, and perception about COVID-19 questions. Results: A total of 300 HCWs were included in the study. A total of 144 (48%) of the HCWs were aged between 18 and 30 years. In addition, 191 (63.34%) participants were willing to take any COVID-19 vaccine while 20 (6.67%) are not sure of taking vaccine. A total of 208 (69.34%) felt that COVID-19 vaccine will limit the spread of infection to family members. Furthermore, 225 (75%) felt that family physicians' decision is important to take a decision on vaccination, whereas 199 (66.33%) avail COVID-19 information from government sources. Moreover, 264 (88%) felt that success will depend on general peoples' acceptance of COVID-19 vaccination. Furthermore, 77 (25.67%) said that they will not be taking COVID-19 vaccine because of side effects, 229 (76.33%) felt that vaccine safety is important, and 144 (48%) are not sure if vaccination will end the COVID 19 pandemic. Discussion: Challenges to motivate HCWs, family physician, and general population needs to be undertaken by focusing on factors like information and education, vaccine side effects, and availability of the vaccine. These all should be highlighted so that maximum population gets immunized. [ABSTRACT FROM AUTHOR]

Background: COVID‑19 ongoing pandemic has proved beyond doubt that all countries in the world from high income to low‑ and middle‑income countries were unprepared with under‑diagnosed and underreported losses of precious human lives on already overstretched healthcare delivery infrastructure. Thus, the urgent need of the hour is to understand and identify the operational issues and challenges encountered in the sample collection process and also at the testing labs in order to respond at the earliest. This early and effective response will help not only to address the identified issues in the whole chain of sample collecting to test result communication but also it will help to improve the functioning of the entire system involved in this process. Objectives: The present study was undertaken to identify the issues faced during various steps involved in laboratory testing as part of the COVID‑19 control activities in selected remote districts of North East and East India. Further, perceived adequacy of human resources, equipment, diagnostic kits, and other essential consumables including PPEs vis‑a‑vis the load of samples received from the catchment areas of the testing laboratories were also explored. Methods: The study was a qualitative research using in‑depth interview method to collect and collate the data from the chain of personnel involved in sample collection, storage, transportation, and testing by recorded telephonic interview by state‑level collaborators as per the study protocol. The respondents were recruited from randomly selected sites of remote districts for sample collection, storage, transportation, and dedicated testing labs in six states of North East and Eastern India. The study findings were analyzed by two‑dimensional scaling and hierarchical cluster analysis to get the collective picture involving transcription, preliminary data scrutiny, content analysis, and interpretation of the verbal IDI; classified and summarized by triangulation; free listing and pile sorting of suggestions. Results: The entire laboratory testing related human resources has been working on war‑footing round‑the‑clock to fulfil the expectation of the stakeholders and maintaining high quality despite the ever‑increasing load of sample testing in both the public and private sectors. The findings indicated that the healthcare workers from all levels of laboratory diagnosis have taken it as a challenge to control the pandemic even with limitations of logistics to capacity building. Positive suggestions to improve laboratory services were to increase human resources, infrastructure, IT with the robust mechanism of monitoring and supervision. Conclusions: Upgradation of laboratory capacities and expertise in public health has become one of the points of concern to contain the COVID‑19 pandemic of the new millennium. [ABSTRACT FROM AUTHOR]

