Page 12 - GHES-2-4

Global Health Economics and
Sustainability
COVID-19 and the burden on healthcare workers

COVID-19 studies have reported depression in as many as 3.1.5. Burden of personal protective equipment (PPE)
50% of frontline HCWs, which indicates that the impact Throughout the world, the mandatory use of PPE has been
is greater than that during the SARS pandemic (Gupta & a mainstay in the fight to control COVID-19 infections in
Sahoo, 2020). frontline HCWs. For these workers, it involves donning
3.1.2. Anxiety a close-fitting N95 face mask, protective eyewear, a
gown, and surgical gloves. It is often cumbersome and
Global studies have reported symptoms of anxiety in uncomfortable and makes drinking water and breathing
44 – 62% of frontline HCWs, with a quarter suffering difficult (Ong et al., 2020). This, in combination with
moderate-to-severe anxiety (Gupta & Sahoo, 2020; fear over a limited supply of PPE and confusion about
Que et al., 2020). A study in India highlighted that its effectiveness, heightens work intensity and increases
60% of frontline HCWs in quarantine or working with feelings of fatigue, which then have detrimental effects on
COVID-19 patients experienced anxiety symptoms mental health (Master et al., 2020, Gupta & Sahoo, 2020).
(Grover et al., 2020). Moreover, a large proportion of Moreover, the use of PPE was associated with headaches
respondents reported anticipatory anxiety (Horesh & that decreased work performance and productivity when
Brown, 2020), with frontline HCWs expressing concerns used for more than 4 h/day (Ong et al., 2020).
regarding the future given the disease trajectory and
virus transmission. In addition, 75 – 80% of frontline 3.2. Measures implemented to assist frontline HCWs
HCWs felt psychologically unsafe and held concerns and reduce their burden
about being a source of COVID-19 infection for their As outlined, frontline HCWs are at considerable risk of
families, as well as failing to provide their usual standard psychological distress, both throughout the COVID-19
of care to colleagues or friends (Felice et al., 2020; pandemic and beyond. This psychological burden can lead
Poonian et al., 2020). to significant detrimental effects on their work, such as poor

3.1.3. PTSD morale, staff conflicts, absenteeism, apathy, and lapses in
care (An, 2020), which increase patient dissatisfaction and
While the risk of PTSD in frontline HCWs has long may result in poor patient outcomes. Staff wellbeing is an
been established under standard working conditions, integral pillar of a hospital’s pandemic response (Poonian
it is even greater during times of natural disasters, such et al., 2020), with multiple strategies being suggested and
as the COVID-19 pandemic, where stress and trauma implemented throughout the world in response to the
are repeated daily (Presti et al., 2020). Studies from the pandemic.
SARS pandemic have demonstrated symptomatic PTSD
in up to 33% of nurses who worked in ICUs (Gupta & 3.2.1. Psychiatric support/support by mental health
Sahoo, 2020) and greater symptomatology in those who practitioners
experienced quarantine or worked in high-risk units Health-care services have utilized consultations with
compared with their colleagues in low-risk units (Gupta mental health experts, the distribution of health-
& Sahoo, 2020; Que et al., 2020; Lee et al., 2007). The promoting webinars, and stress management training
response to the COVID-19 pandemic demonstrated many as means of reducing the mental health burden faced
characteristics of mass trauma, with individuals moving by frontline HCWs (Gupta & Sahoo, 2020). With the
into a state of hypervigilance, manifesting avoidance majority of frontline HCWs reporting mild symptoms
strategies, and experiencing negative moods, culminating of psychological distress, interventions such as activity
in psychological distress (Grover et al., 2020). Surveys scheduling, behavioral activation, and relaxation
from Chinese pediatric ICUs demonstrated rates of PTSD techniques are beneficial (Grover et al., 2020). Throughout
in 46% of frontline HCWs during the 1 months of the Italy, access to a hotline with psychiatric support has been
st
pandemic (Zhang et al., 2022). offered in major hospitals, along with the implementation
of acceptance and commitment therapy (ACT). ACT is a
3.1.4. Insomnia
mindfulness-based cognitive behavioral therapy aimed at
While evidence remains limited, a recent publication improving psychological flexibility and was demonstrated
involving 150 frontline HCWs reported poor sleep in 60% to be effective in patients with PTSD (Prevedini et al.,
of participants (Vadi et al., 2022). This figure is higher than 2011). An ACT-based psychoeducation booklet has also
previously reported in 29% of frontline workers and in up been designed for HCWs (Presti et al., 2020). Finally, peer
to 45% of those required to quarantine or who worked supporters trained in psychological first aid have been
directly with confirmed positive cases (Gupta & Sahoo, engaged in emergency departments to promote natural
2020, Que et al., 2020, Grover et al., 2020). recovery from crisis and traumatic events, along with

Volume 2 Issue 4 (2024) 4 https://doi.org/10.36922/ghes.2530