Inpatient Physician and Nurse Experience During the COVID-19 Crisis at a Public Safety Net Hospital

**Background:** The COVID-19 pandemic has been associated with front line health care provider burnout, depression, and post-traumatic stress disorder. We sought to better understand how nurses and physicians of differing genders may have been affected differently by the COVID-19 crisis. **Methods:** Between July 17, 2020, and October 31, 2020, we surveyed nurses and physicians caring for COVID-19 patients at a large, academic, public safety net hospital in the southern United States. Survey questions were adapted from validated questionnaires used to determine quality of life, assess levels of anxiety, and determine how COVID-19 may have affected our nurses' and physicians' work, home and social lives. **Results:** Overall, 120 (41.7%) providers responded, including 39 (50%) physicians and 81 (38.6%) nurses. 69.3% reported disruption to their home/family, 76.3% to their social lives, and 29.8% worried about financial strain. More nurses than physicians worried about being excluded from social gatherings (59.7% v 35.1%, p=0.01). Similarly, 70.1% of nurses and 46.0% of physicians expressed concern of exposing others to COVID-19 (p=0.01). Nurses also expressed greater concern about being treated differently by others when compared to physicians (64.5% v 37.8%, p= 0.01). Female physicians reported greater difficulty separating their personal lives from their professional lives than male physicians and either male or female nurses (84.6%% vs 35% vs 33.3% vs 35.9%, p \<0.05). Most physicians (89.7%) and nurses (93.8%) reported some level of anxiety, with 31.5% of respondents experiencing moderate or severe anxiety. **Conclusion:** Healthcare workers on the frontline of COVID-19 pandemic, regardless of profession, reported increased anxiety that extended beyond the hospital into their homes and social lives. Physicians and nurses, as well as men and women, reported different sources and degrees of stress and disruption to their work, home and social lives

Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey

Background: The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. Methods and Findings: We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March–April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011–June 14, 2014) or EVD period (June 15, 2014–April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48–0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50–0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50–0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36–0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59–1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. Conclusions: We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies

Logistic regression models of facility-based delivery among women of child-bearing age in Rivercess County, Liberia, 2011–2015.

<p>Logistic regression models of facility-based delivery among women of child-bearing age in Rivercess County, Liberia, 2011–2015.</p

Proportion of women with facility-based delivery in Rivercess County, Liberia, during 2011–2014.

<p>Years begin in June, such that the 2014 estimate corresponds to the generalized Ebola virus disease epidemic in the country (June 2014–April 2015). Error bars represent 95% confidence intervals.</p

Demographic and social characteristics, Rivercess, Liberia, by births that occurred before and during the Ebola period.

<p>Demographic and social characteristics, Rivercess, Liberia, by births that occurred before and during the Ebola period.</p