How Institutions Can Protect the Mental Health and Psychosocial Well-Being of Their Healthcare Workers in the Current COVID-19 Pandemic

Abstract

When the World Health Organisation (WHO) declared the spread of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) a global pandemic on March 11, 2020, there were approximately 147,000 confirmed cases worldwide. Just one month later, the COVID-19 disease had spread dramatically; the number of cases had increased ten-fold (1), with 15% of infected patients requiring hospitalization and 5% in intensive care units (3). This meteoric rise in cases resulted in an overloaded demand for medical resources, often exceeding the available resources of healthcare systems around the world. Although we often conceive of healthcare systems in terms of the physical hospital beds and medical equipment, the system’s most fundamental, valuable, and vulnerable assets are, undoubtedly, its manpower resources. Medical doctors, nurses, physiotherapists, technicians, and countless other professionals must all come together for the system to work effectively. Indeed, in order to buffer the effect of the pandemic on our healthcare systems and society as a whole, we rely heavily on the extent to which these individuals can function in a cohesive, effective manner (5). Healthcare workers are being impacted by the current pandemic on two fronts. Like all of us, they are navigating social distancing, school and day care closures, the economic crisis, concerns about the health of their loved ones, and general uncertainty about the future. Also, because of their profession, they are likely to be exposed to overloaded working hours and a higher risk of infection amidst potential shortages of adequate personal protection equipment (PPE) and other supplies. Further stressful factors include feeling a lack of control or sense of helplessness, daily contact with suffering and death, as well as the need to communicate bad news and establish new communication strategies with family members who cannot visit hospitalized patients. In addition, concerns about infecting their families has resulted in many professionals leaving their homes and sheltering elsewhere, which may further worsen their psychological well-being. Finally, they are worried about whether they will be prioritized in care if they become ill and whether they will face ethical dilemmas such as those reported in other countries where the health system has collapsed (7). Clearly, this pandemic is exerting great stress on the personnel working on the front line of efforts to control the virus in the healthcare system (5). Studies have already shown that most health care providers are exhibiting stress-related symptoms such as anxiety, depression, sleep disturbances, and emotional distress, and around 50% of them will fulfil criteria for a mental disorder (6). It is still not completely clear who among us is at a higher risk. As an example, early data suggest that females nurses may be particularly vulnerable (6,8), especially those working in direct contact with infected patients for longer hours. Also, anyone with a preexisting chronic disease or mental health condition is at greater risk (5,6). These data demonstrate that we are facing a situation in which the backbone of our health system, our personnel, is highly exposed, both physically and psychologically. The relevance of that unfolds in the consequences: if care providers are hampered by mental health and psychosocial issues, infection rates will increase (due to lower compliance with safe practices), which, in turn, would reduce staff numbers and amplify emotional distress in a vicious cycle. Indeed, this pandemic has already resulted in soaring rates of absenteeism, medical leaves, and even resignations. For these reasons, any strategy to combat the COVID-19 crisis must take the mental health and psychosocial aspects of its healthcare workers into consideration. The strategy should be established at several levels: governmental, institutional, and individual. In fact, recent studies show that governmental and institutional attitudes toward the pandemic can directly increase motivation and performance levels of healthcare personnel, thereby protecting against negative mental health effects (8). Simply put, our healthcare DOI: 10.6061/clinics/2020/e1963 Copyright & 2020 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/ 4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.