12Diagnostic testing for COVID-19 is central to controlling the global pandemic. Recently, To and 13 colleagues reported that 20 of 23 (87%) patients who had SARS-CoV-2 detected by reverse-14 transcriptase PCR (RT-PCR) in nasopharyngeal swabs (NPS) or sputum also had SARS-CoV-2 15 detectable in saliva (1). The use of saliva has several advantages compared to collection of NPS. In 16 particular, the close contact involved in swab collection poses a risk to healthcare workers, and 17 collection of saliva may reduce this risk. Further, saliva collection does not require specialised 18 consumables, causes less patient discomfort, and may be a useful sample for self-collection (2). 20We further investigated the feasibility and utility of saliva collection from ambulatory patients 21 presenting to a dedicated COVID-19 screening clinic at the Royal Melbourne Hospital (RMH), 22Melbourne, Australia. Between 25 th March and 1 st April 2020, 622 patients were tested for COVID-23 19 through the screening clinic. All patients had NPS, and 522/622 (83.9%) patients also provided 24 saliva. Patients were asked to pool saliva in their mouth for 1-2 minutes prior to collection, and gently 25 spit 1-2 mL of saliva into a 25mL collection pot. Neat saliva specimens were transported to the 26 laboratory where an approximate 1:1 ratio of liquid Amies media was immediately added. We 27 specifically chose to use liquid Amies media in order to: (i) evaluate the use of an alternative transport 28 media in the face of global shortages of viral transport medium (VTM), and (ii) to preserve VTM in 29 our own laboratory. The median time from sample collection to addition of media was 180 minutes 30 (range 55 -537 minutes). NPS and saliva specimens underwent nucleic acid extraction on the Qiagen 31 EZ1 platform (QIAGEN, Hilden, Germany). An extraction volume of 200uL of the sample was used, 32 with RNA eluted in 60uL. Reverse-transcriptase PCR (RT-PCR) testing was performed using a 33 multiplex RT-PCR test for SARS-CoV-2 and other seasonal coronaviruses (Coronavirus Typing (8-34 well) assay, AusDiagnostics, Mascot, Australia). All positive NPS samples for SARS-CoV-2 35 underwent confirmatory testing at a local reference laboratory (the Victorian Infectious Diseases 36 Reference Laboratory) using previously published primers (3). 38Overall, 39/622 (6.3%; 95% confidence interval [CI] 4.6%-8.5%) patients had PCR-positive NPS, and 39 33/39 patients (84.6%; 95% CI 70.0%-93.1%) had SARS-CoV-2 detected in saliva. The median cycle 40 threshold (Ct) value was significantly lower in NPS than saliva ( Figure 1A), suggestive of higher viral 41 loads in NPS, and in both samples, there was a correlation between Ct value and days from symptom 42 onset ( Figure 1B). To assess specificity, a subset of saliva specimens from 50 patients with PCR-43 negative swabs was also tested. Of note, SARS-CoV-2 was detected in 1/50 (2%; 95% CI 0.1%-44 11.5%) of these saliva samples, which may reflect differing quality of NPS collection. 46To date, studies assessing the utilit...

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.AimsThe Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.MethodsA nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected.ResultsA total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19.ConclusionsThe COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.

Objectives The Australian COVID-19 Frontline Healthcare Workers Study investigated coping strategies and help-seeking behaviours, and their relationship to mental health symptoms experienced by Australian healthcare workers (HCWs) during the COVID-19 pandemic. Methods Australian HCWs were invited to participate a nationwide, voluntary, anonymous, single time-point, online survey between 27th August and 23rd October 2020. Complete responses on demographics, home and work situation, and measures of health and psychological wellbeing were received from 7846 participants. Results The most commonly reported adaptive coping strategies were maintaining exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) reported increased alcohol use which was associated with a history of poor mental health and worse personal relationships. Few used psychological wellbeing apps or sought professional help; those who did were more likely to be suffering from moderate to severe symptoms of mental illness. People living in Victoria, in regional areas, and those with children at home were significantly less likely to report adaptive coping strategies. Conclusions Personal, social, and workplace predictors of coping strategies and help-seeking behaviour during the pandemic were identified. Use of maladaptive coping strategies and low rates of professional help-seeking indicate an urgent need to understand the effectiveness of, and the barriers and enablers of accessing, different coping strategies.