The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19) has threatened millions of lives and plagued every industry of the world. The highly contagious SARS-CoV-2 was first detected in December 2019 in Wuhan, China as an outbreak of a pneumonia-like illness [1, 2]. SARS-CoV-2 is the third outbreak of Coronavirus in the 21st century after severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak in Beijing, China from 2002–2003, and the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in 2012 in Saudi Arabia [1, 3]. In response to this serious situation, the World Health Organization (WHO) declared COVID-19 as a public health emergency of international concern on January 30 and pandemic on 11 March 2020 . Starting from Wuhan, China as an epicenter of the origin, the virus quickly spread to the different parts of China and to the globe afflicting 219 countries .
In Nepal, the first case of COVID-19 was reported on 23rd January 2020, in a 32-year old Nepali man who had returned from Wuhan, China. Two months after the first case, the second case was diagnosed through domestic testing on March 23rd, in a returnee from France [6, 7]. Since then, there had been a sharp rise in the number of COVID-19 positive cases till the middle of November 2020 . In recent months the number of positive cases is gradually declining and has returned to around 200 per day at the time of preparing this manuscript . To tackle this pandemic situation, Nepal Government had enforced a movement control order (MCO) as a preventive measure to control the spread of the disease from the very beginning. MCO includes restriction of most of the non-essential activities outside the home, travel restriction across the border of two countries and halted flights and other transportation inside the country [10, 11]. Despite these control measures, as of March 1, 2021, over 114 million of the population had been infected with COVID-19 among which around 2.5 million deaths have been reported globally . Study suggests that a large number of people around the world has suffered from mental health problems besides death due to the pandemic . In Nepal, the total number of COVID-19 infected cases are around 274 thousand and the total number of deaths due to the disease is around 3 thousand as of the Government record of March 7, 2021 . The data seems relatively high in comparison to the total population of the country. This scenario has led us to concern over a very critical issue related to national capacity and health systems in the country to tackle the crisis like the COVID-19 pandemic. Nepal is a low-income country with insufficient health infrastructure. There were a very limited number of molecular laboratories for COVID-19 PCR testing inside the country before the outbreak of the pandemic. However, by now the government has been able to set up more than 80 PCR laboratories across the country with the help of public-private partnership. Setting up a molecular laboratory not only requires a well-managed infrastructure, but also well-trained and educated human resources. The information about COVID-19 comes from different sources, viz., governmental information, social media, and the internet, previous personal experiences, medical sources, training, conferences and hands out pamphlets. The accuracy of perception and practice of these beliefs may determine different behaviors about prevention and can vary among the laboratory staff too. In many cases, the lack of knowledge, lack of good clinical (and laboratory) practice may carry a potential risk to the staff and may result in laboratory reports of compromised quality .
Medical Laboratory Staffs (MLS) face a substantially higher risk of infection and death due to excessive COVID-19 exposure at different stages from collection to the dispatch of reports. They deal with elective treatment, a medical emergency and the pandemic by producing quality reports [16, 17]. In the case of Health Care Workers (HCWs), it is estimated that the risk could account for 10–20% of all diagnoses . Since HCWs have greater risk of increased exposure, they also have fear of infecting their loved ones and children. This imbalance between professionalism, altruism and fear give rise to psychological distress . Given the high burden, there is a growing demand and focus on protecting HCWs across the world through the provision of personal protective equipment (PPE), training, addressing fatigue, and countering the psychosocial consequences . The literature on the health consequences of HCWs providing care to COVID-19 patients is proliferating; however, limited study is available on knowledge, practice and physiological impact of COVID-19 among MLSs . Knowledge, practice and physiological impact are the major cognitive keys in public health, and are indispensable for evaluating knowledge, communication and practical interventions on COVID-19. Furthermore, mental health is an important dimension that regulates working capacity of HCWs, which may be affected due to occupational injury and potential risk of infection . Researches suggest that higher number of people including HCWs had the psychological symptoms of anxiety and depression due to COVID-19 pandemic [22, 23]. This has created an unprecedented challenge for healthcare systems of all countries. In the context of MLS front-line workers, their knowledge involves a range of beliefs about methods for testing, samples handling, collection, transportation, storage, processing, testing and reporting [24, 25]. Proper practice involves working inside a laboratory following recommended guidelines for using personal protective equipment. Likewise, mental health refers to working in the laboratory without having any psychological symptoms such as; anxiety, stress, depression and so on. The lack of understanding of such beliefs, inappropriate practices and disturbed mental well-being may generate reports that can vary between the laboratories. Nepal has faced the similar situation during past months . In this scenario, we designed this survey for medical laboratory staff working in Nepal with two central objectives; 1) to assess knowledge level and laboratory practice for diagnosis of COVID-19 cases and, 2) to find the level of psychological distress arising due to the COVID-19 pandemic.