New search completed August 17, 2021 containing 8 grey literature sources and 51 published journal articles including preprints.
Review of new search resulted in conformation of previously compiled information, relevant evidences and updates have been added to evidence table to reflect updated review.
Vaccine hesitancy was most commonly found in females and pregnant women as males generally showed greater willingness towards vaccine uptake.
Regardless of country and phase of the pandemic, there were evidences of widespread mistrust in the healthcare system and the governments with speed of vaccine development and approval. The greatest impact was seen in minority groups and people of colour.
Significant uptake of vaccination is due to the tailored recommendation of health provider in hesitant population, this has reinforced the importance of vaccination and also promoted vaccination of children with hesitant parents.
Previous vaccination has a positive influence on covid 19 vaccine uptake, (most popularly with influenza vaccine)
Higher age and underlying conditions/vulnerability to diseases along with employment and retirement had significantly lower vaccine hesitancy.
Greater financial incentives were some of the modifying of attitudes towards vaccination.
Social media and internet had mixed impact on hesitancy- restriction of certain vaccines had a direct impact on vaccination uptake whereas some reinforced confidence.
May 10, 2021
New search completed April 19, 2021 containing 29 grey literature sources and 128 published articles
Review of new search resulted in confirmation of previously compiled information, review update deemed not necessary at this time, relevant evidence has been added to the evidence table to reflect updated review
February 1, 2021
Vaccine hesitancy towards the COVID vaccine varies from 2% to 44% in the general population, depending on country, phase of pandemic and specific population
Vaccine hesitancy tends to be lower in healthcare workers than the general population, but still exists at rates up to 56%, again, dependent on the country of residence and phase of the pandemic
The most commonly cited reasons for vaccine hesitancy are concerns about the efficacy and safety, largely due to the expedited testing/approval process
Country of residence and corresponding trust in government/pharmaceutical industries can have a significant role in vaccine acceptance
Strategies to increase vaccine uptake should range from personal-level interventions such as patient education materials to health system level interventions such as healthcare provider training and targeted population vaccine acceptance campaigns
Jagwani, M; Badea, A; Groot, G; Mueller, M; Young, C. What are the causes of vaccine hesitancy? What programs/approaches have been successful in reducing vaccine hesitancy? 2021 Aug 17 Document no.: EOC012201v3 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 15 p. (CEST evidence search report).
The group designated in Saskatchewan as Clinically Extremely Vulnerable (CEV) is a heterogenous clinical population with factors that impair their immune response to differing degrees.
Very Limited evidence is currently available to assess the immune response following vaccination is selected clinical populations; no evidence is available to assess vaccine efficacy or effectiveness in these populations. The clinical relevance of measured immune response with respect to protection from disease is still uncertain.
In considering the immune response of the CEV population, it is recommended that the absolute difference in immune response between 1 and 2 doses be considered, as it is possible some patient groups will have lowered protection regardless of vaccine strategy.
In terms of clinical subgroups:
oOrgan transplantation recipients on immunosuppressive medication: solid organ transplant recipients receiving anti-metabolite maintenance immunosuppression therapy were less likely to develop an antibody response to an mRNA vaccine, compared to those receiving other types of therapies (37% vs 63%). In a study of 242 kidney transplant recipients on immunosuppressive therapy only 10.8% became seropositive at 28 days after a single dose of mRNA vaccine.
oCancer: A study of 151 elderly patients with solid and hematological malignancies and 54 healthy controls who received one or two doses of BNT162b2 (Pfizer-BioNTech) vaccine shows approximately 39% of solid cancer patients, 13% of hematological cancer patients, and 97% of healthy controls (p<0.0001) developed anti-S IgG 21 days following a single dose vaccine. However, response in solid cancer patients increased to 95% within 2 weeks of the second dose at 21 days.
oOther immunocompromising conditions (e.g., auto-immune disorders and therapy): some level of immunity is generated with vaccination; however, what this means clinically is unknown. It seems that ensuring the dosing is properly timed around biologic therapy is important.
Azizian, A; Lee, S; Shumilak, G; Groot, G; Reeder, B; Miller, L; Howell-Spooner, B. What are the risks or benefits of extended intervals between doses of COVID-19 vaccines compared to recommended dosing in extremely vulnerable populations? 2021 Apr 20, Document no.: EOC210302 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 15 p. (CEST rapid review report).
