Psychological Effects of COVID-19 on Health Care Workers: Some Lights From Previous Pandemics

Ibrahim El Bayoumy

Professor of Public Health and Community Medicine-Tanta Faculty of Medicine, Egypt

*Correspondence to: Dr. Ibrahim El Bayoumy, Professor of Public Health and Community Medicine- Tanta Faculty of Medicine, Egypt.

Copyright © 2020 Dr. Ibrahim El Bayoumy. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The mental and physical stress in treating patients during pandemics facing doctors nurses and other health care workers dealing with earlier stages of infectious disease outbreak is prominent, as they are exposed to a variety of mental health issues like insomnia, anxiety and depression. Doctors and nurses act as important force in the fight against epidemics as H1N1, SARS, Epola and finally COVID-19 in December 2019 in Wuhan, Hubei province in China that quickly spread to the whole country [1]. Doctors and nurses work under intensive pressure from the patients and from the community in order to reduce human-to human transmission in hospital and in treating patients with COVID-19 [2-5].

Though physicians are so critical to effective responses to public health crises, they are exposed to get the infections from patients, and exposed to mental stress due to exposure of unexpected suffering and death. In the 14^th century, doctors and nurses are exposed to Black Death (Plague) in Europe, not only because they succumbed to the bubonic plague, but also, doctors are too afraid to expose themselves to infected patients [6]. Doctors, nurses and ambulance men are more likely to get infection than any other health professionals. In China by February 11, 2020, about 1716 medical workers were infected by COVID-19 constituting about 3.8% of the country confirmed cases, that meanwhile, six of them were died from the disease, accounting for 0.4% of deaths in China [7].

High expectations, lack of time skills social support may cause occupational stress that in turn can lead to anxiety, post traumatic disorder, so that health care workers may be not able to provide high quality medical services [8,9].

Several psychological problems were observed in physicians dealing with pandemics and emergence of symptoms related to anxiety and depression. For example, COVID-19 health workers are experiencing a sort of guilt on watching patients dying alone in front of them, and their need to inform loved ones via technology rather than in person [10,11]. The guilt will be transmitted directly to a state of depression and anxiety. During SARS outbreak in 2003, health care workers were suffering in Taiwan from anxiety symptoms for a short term that eventually translated to depression.

About 75% of 1257 health care workers were suffering from symptoms of anxiety and depression in the outbreak of SARS [12].

In Europe, in Greece during pandemic swine flu (H1N1) in 2009, Goulia et al. 2010 [13] have reported that more than 50% of health care workers in a tertiary hospital were suffering from moderate to high state of anxiety. Also another study in Taiwan has reported that 30% of physicians and 42% of nurses have the symptoms of fear and anxiety due to avian flu (H5N1) [14].

In the outbreak of Ebola virus outbreak, health care workers suffered both anxiety and depression, also health care workers felt a loss of social connectedness in their communities [15].

Recent research study in Singapore conducted in the period from 19 February to 13 March 2020, it included health care workers in two major tertiary hospitals in Singapore who were caring for patients with COVID-19, of invited 500 health care workers 470 persons(94%) have participated in the study, the study revealed that 14.5% of them showed symptoms of anxiety, 8.9% have showed also symptoms of depression and 7.7% showed post -traumatic stress disorder (PTSD) symptoms. 28.7% of the sample were doctors and 34.3% of the sample were nurses, the rest of sample were allied health professionals and technicians [16].

Another problem facing health health care workers is the absence from work during pandemics like avian flu, nearly one of every four health care workers were absent [17]. Also another study conducted in Japan has revealed that 20-30% of health care workers during H1N! pandemic, showed a great hesitation about working at the time of pandemic [18]. Lack of sufficient preparation to deal with pandemics is another problem facing health workers. El Gaafary et al 2010 [19], have reported that 30% of physicians showed no preparedness to deal with H1N! pandemic and they showed lack of personal protective equipment training and shortage of these equipment and so many nurses were having to treat COVID-19 without adequate protection and this was a source of anxiety fear.

Health care workers are in the need of psychological support, due to the p to exposed to it. This support can be given through their or through support from their colleagues i.e psychologists, so it is crucial to reduce the psychological upsets for mental health in the workers, they face during pandemics and enhancing the clinical skills through training esp. through simulation scenarios and increase their preparedness among all health care workers and getting the skills and learning them how to keep with mental illness like anxiety and depression during pandemics.

