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

a reduction in symptoms of depression and stress levels and burden faced by each heterogeneous hospital, the
when based on the principles of mindfulness, cognitive quantitative evaluation of implemented measures is
behavioral therapy, and ACT (Kunzler et al., 2020). In required to assess improvements in mental health and
addition, yoga-based interventions were demonstrated to resilience. This could be achieved through the creation
reduce emotional exhaustion, burnout, and anxiety while and confidential distribution of anonymous pre- and
improving sleep and mental health (Spinelli et al., 2019). post-intervention questionnaires that address symptoms
Moreover, mindfulness practices such as weekly 30-min of psychological distress, such as the one presented in
sessions, structured programs, and the use of apps such Appendix 2, with global studies to assess their validity and
as Smiling Mind have further demonstrated reductions in reliability in each diverse and heterogeneous population.
perceived stress, anxiety levels, and depressive symptoms
(Spinelli et al., 2019; Smith et al., 2007; Flett, 2018; Braganza 4.2. Limitations
et al., 2018; Barattucci, 2019). These strategies have been This study was limited by heterogeneity in global study
recommended by the ACEM and the UK Intensive Care populations and variations in symptom evaluation tools.
Society for improving staff well-being during and beyond Furthermore, limiting the search strategy to emergency
COVID-19 (ACEM, 2020; Braganza and Popham, 2020). departments may reduce the findings’ generalizability to
There is limited evidence supporting the efficacy of other other frontline HCWs.
strategies that have been initiated, such as engaging mental
health professionals; peer-support groups; and provision 5. Conclusion
of effective, open communication (Serrano-Ripoll et al., The impact of the COVID-19 pandemic has been
2020). However, a supportive supervisor and work culture, enormous, with its true toll unknown. Thus far, over 766
along with practical support, were demonstrated to protect million cases have been recorded worldwide, with almost
staff mental health (Greenberg et al., 2020). Despite the 7 million deaths. While the spread is now more contained,
lack of evidence, both the ACEM and ICS recommend frontline HCWs are charged with continuing to ensure
these strategies, when endorsed by strong leadership, as that the health needs of this patient population are met,
feasible and sustainable measures to support staff well- recovering from the challenges posed by COVID-19,
being (Braganza et al., 2018, Braganza and Popham, 2020). and preparing for the next pandemic or major event. The
The implementation of policies and practices to psychological burden placed on future frontline HCWs
improve the psychological health of frontline HCWs during the early stages of a pandemic is a crisis that must
was shown to be positively associated with increased job be anticipated and addressed in advance. With over 50%
satisfaction, improved workplace culture, and better patient of frontline HCWs reporting symptoms of psychological
outcomes (Braithwaite et al., 2017). Patient mortality rates, distress, the impact of another pandemic will extend far
readmission rates, adverse events, and patient satisfaction – beyond the problem caused by the virus itself.
all improve with a positive workplace culture (Braithwaite Health institutions have implemented a multitude of
et al., 2017). The adoption of health-promoting strategies strategies to assist in minimizing the burden placed on
is, therefore, a crucial tool in the arsenal of any health frontline workers. These resilience strategies may be costly;
service to support staff through their careers, where they their use should be rigorously tested for efficacy as we move
will face many significant challenges, including potential into an unknown and uncertain future. The use of validated
future pandemics or major events. strategies will provide a crucial tool for supporting the

4.1. Future directions mental health of frontline staff, allowing them to continue
their much-needed work and ensuring the safety of their
Future research should focus on ensuring that all health entire communities now and in the future.
services are aware of the high risks facing their frontline
HCWs, as well as evidence-based interventions that can Acknowledgments
be implemented to support psychological well-being. This
could be achieved through the distribution of informative The author would like to acknowledge Oliver Hoffman,
flyers, such as the example provided in Appendix 1, followed who assisted in designing an informative flyer to be
by research that assesses psychological symptoms pre- and distributed to health services, and also the hard work and
post-implementation and the creation of an evidence- dedication of frontline HCWs throughout the COVID-19
based toolkit for other health services to replicate. Further pandemic.
research should also investigate the long-term prevalence Funding
of psychological distress in individual hospitals and its
associated burden. With the large variation in the exposure None.

Volume 2 Issue 4 (2024) 6 https://doi.org/10.36922/ghes.2530