Background: While Covid-19 infection rate in children is low, respiratory symptoms are a common mode of presentation which calls for better management of such symptoms. However, ARI case managemnet in primary health settings settings has challenges as health workers lack skills to count respiratory rate and check chest indrawing. To address this multimodal pulse oximeters have been introduced in health and wellness centres of seven states to ease the work of front line health workers. A study was undertaken to understand the usability of the multimodal pulse oximeter during Covid times. Methods: A qualitative study was conducted with the aid of indepth interviews among a convenience sample of eleven health care workers from ten health and wellness centres. Interviews were conducted and recorded over phone, after obtaining consent. Transcribed interviews were coded and analysed on a qualitative analysis software. Content analysis was conducted. Results: Total children screened during covid lockdown period (April 1-May 31) is 571, those diagnosed with pneumonia and severe pneumonia is 68 and 2. Health care workers were satisfied with pulse oximeter as it helped in timely diagnosis and treatment, and offered protection from possible infection as it mitigated the need for physical contact. Conclusion: The multimodal pulse oximeter is well accepted among providers as it is easy to use aiding in timely management of ARI in children. It has an added protection as it's use reduces the need for physical contact. It can be adopted in other HWC and primary health facilities. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has resulted in disruption to routine health services delivery as strict lockdowns were implemented in India and health workforce redeployed for COVID-19 focused responses. We assess the perceptions about COVID-19, the impact of the lockdown on access to health services and continuum of care for Non-communicable diseases (NCDs) among a cohort of adults in rural India. Methodology: Since 2018, we have been following up a cohort of persons with non-communicable diseases in a high NCD burden region in Srikakulam District of Andhra Pradesh under the STOP CKDu study. We conducted this mixed methods study, administered through a structured telephonic questionnaire and interview to determine the awareness, perceptions and their compliance to ongoing treatment schedules. Results: Overall, 68% of the participants exhibited adequate knowledge of symptoms of COVID-19, while 43% were not aware of the mode of transmission of the virus. In all, 822 (36.1%) participants reported at least one NCD condition. Among them, 115 (14%) missed their follow-up visit, 110 (13.4%) reported facing challenges in medication procurement and 11.6% either developed new complaints or experienced worsening of pre-existing symptoms. A total of 233 (28.5%) used a telemedicine facility and took telephonic advice from (private) physicians. As the access to medicines was restricted due to the lockdown, majority of the respondents were depending on rural medical practitioners (RMPs) for the procurement of medication. Conclusion: Our finding implies the need for the future guidelines on adaptation of telehealth approaches within health systems to maintain the continuum of care, digital health tools to facilitate the patient's appointments including virtual follow-up visits for those with NCDs coupled with regular engagement by frontline healthcare workers at the local levels, evidence informed public health messaging taking into consideration the social and behavioural aspect and uninterrupted essential primary healthcare services. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has involved nations and incapacitated the health systems globally. The pandemic preparedness has been tested with immense losses. Universal health coverage is needed more than ever to recuperate from the effects of the current pandemic. Post pandemic, many lessons need to be learnt especially for developing economies like India where public healthcare system is grossly inadequate to take care of health needs of citizens. World Health Organization's framework of six health system building blocks was utilized to study the lessons learnt and actionable points in the post pandemic period. Participation in Global Health Security Alliance has to be stepped up with involvement in Joint external evaluation and development of epidemiological core capacities. National Health Security Action Plan needs to drafted and available for health emergences. Ayushman Bharat scheme should incorporate elements to address surge capacity at the time of health emergencies and measures to deliver care at the time of pandemic. Technology through telemedicine, m-health, and digital platforms or apps should contribute to trainings, supervision, and facilitation of healthcare delivery at remote locations. Open data sharing policies should be developed for the practice of evidence-based public health. Public healthcare system and health manpower trained in epidemiology should be given a boost to have system readiness to respond in case of future pandemics. [ABSTRACT FROM AUTHOR]

Background and Aims: The COVID-19 Pandemic has been raging across continents in recent months. Public health measures are crucial in preventing COVID-19. The Government of India declared a nationwide lockdown on 24 March, 2020. The objective of this study is to assess preparedness among general public and healthcare providers against COVID-19 by way of adopting public health measures at the very beginning of the nationwide lockdown in India. Settings and Design: A rapid cross sectional electronic survey was conducted across the country between 25 and 27 March, 2020. Methods and Materials: Participants were general public and healthcare providers. Online questionnaire was generated in Google Forms. This included precautionary measures such as staying home, hand hygiene, wearing masks, cough hygiene and advisory against face touching. The web link to the form was shared through WhatsApp. Statistical Analysis Used: Descriptive data analysis was done using Epi Info software (version-7). Results: A total of 226 persons (general public = 183; healthcare providers [HCPs] = 43) participated in the study. During the lockdown, HCPs spent more time outside than the general public (p = 0.009). Only 47% of the participants claimed to practise frequent hand washing and majority (72%; n = 163) did not wear masks while outdoors. Almost a half (45%) of the participants touched their face frequently and very few (8%) participants covered their mouth or nose while coughing or sneezing. There was no significant difference between HCPs and general public in frequent hand washing (p = 0.456), wearing masks (p = 0.255), face touching (p = 0.632) or covering mouth/nose while coughing or sneezing (p = 0.428). Conclusion: There is lack of preparedness among general public and healthcare providers against COVID-19 at the beginning of the nationwide lockdown in India. [ABSTRACT FROM AUTHOR]