Impact of the COVID-19 pandemic on healthcare workers

The COVID-19 pandemic has impacted healthcare workers physically and psychologically. Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with infected individuals. Healthcare workers have been required to work under stressful conditions without proper protective equipment, and make difficult decisions involving ethical implications. Health and social systems across the globe are struggling to cope. The situation is especially challenging in humanitarian, fragile and low-income country contexts, where health and social systems are already weak. Services to provide sexual and reproductive health care risk being sidelined, which will lead to higher maternal mortality and morbidity.
Risk of infection.
The World Health Organization reported that one in ten health workers is infected with coronavirus in some countries. In March 2020, 9% of those affected with COVID-19 in Italy were health workers. In May 2020, the International Council of Nurses reported that at least 90,000 healthcare workers have been infected and more than 260 nurses had died in the COVID-19 pandemic. In March 2020, one in four doctors in the UK were off sick, in isolation or caring for a family member with COVID-19.
The UK government announced that retired healthcare professionals would be brought out of retirement to help during the COVID-19 crisis. This led to concerns that they could be at a higher risk for severe COVID-19 illness.
Shortage of PPEs.
Shortcomings of personal protective equipment have been reported from several countries. In China, inadequate staff training, shortage of PPEs, reduced understanding of PPE use and confused PPE guidance have resulted in infections and deaths among healthcare workers.
In the United States, many hospitals have reported a shortage of PPE for hospital staff. As COVID-19 cases increase, it is suggested that the United States will need far more surgical masks than they currently have.
The shortage of PPE has put many healthcare workers at risks for getting infected with COVID-19. Healthcare workers have created unconventional solutions to make up for the lack of PPE by using the resources they do have in stock. They have used plastic bags as gowns and plastic water bottle cutouts for eye protection.
The shortage of PPE is even worse for hospitals in low income communities. Items such as PPE have always been scare commodities in low income countries. UICEF reported that the organization was only able to acquire one tenth of the 240 million masks requested by these communities.
Deaths.
Nurse and doctor deaths due to COVID-19 have been reported from several countries. In May 2020, they added that at least 260 nurses have died due to COVID-19. In March 2020, at least 50 doctors were reported to have died in Italy due to COVID-19. The number of deaths in Italy continued to go up. By April 2020, the estimated number of medical doctor deaths was about 119 and for nurses about 34. Two of the deaths within those who were nurses were suicides due to unsustainable pressure at work.
On 8 August 2020, the Indian Medical Association announced that 198 doctors have died in India due to COVID-19. By February 2021, the Indian Medical Association said the number of deaths of doctor in India due to COVID-19 had increased to 734; however the government of India said that only 162 doctors had died due to COVID-19.
Psychological impact.
A study from Singapore showed that healthcare workers caring for patients with COVID-19 reported anxiety, depression and stress. Increasing work demands on healthcare professionals conflict with their duties to family and friends, which causes psychological stress. Healthcare professionals reported being anxious about having to self-isolate, quarantine or becoming ill. For healthcare workers, being quarantined was positively associated with minimizing direct contact with patients and not reporting to work.
Healthcare workers like nurses, doctors and other medical staff that worked on the front-lines in China experienced symptoms of anxiety, depression and difficulty sleeping. More specifically, about 46.04% had anxiety, 44.37% had depression, and 28.75% experienced insomnia. In Wuhan, China, over 70% of healthcare workers reported psychological distress.
Healthcare workers are at risk for developing trauma or other stress-related disorders due to fears of falling ill and not knowing what will happen in the future. Post-traumatic stress was common among health workers, with nurses demonstrating a higher likelihood of developing or having anxiety among others in the medical field.
An Italian nurse committed suicide after being traumatized trying to save the lives of those with COVID-19.
In Mexico, healthcare professional have also reported high levels of anxiety, because of the fear of being an asymptomatic patient, which could potentially lead to the unknowingly spread of the disease amongst their patients and their families.
Violence against healthcare workers.
Healthcare workers have been subjected to violent crimes, such as assault. Hospitals and governments have taken stricter measures to ensure the safety of their staff; however, many healthcare workers still face significant risk of physical injury.
Because of COVID-19, healthcare personnel have experienced over 600 instances of negativity directed towards them in different forms. In Pakistan, doctors were attacked by family members of a deceased patient who succumbed to COVID-19. Residents of a community in Bangladesh forced a doctor who was COVID-19 positive and his family to leave his home and the area by throwing bricks at their home.
Ethical decisions.
"The Conversation" reports that healthcare workers will have to face 'moral injury' for making difficult decisions such as moving a patient off the ventilator or refusing an ICU bed due to limited resources. COVID-19 has forced healthcare workers to make many difficult ethical decisions. These include concerns for the safety of spreading COVID-19 to their families since the risk is higher when they work and care for COVID-19 patients, deciding how to distribute limited resources such as ventilators among many patients who all need it, and deciding at what point healthcare workers should stay home instead of continue to go to work if they suspect they might have been exposed to COVID-19.
Impact on female staff.
Globally, women make up 70 percent of workers in the health and social sector. Women are playing a disproportionate role in responding to the disease, whether that be as front line healthcare workers, carers at home or community leaders and mobilisers. In some countries, COVID-19 infections among female health workers are twice that of their male counterparts. Women are still paid much less than their male counterparts in almost all countries and hold fewer leadership positions in the health sector. Masks and other protective equipment designed and sized for men leave women at greater risk of exposure. (Primary data on PPE fit, please?)
During the COVID-19 pandemic, rates of burnout are higher in female healthcare workers than male workers. Female healthcare workers were 55% more likely to report burnout compared to their male coworkers.
Recommendations.
World Health Organization.
The World Health Organization has given the following key recommendations to decrease the spread of COVID-19 among healthcare workers:
Centers for Disease Control and Prevention.
The Centers for Disease Control and Prevention has issued guidance on preventing transmission and reducing job stress in response to the COVID-19 pandemic for healthcare workers:
Managing job stress.
A 2020 Cochrane review found that among healthcare workers there is low certainty evidence that resilience training may lead to greater levels of individual resilience for healthcare workers. Due to limitations in the reviewed studies (44 RCTs), the authors advise caution in drawing definitive conclusions and recommend more studies with improved designs.
Other recommendations:
UNFPA.
UNFPA recommends that all women and girls must have access to a continuum of sexual and reproductive health services. In accordance to national guidelines and standards, some services for women and girls include antenatal, perinatal and postnatal care, and screening tests.
Karolinska Institute.
The Karolinska Institute recommends health workers to take care of oneself, avoid unhelpful strategies, stay in touch with loved ones, not blame oneself and reach out if physical or psychological help is required.