“With the onset of COVID we as healthcare workers are naturally at the front of everything and we are soldiers…we will go out, we will fight, and what we are asking for  is the tools to do our jobs.”

Dr. Orrett Thane, Deputy Head of the General Practice, Cayman Islands

INTRODUCTION

There is a growing concern that front-line healthcare workers from all disciplines in hospitals and other care settings are not being provided with the tools to ensure their safety during the COVID-19 pandemic. An article by Vox titled “Doctors and nurses are risking their mental health for us” outlines some of the short and long-term negative consequences from working regularly in extremely stressful environments. This was based on a study published in the Journal of the American Medical Association (JAMA) that found that healthcare workers in China, the first country to be hit with COVID-19, are experiencing many psychological impacts such as anxiety and depression. 

The psychological impacts can range from the stress of needing to physically isolate from social support networks to witnessing firsthand the death toll hitting new highs every day, with no end in sight. In the aftermath of COVID-19, interventions to address the short- and long-term psychological damage will be needed.

In this blog post, we’ll be exploring:

• Part 1: Physical Health Hazards: Working in High-Risk Environments Without Essential Resources
• Part 2: Short and Long-Term Mental Health Consequences
• Part 3: Solutions and Interventions   

Part 1: Physical Health Hazards: Working in High-Risk Environments Without Essential Resources

While much of the world has experienced frustrating lockdowns and stay-at-home orders, healthcare workers have been working in high-risk environments. During the initial wave of the pandemic, healthcare workers were subjected to long working hours, fatigue, and extremely stressful environments. They not only risk becoming infected themselves but also passing COVID-19 along to their loved ones (Karlsson & Fraenkel, 2020). 

In the early months of the pandemic, insufficient personal protective equipment (PPE) and equipment meant that healthcare workers were often left open to infection (Karlsson & Fraenkel, 2020). Healthcare personnel were often tasked with caring for patients with known or suspected COVID-19 infections without the appropriate protection (Lancet, 2020). As a result, healthcare workers have been overrepresented in the number of confirmed infections in many parts of the world. By March 2020, 20% of Italy’s healthcare workers involved in the pandemic response had been infected with COVID-19 (Remuzzi & Remuzzi, 2020). 

The scarcity of COVID-19 testing in the early months of the pandemic added to the stress and uncertainty of the healthcare environment. Most countries struggled to provide sufficient testing (Karlsson & Fraenkel, 2020). As a result, many healthcare workers risked infection or infecting others while awaiting results.

Beyond equipment availability, healthcare workers did not have access to timely information about the disease and its spread while rapidly shifting protocols added to the confusion. Without critical information, health workers and administrators were unable to keep themselves safe and make the best use of available resources.

Part 2: Short and Long-Term Mental Health Consequences

The immediate effects of mental strain on healthcare workers involved in the pandemic response are already evident. Healthcare workers have reported anxiety, fear, and sleep disturbances. In China, three in four healthcare workers reported some form of psychological trauma and were more than 60% more likely to experience depression or anxiety than those not involved in the pandemic response (Lai et al., 2020).

Even seasoned specialists have been overwhelmed with the scale of the pandemic as the death toll continues to climb. The lack of lifesaving resources and space places physicians in the position of deciding which patients are allocated equipment such as ventilators and intensive care beds (Remuzzi & Remuzzi, 2020). Preventable deaths due to insufficient resources places a huge burden on healthcare workers.

Evidence from previous pandemics shows that healthcare workers involved in the response can be left with serious mental health concerns such as PTSD, acute stress disorders, and depressive symptoms for years after the crisis abates (Cabarkapa, Nadjidai, Murgier, & Ng, 2020). As the mental health impacts of the current COVID-19 pandemic continue to unfold, health systems need to support both short- and long-term mental health concerns that develop in the healthcare worker population.

Part 3: Solutions and Interventions

Many health systems were already providing counselling, psychological, and psychiatric support for healthcare workers before the start of the pandemic. However, the onus is generally on the healthcare worker to recognise the symptoms of mental strain and seek out help when needed. In the wake of the pandemic, the emphasis needs to shift to proactively protecting mental health (Søvold et al., 2021).

Despite often serving as advocates for seeking mental health support, there is often a stigma amongst healthcare workers in seeking mental health help themselves. Those that do seek support often do so outside of their own network due to fear of ostracisation and judgement from their colleagues (Søvold et al., 2021). Many are concerned that seeking care may appear weak or impact their professional licensure (Muller et al., 2020; Søvold et al., 2021). Normalising mental health seeking behaviour and mental health screening can assist in the de-stigmatisation of help-seeking among healthcare workers (Søvold et al., 2021).

Part 3: Solutions and Interventions

• Healthcare workers responding to COVID-19 have been working in rapidly changing and often unsafe environments without the equipment and information needed to keep themselves and others safe
• This ‘warzone’ environment has led to emerging mental health concerns including anxiety and depression, while long-term mental health impacts are likely to develop in the future
• Healthcare professionals across the world need additional mental health support both now and for years to come

Addendum: Update, August 2021

The above blog reflects the situation from April 2020. Many countries have since made improvements in certain areas such as resource availability and testing (World Health Organization, 2020). However, others like  India and Brazil have experienced devastating oxygen shortages leading to high COVID-19 mortality.

Increased understanding of COVID 19 means that healthcare workers are able to better protect themselves and others (Karlsson & Fraenkel, 2020), although emerging variants continue to create uncertainty.

Updated studies confirm that healthcare workers continue to experience significant mental health strain (Muller et al., 2020; Vizheh et al., 2020) and the tragic, high-profile suicides of front-line health workers underscore the need to support this population. 

The development and global roll-out of effective COVID-19 vaccines offers hope that there is an end in sight to the crisis. In the meantime, supporting our front-line healthcare workers both now and in the future remains critical to preserving their mental health.