Work related stress factors among healthcare professionals during COVID-19 pandemic; a call for immediate action

Dear Editor,

Since the declaration of COVID-19 outbreak as a public health emergency, the number of hospitals and intensive care units (ICU) admissions have been drastically increased around the globe. The outsized impact of this pandemic has resulted in overall 1,696,588 confirmed cases with total mortality cases of 105,592 by 5 April 2020 [1]. Current health crisis has affected people from various fields of life irrespective of their age, socioeconomic, and health status. Approximately, one-third of the world’s population is living under either self-imposed or forced quarantine. The daily life activities of people have been changed entirely due to home confinement, loss of daily wagers and jobs, work-from-home policy, closing of educational and recreational centers [2]. On the other hand, the contagious nature of the disease, rapid rise of infected cases, limited diagnostic facilities, and shortage of ventilators for severely infected patients portending substantial burden on the health-care system. Health-care professionals (HCPs) along with other public health authorities are working beyond their potential to contain the COVID-19 outbreak. Currently, the main global public health concern is to prevent or minimize the disease transmission, management with available medication as well as research for vaccines and improving mental health of both general and infected populations. In such circumstances, HCPs who are working on the front line and are directly involved in diagnosis, treatment, and management of COVID-19 patients are subjected to various emotional, psychological, and workplace-associated stress factors. These factors are imposing an adverse impact on their mental health and we believe that these should be addressed in haste to quell further mental health deterioration. Since the motivation and good mental health among HCPs are of utmost importance to combat this deadly pandemic, there is dire need to put aggressive maneuvers in place to resolve all possible stressors. This manuscript underscores the important stressors being faced by HCPs and provides key considerations that could help to pursue their duties efficiently during the ongoing pandemic.

The first and foremost fear experienced by HCPs is direct contact with confirmed and suspected cases of COVID-19 cases which puts them at increased risk of virus contraction. In the US alone, a total of 9,282 active COVID-19 cases (19% of the total cases reported in the US) have been reported in HCPs with a mortality rate of 0.03% (27 deaths) [3]. The possibility of reversal of role from being a caregiver to being a COVID patient or suspect increases frustration and vulnerability among HCPs. This risk is further amplified due to the lack of personal protective equipments (PPE) such as face masks, gloves, goggles, and protective clothing. The shortage of PPE is not only faced by developing or underdeveloped countries but developed countries are also experiencing the limited supply of protective gears for HCPs. As a result of constant fear of getting infection, many HCPs have socially isolated themselves from their families and homes in order to protect them and even some are using their cars for sleeping and staying away from home. This social isolation, over burdening working hours along with lack of proper place for physical rest might pose serious effect on their mental health resulting in depression and acute stress [4]. Moreover, reports of many HCPs’ deaths while fighting COVID-19 have also created anxiety. Fear of stigmatization and labeling prohibits them to seek professional psychotherapeutic help. A recently conducted multi-center (n = 34 hospitals) study in China addressed mental health issues among more than 1200 HCPs dealing with COVID-19 patients reported high incidence of self-reported depression (50%), anxiety (45%), insomnia (32%), and psychological distress (72%) [5]. Although many HCPs have chosen their professional responsibilities over personnel safety, still there are considerable numbers of HCPs who have opted to quit medicine as they feel betrayed by their employers and governments for expecting them to handle this pandemic without sufficient resources. This outbreak has put HCPs around the globe in an unprecedented situation where they have to make critical decisions about allocation of constrained resources among equally needed critically ill patients (ventilators) and work under physical and mental pressure. The choice to continue professional duties or resign is not an easy decision and this has resulted in further deterioration of mental health by inducing anxiety and insomnia among HCPs [6].

During the ongoing critical circumstances, it is imperative to support HCPs by paying attention to their physical as well as mental health [7]. Indeed, it is not possible to provide protective gears to each HCPs but the provision of some basic facilities might be helpful for them to cope with stress. The organizational leaders and administrative staff should proactively clarify work hours, ensure access to free healthy food and drinking water during the work hours as well as provide proper resting facilities for all HCPs working in their respective organizations. Access to food, toiletries, and physical rest is the basic need of every human being and it becomes extremely important in such a scenario when the over exhausting nature of work does not allow the body to meet its basic needs. Moreover, all HCPs should have access to free internet services, charging stations, and electronic devices to contact their families according to their convenience. Lastly, addressing all types of mental health issues among HCPs by professionally certified or trained personnel is very crucial. This can be done by providing free access to counseling sessions or a virtual visit to psychiatrist by the respective organization in which HCPs are serving. Such sessions should be mandatory for all HCPs at least once a week or fortnight depending upon availability of resources. A supportive work culture is the key to maintain resilience among HCPs during this pandemic.

The global war against COVID-19 cannot be won without integrated efforts of all HCPs and at this time, hospital administrations and various government and nonprofit organizations should work together to ensure sound mental health and psychosocial well-being of HCPs.

Declaration of interest

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.