Who Will Take Care of COVID-19 Health Care Workers?

Exposed health workers could be stressed with no mental health help.

Posted Apr 20, 2020

This post was written by Hannah Sudhakar.

At the end of the year 2019, the city of Wuhan, China, reported a novel pneumonia caused by the coronavirus disease (which has come to be known as COVID-19). The virus spread widely both domestically and internationally, resulting in a global pandemic—with its current highest number of infections being, shockingly, in the United States. According to the New York Times, as of April 15, 2020, 624,048 people have tested positive for the virus in the U.S.

With the predicted worst yet to come, the world now depends on health care workers of all capacities to step up and provide round-the-clock care. They are being rightfully lauded as heroes who have put their lives on the line to serve the afflicted. But, as research has shown, the ever-increasing number of confirmed and suspected cases, overwhelming workload, depletion of personal protection equipment, widespread media coverage, lack of specific drugs, and feelings of being inadequately supported may all contribute to the mental burden of these health care workers. 

Photo by Clay Banks on Unsplash
Source: Photo by Clay Banks on Unsplash

The research, led by senior authors Zhongchun Liu, M.D., and Shaohua Hu, M.D., along with first author-contributors J. Lai, S. Ma, and Y. Wang, was funded by grants from the National Key Research and Development Program of China. It was published as an open-access article in the JAMA Network Open on March 23, 2020. The purpose of the study was to answer the question, “What factors are associated with mental health outcomes among health care workers in China who are treating patients with COVID-19?” They did this by quantifying the magnitude of symptoms of depression, anxiety, insomnia, and distress and by analyzing potential risk factors associated with these symptoms.

This survey-based study collected demographic data and mental health measurements from 1,257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China around Wuhan, which at that time was considered the epicenter of the pandemic. Eligibility for this study was determined by the presence of fever clinics or wards for patients with COVID-19. The method of this study followed the American Association for Public Opinion Research (AAPOR) reporting guidelines.

Participants from 34 selected hospitals were asked to fill out surveys. They were asked whether they were directly engaged in clinical activities of diagnosing, treating, or providing nursing care to patients with elevated temperature or patients with confirmed COVID-19. Those who responded affirmatively were characterized as frontline workers, while the others were secondary workers. The questions on the survey were focused on symptoms of depression, anxiety, insomnia, and distress for all participants, using validated measurement tools. A quantitative cutoff score for detecting symptoms was established, and participants who had scores above the cutoff were characterized as having severe symptoms.

The results presented from the research showed that 50.4 percent, 44.6 percent, 34.0 percent, and 71.5 percent of all participants reported symptoms of depression, anxiety, insomnia, and distress, respectively. These results also reported a disturbing effect on certain demographics of the participants. The authors stated:

“Our study further indicated that being a woman and having an intermediate technical title were associated with experiencing severe depression, anxiety, and distress. Working in the front line was an independent risk factor for worse mental health outcomes in all dimensions of interest. Together, our findings present concerns about the psychological well-being of physicians and nurses involved in the acute COVID-19 outbreak.”

The authors also compared their study with the results of a previous study conducted during an acute SARS outbreak. While the COVID-19 study reported that 70 percent of health care workers experienced psychological distress during an initial stage of the disease spread, 89 percent of health care workers reported psychological distress during the peak of the SARS outbreak. Regarding this psychological distress, the authors say:

“The psychological response of health care workers to an epidemic of infectious diseases is complicated. Sources of distress may include feelings of vulnerability or loss of control and concerns about health of self, spread of virus, health of family and others, changes in work, and being isolated. The fact that COVID-19 is human-to-human transmissible, associated with high morbidity, and potentially fatal may intensify the perception of personal danger. Additionally, predictable shortages of supplies and an increasing influx of suspected and actual cases of COVID-19 contribute to the pressures and concerns of health care workers.”

In order to combat this high prevalence of mental health issues, the authors concluded that:

“Protecting health care workers is an important component of public health measures for addressing the COVID-19 epidemic. Special interventions to promote mental well-being in health care workers exposed to COVID-19 need to be immediately implemented, with women, nurses, and frontline workers requiring particular attention.”

Amidst this global health crisis, psychological assistance services like telephone-based, internet-based, and application-based counseling and interventions have been widely deployed by local and national mental health institutions. Many regions both in China and internationally have set up psychological assistance hotlines to help those in quarantine. However, evidence-based evaluations and mental health interventions targeting frontline health care workers are scarce. This cannot continue, as it will lead to the breakdown of many health care workers as they continue to work under such intense psychological stress. States must also consider the mental health of their health care workers and provide opportunities for mental health intervention. Organizations that provide mental health care for quarantined citizens must also take up the case of our overworked health care workers to ensure that their sacrifice is valued and treated with respect.

Hannah Sudhakar is a student of the M.A. in Humanitarian and Disaster Leadership program at Wheaton College. She has a background in Electrical Engineering and Biblical studies. She is passionate about ministering to children—with a heart for children with special needs—and has served in that capacity at various organizations in the United States and in her home country, India.

References

Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976