COVID-19: The Effects on Frontline Healthcare Workers

COVID-19: The Effects on Frontline Healthcare Workers

Garvita Thareja, Autumn Ortega, and Andrew Salter

The pandemic, as we all can attest, has made a significant impact in our lives and day to day operations. Since the beginning of the pandemic in 2020, we all have felt the devastating grasp that COVID-19 has had on everyone's normal life. As a human race, we have grieved terrible losses, experienced crippling sickness, and have been shoved into our homes for hiding to come out only as needed. The mental health impacts are devastating. A nationwide study found that during the first year of COVID, depression rates tripled (1). The same study also indicated that the symptoms of depression did not peak and fall, rather continued to rise (1). But what about the impacts on our frontline workers? Those working face-toface with the deadly virus… everyday! It’s clear that these populations, who directly interact with cases of COVID-19 and experience either the symptoms of or death due to COVID, are possibly the most vulnerable population. In order to mitigate these mental health issues faced by healthcare workers, strategies for coping and public awareness of COVID prevention measures are crucial.

Picture this, you're an ICU nurse working your 12- hour shift during a surge in COVID-19 cases. Your floor is full of COVID cases, patients are overflowing into the hallways, and you and your team are desperate to locate lifesaving respirators. Death is at every corner of the building, patients plead to see their loved ones, and all you can provide is a video call and your compassion. You’re understaffed, you're low on PPE, and the patient flow never stops. The result is burnout, turnover, depression, anxiety, PTSD, and even COVID-19 itself (9). Further, during COVID-19, female nurses were twice as likely to commit suicide than their general female counterparts (7-9). It was even recorded that nurses working in stressful COVID conditions, such as witnessing tragic goodbyes, were experiencing moral distress like combat veterans (9).

Figure 1: Participants in a study indicating nurses are the largest healthcare workers on site. Data from study at the Suez Canal University hospitals6.

The data supports that these mental health impacts were real and measurable. In a short analysis of 37 studies, filtered for accuracy, the prevalence of mental health issues was clear among healthcare professionals who work directly with COVID-19 patients (8). A study in China indicated that 512 healthcare workers, who were in direct contact with COVID patients, had a prevalence of 12.5% in anxiety and generally were at risk for anxiety when compared with the workers who were not handling COVID-19 patients (8). Additionally, an examination of medical staff and administrative staff indicated that the medical staff experienced greater fear, anxiety, and depression levels than administrative staff, and that units for COVID-19 were experiencing higher levels of mental health issues than other medical units (8). The same study further showed that younger nurses who worked on the frontline in COVID-19 were at higher risk for depression and anxiety, with 13.5% experiencing mid to high levels of those symptoms. Another study in Canada (7) conducted among 455 ICU healthcare workers, made up of physicians, nurses, and other healthcare professionals, utilized a self-reported questionnaire to analyze the levels of mental distress. Approximately 60% of respondents felt that they were at great risk for COVID-19, while 76% showed concern for infecting family, 67% felt more stressed, and 37% considered leaving their job. This study indicated that approximately 25% had probable PTSD. Yet again, nurses were at the highest risk for psychological concern. Finally, a study (6) at the Suez Canal University hospitals examined the correlation between COVID-19 stress and work performance. They reported that COVID-19 significantly affected work performance and success in the job, when compared with other factors like confidence and knowledge of work. Additionally, about half of the workers had moderate psychological stress while few had severe stress. These studies show that the mental health impacts felt by frontline workers are felt across the globe.

Figure 2: Types of Psychological Stressors faced by healthcare workers. Data from study at the Suez Canal University hospitals.

For healthcare workers, self-care to cope with stress is critical. Undoubtedly, witnessing traumatic events and repeatedly working long hours takes a physical and mental toll. The first step is recognizing the symptoms of distress and mental health illness such as feeling out of control, lacking motivation, feeling burnt out, loss of mood, loss of pleasure in doing one’s job, having trouble sleeping, and lack of concentrating (3).

Although there is very little that can be done as healthcare workers are overwhelmed with working extra hours and getting few breaks or time to disconnect from clinical work due to the ongoing pandemic, recognizing mental health issues early on can prevent adverse health effects from persistent stress. Positive coping skills include keeping a daily routine to maintain a sense of control. Coping looks like eating regularly, sleeping adequately, and maintaining regularity in one’s schedule (2,4). With this, it is essential to take time away from work and disconnect for a healthy work-life balance. Time away from work must also include regulating one’s consumption of COVID-related news. Directly dealing with the pandemic and consuming media related to COVID is mentally exhausting and can lead to compassion fatigue.

Ultimately, to help ourselves and our fellow healthcare workers, getting vaccinated, wearing a mask, and social distancing are imperative. COVID-19 is primarily spread by inhaling respiratory drops from individuals carrying the virus when they talk, breathe, sneeze, or cough (2,4). The CDC recommends wearing a wellfitting mask to reduce the spread of “COVID-19”. Mask wearing minimizes the number of droplets exhaled in the environment and can reduce the amount inhaled. Mask wearing can be encouraged by mask distribution, role modeling, and mask promotion. In a clusterrandomized study in Bangladesh, these three tactics tripled mask usage. Masks are proved effective in several studies (1-4, 9). One taking place on the “USS Theodore Roosevelt, an environment notable for congregate living quarters and close working environments, found that use of face coverings on-board was associated with a 70% reduced risk of infection” (2-4).

Additionally, the CDC recommends getting fully vaccinated against COVID-19. A report (2) on the vaccine efficacy in preventing hospitalizations concluded that in adults aged 65-74, the Pfizer-BioNTech and Moderna vaccines were 96% effective in preventing hospitalization for fully vaccinated individuals. For fully vaccinated adults, aged 75 and under, Pfizer-BioNTech was found to be 91% effective while Moderna was found to be 96% effective.

Figure 3. Role of masks in controlling the spread of COVID-19 virus. Data from Center of Disease Control and Prevention report.

The pandemic has had a significant effect on healthcare workers' mental health. More research is recommended on vaccine efficacy, and alternatives for those unable to get vaccinated should be provided. Vaccines are an excellent place to start; although many people have conflicting opinions about it, it is essential to appreciate the proven efficacy of the COVID-19 vaccines. Further, to save the lives of our loved ones as well as those in the community and public health and healthcare workforce, educational events and policy changes should be promoted to mitigate the spread of the virus. The public should be made aware that vaccines are a common and safe practice that we have been using for a long time. With PTSD, anxiety, and suicide rates the rise, we must do all we can to help each other.

25