Bibliography

1. Cardoso, C. W., Paploski, I. A., Kikuti, M., Rodrigues, M. S., Silva, M. M., Campos, G. S., Sardi, S. I., Kitron, U., Reis, M. G. & Ribeiro, G. S. (2015). Outbreak of Exanthematous Illness Associated with Zika, Chikungunya, and Dengue Viruses, Salvador, Brazil. Emerg Infect Dis., 21(12), 2274-2276.
2. Team Whoer, Aylward, B., Barboza, P., Bawo, L., Bertherat, E., Bilivogui, P., Blake, I., Brennan, R., Briand, S., Chakauya, J. M., et al. (2014). Ebola virus disease in West Africa-the first 9 months of the epidemic and forward projections. N Engl J Med., 371(16), 1481-1495.
3. Abdalla, O., Mohammed, M., Hakawi, A. M., Aljifri, A., Abdalla, M., Eltigani, S., Mujib, S. A. & Assiri, A. (2020). Hospital-based surveillance of influenza A(H1N1) pdm09 virus in Saudi Arabia, 2010-2016. Ann Saudi Med., 40(1), 1-6.
4. Hussein, A. (2004). Guest Editorial: SARS-future considerations for nurses. Journal of Advanced Nursing, 45(2), 111-112.
5. Carlson, C. J., Dougherty, E. R. & Getz, W. (2016). An Ecological Assessment of the Pandemic Threat of Zika Virus. PLoS Negl Trop Dis., 10(8), e0004968.
6. Huremovic, D. (2019). Brief history of pandemics (pandemics throughout history). Psychiatry of Pandemics, 7-35.
7. National Health Commission of the People's Republic of China.
8. Ruotsalainen, J. H., Verbeek, J. H., Marine, A. & Serra, C. (2015). Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev., (4), CD002892.
9. Chen, R., Chou, K. R., Huang, Y. J., Wang, T. S., Liu, S. Y. & Ho, L. Y. (2006). Effects of a SARS prevention programme in Taiwan on nursing staff's anxiety, depression and sleep quality: a longitudinal survey. Int J Nurs Stud., 43(2), 215-225.
10. Straus, S. E., Wilson, K., Rambaldini, G., et al. (2004). Severe acute respiratory syndrome and its impact on professionalism: qualitative study of physicians’ behaviour during an emerging healthcare crisis. BMJ., 329(7457), 83.
11. Styra, R., Hawryluck, L., Robinson, S., Kasapinovic, S., Fones, C. & Gold, W. L. (2008). Impact on health care workers employed in high-risk areas during the Toronto SARS outbreak. J Psychosom Res., 64(2), 177-183.
12. Chong, M. Y., Wang, W. C., Hsieh, W. C., et al. (2004). Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry., 185, 127-133.
13. Goulia, P., Mantas, C., Dimitroula, D., Mantis, D. & Hyphantis, T. (2010). General hospital staff worries, perceived sufficiency of information and associated psychological distress during the A/H1N1 influenza pandemic. BMC Infect Dis., 10, 322.
14. Tzeng, H. M., Yin, C. Y. (2008). A crisis: fear toward a possible H5N1 pandemic. J Nurs Care Qual., 23(2), 177-183.
15. McMahon, S. A., Ho, L. S., Brown, H., Miller, L., Ansumana, R. & Kennedy, C. E. (2016). Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic. Health Policy Plan, 31(9), 1232-1239.
16. Benjamin, Y. Q., et al. (2020). Psychological impact of COVID-19 pandemic on health care workers in Singapore. Annals of Internal Medicine.
17. Butsashvili, M., Triner, W., Kamkamidze, G., Kajaia, M., McNutt, L. A. (2008). Knowledge and anticipated behaviour of health-care workers in response to an outbreak of pandemic influenza in Georgia. World Hosp Health Serv., 44(2), 24-26.
18. Imai, H., Matsuishi, K., Ito, A., et al. (2009). Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009. BMC Public Health., 10, 672.
19. El Gaafary, M. M., Abd Elaziz, K. M., Abdel-Rahman, A. G. & Allam, M. F. (2010). Concerns, perceived impacts and preparedness of health care workers in a referral hospital in Egypt in facing influenza (H1N1) epidemic. J Prev Med Hyg., 51(3), 105-109.