Vulnerable populations such as those experiencing homelessness are 20 times more likely to be hospitalised due to COVID-19, 10 times more likely to require intensive care for COVID-19 and 5 times more likely to die within 21 days of a positive test for COVID-19
Many organizations advocate for socially vulnerable populations to be considered priority populations due to their oftencomplex health needs and inability to fully execute best practices for infection prevention and control
Past experiences from Hepatitis vaccination (requiring 3 injections) and H1N1 pandemic influenza vaccination indicate that partnering with community organizations to provide vaccinations in shelters, community centers and other frequently accessed places along with education and access to known, trusted healthcare providers greatly increase the uptake of vaccination among socially vulnerable populations
Beyond sheltered populations experiencing homelessness, considerations for equitable vaccination programs for the general population should include plans for accessibility for all, including underserved geographic regions
Badea, A; Reeder, B; Hanson, L; Miller, L; Howell-Spooner, B. What are the vaccination strategies for vulnerable populations? 2021 Mar 12; Document no.: PH030401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
· There is little literature on the performance of triage frameworks. However, critiques of frameworks can help to inform the development of future protocols.
· It is ethically problematic to include age as a triage factor rather than the more nuanced factors of frailty and chronic comorbidities.
· The public should be included when creating triage protocols to create transparency and trust in the health system.
· Healthcare providers should be familiar with the ethical decisions that have been made in establishing the protocols. However, using a triage team to make decisions about resource allocation would alleviate moral burden from clinicians.
· Regular review of current guidelines, such as the use of SOFA scores, is recommended as knowledge about COVID-19 changes.
Rapid Review Report: CC120401 RR (Version 1: December 17, 2020 11:45) 2
· Patients should be regularly reassessed to allow for timely redistribution of critical resources.
Fick, F; Valiani, S; Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 17; Document no.: CC120401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 91 p. (CEST rapid review report)
No studies directly evaluated the association between level of surge capacity and quality of care indicators for COVID-19 patients. However, in more broad studies, the findings suggest that mortality and other adverse events increase when the strain on the intensive care capacity increases.
A tiered staffing strategy is recommended to meet surge capacity needs in the ICU: High critical care nurse to patient ratios (1:1 or 1:2) are recommended to provide high quality patient care.
There is a lack of high-quality evidence to support ICU triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible, adaptable according to the availability of local resources, and effective for inter-hospital patient transfer.
While the Crisis Standards of Care (CSC) guidelines (e.g., Saskatchewan’s Critical Care Resource Allocation Framework, published on September 2020) can be used to triage newly admitted COVID-19 patients requiring critical care, there is contradicting evidence about using the Sequential Organ Failure Assessment (SOFA) score for ICU triage of patients with COVID-19.
The literature suggests the use of mathematical modeling to support capacity planning (e.g., very low, low, medium, and high intensity patient surge response)
To relieve pressure from ICUs, other types of units (e.g., Step Down Unit [SDU] or Surge Clinic) can be implemented.
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
No scientific evidence was found to support limits of a specific number of visitors. The Newfoundland/Labrador visitor policy referred to evidence supporting restrictions to 6 contact persons including one designated support person and 5 visitors; however, supporting references were not provided (25; 4.1).
The majority of Canadian and international visitation or family presence policies differentiate between general visitors (those attending for social visits) and designated support persons (essential care providers involved in physical, psychosocial, behavioral, cultural, or language support).
Designated support persons are not limited in duration, timing, or frequency of access to resident (3, 7, 9, 11, 12, 14, 16, 24, 26).
The majority of policies limit the number of general visitors to 2 persons. These visits typically have to be scheduled and may be restricted if there is an outbreak, if the resident is COVID+, or if community transmission is high. General visitors are usually not restricted during end of life or other compassionate care reasons.
Although modeling data supports contact restrictions as an effective measure to reduce infection spread, contact restriction can be achieved with infection prevention and control measures of micro-distancing, including hand and respiratory hygiene, physical distancing, and mask use (49). Family presence in LTC can support efforts to reduce resident wandering, micro-distancing, and hand hygiene.
There continues to be no scientific evidence that family presence increases risk of infection spread into and throughout LTC homes (1, 2, 44, 46)
No evidence was found that examined adherence of family caregivers to IPAC practices. A self-report survey of visitors and staff in 87 LTC homes in Hong Kong found that visitors self-reported high compliance with most infection prevention measures despite only one quarter of homes providing education (50). Low knowledge was identified as a primary barrier for infection prevention for visitors.
Education materials have been developed in several jurisdictions for family caregivers regarding COVID-19 IPAC best practices (4, 6, 8, 28).
No evidence was found regarding the impact of staff or family caregiver education on COVID-19 infection or transmission in LTC homes.
Ward, H; Tupper, S; Miller, L; Boden, C; Mueller, M. What is the evidence regarding limiting patient visitors in long-term care facilities to 2 or less, and how are other jurisdictions managing family caregivers? 2020 Dec 4; Document no.: LTC101501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 35 p. (CEST rapid review report)