Objective The COVID-19 pandemic has been associated with significant occupational stressors and challenges for front-line healthcare workers (HCWs), including COVID-19 exposure risk. Our study sought to assess factors contributing to HCW infection and psychological distress during the COVID-19 pandemic in the USA. Design We conducted a cross sectional survey of HCWs (physicians, nurses, emergency medical technicians (EMTs), non-clinical staff) during May 2020. Participants completed a 42-item survey assessing disease transmission risk (clinical role, work environment, availability of personal protective equipment) and mental health (anxiety, depression and burn-out). Setting The questionnaire was disseminated over various social media platforms. 3083 respondents from 48 states, the District of Columbia and US territories accessed the survey. Participants Using a convenience sample of HCWs who worked during the pandemic, 3083 respondents accessed the survey and 2040 participants completed at least 80% of the survey. Primary outcome Prevalence of self-reported COVID-19 infection, in addition to burn-out, depression and anxiety symptoms. Results Participants were largely from the Northeast and Southern USA, with attending physicians (31.12%), nurses (26.80%), EMTs (13.04%) with emergency medicine department (38.30%) being the most common department and specialty represented. Twenty-nine per cent of respondents met the criteria for being a probable case due to reported COVID-19 symptoms or a positive test. HCWs in the emergency department (31.64%) were more likely to contract COVID-19 compared with HCWs in the ICU (23.17%) and inpatient settings (25.53%). HCWs that contracted COVID-19 also reported higher levels of depressive symptoms (mean diff.=0.31; 95% CI 0.16 to 0.47), anxiety symptoms (mean diff.=0.34; 95% CI 0.17 to 0.52) and burn-out (mean diff.=0.54; 95% CI 0.36 to 0.71). Conclusion HCWs have experienced significant physical and psychological risk while working during the COVID-19 pandemic. These findings highlight the urgent need for increased support for provider physical and mental health well-being.

On September 27, 2024, Rwanda reported an outbreak of Marburg virus disease (MVD), after a cluster of cases of viral hemorrhagic fever was detected at two urban hospitals. We report key aspects of the epidemiology, clinical manifestations, and treatment of MVD during this outbreak, as well as the overall response to the outbreak. We performed a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response and a case-series analysis to characterize clinical features, disease progression, and outcomes among patients who received supportive care and investigational therapeutic agents. Among the 6340 patients with suspected MVD who underwent testing, 66 had laboratory-confirmed MVD, 51 (77%) of whom were health care workers. The median estimated incubation period was 10 days (interquartile range, 8 to 13), and symptom onset occurred a median of 2 days (interquartile range, 1 to 3) before hospital admission. The results of epidemiologic investigations were highly suggestive of a zoonotic origin of the outbreak: an index patient was identified who had been exposed to Egyptian fruit bats at a mining site. The case fatality rate in the outbreak was 23% (15 deaths among 66 patients). Remdesivir and the monoclonal antibody MBP091 were used under expanded access and clinical trial protocols. In addition, 1710 frontline workers and high-risk contacts received the chimpanzee adenovirus 3-vectored vaccine ChAd3-MARV under emergency use authorization in a phase 2 clinical trial. Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may have contributed to reduced mortality from MVD in this outbreak. Enhancing surveillance, improving infection prevention and control in health care settings, and ensuring timely deployment of medical countermeasures will be critical for mitigating the effects of future filovirus disease outbreaks.

In Ethiopia, the specialty of Emergency Medicine is a relatively new discipline. In the last few decades, policymakers have made Emergency Medicine a priority for improving population health. This study aims to contribute to this strengthening of Emergency Medicine, by conducting the country’s first baseline gap analysis of Emergency Medicine Capacity at the pre-hospital and hospital level in order to help identify needs and areas for intervention. This is a cross sectional investigation that utilized a convenience sampling of 22 primary, general and tertiary hospitals. Trained personnel visited the hospitals and conducted 4-hour interviews with hospital administrators and emergency care area personnel. The tool used in the interview was the Columbia University sidHARTe Program Emergency Services Resource Assessment Tool (ESRAT) to evaluate both emergency and trauma capacity in different regions of Ethiopia. The findings of this survey were then compared against two established standards: the World Health Organization’s Essential Package of Emergency Care (EPEC), as well as those set by Ethiopia’s Federal Ministry of Health. The tool assessed the services provided at each hospital and evaluated the infrastructure of emergency care at the facility. Triage systems differed amongst the hospitals surveyed though triaging and emergency unit infrastructures were relatively similar amongst the hospitals. There was a marked variability in the level of training, guidelines, staffing, disaster preparedness, drug availability, procedures performed, and quality assurance measures from hospital to hospital. Most regional and district hospitals did not have nurses or doctors trained in Emergency Medicine and over 70% of the hospitals did not have written guidelines for standardized emergency care. This gap analysis has revealed numerous inconsistencies in health care practice, resources, and infrastructure within the scope of Emergency Medicine in Ethiopia. Major gaps were identified, and the results of this assessment were used to devise action priorities for the Ministry of Health. Much remains to be done to strengthen Emergency Medicine in Ethiopia, and numerous opportunities exist to make additional short and long-term improvements.

Sleep disturbance and burnout are common in emergency department health care workers (HCWs), and the 2 are linked. This cross-sectional study evaluated whether gender, race/ethnicity, and clinical roles moderate the association between sleep quality and burnout among emergency department HCWs (N = 129). Sleep was assessed with the Pittsburgh Sleep Quality Index (Pittsburgh Sleep Quality Index > 5: poor sleep) and Insomnia Severity Index (Insomnia Severity Index > 8: insomnia). The abbreviated Maslach Burnout Inventory-9 assessed the burnout dimensions of emotional exhaustion, depersonalization , and reduced personal accomplishment . Emotional exhaustion > 9 and either (or both) depersonalization > 6 or personal accomplishment < 9 indicated burnout. Logistic regressions were computed for the association of poor sleep and insomnia with burnout for gender, race/ethnicity, and job role separately. Poor sleep quality, insomnia, and burnout were seen in 64%, 59%, and 24% of participants, respectively. Poor sleep was more frequently reported in Black, Indigenous, and People of Color (BIPOC) HCWs vs non-BIPOC (72.9% vs 52.5%, P = .017). Overall, poor (vs not poor) sleep quality was associated with burnout (odds ratio [OR], 3.14; 95% CI, 1.14-8.64). There was a significant poor sleep-burnout relationship in women (OR, 4.52; 95% CI, 1.10-18.60) that was not seen in men. The poor sleep-burnout relationship was significantly stronger in attending physicians (OR, 6.92; 95% CI, 1.44-33.24) vs registered nurses (OR, 0.28; 95% CI, 0.03-2.30; P value for group ∗ predictor interaction term = .021). BIPOC HCWs had worse sleep quality than non-BIPOC HCWs, and the relationship between sleep quality and burnout was affected by gender and clinical role. These findings highlight the importance of person-level factors in the sleep-burnout relationship in HCWs.