By: Dhanya Janga and Tanishka Aglave

Abstract

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In this research article, we have circulated a questionnaire among the health professionals with different duties. We will evaluate their responses to reflect how they were affected by COVID-19. The study aims to assess the psychological symptoms health professionals face, such as stress, anxiety, and depression, and describe how they cope with psychological problems. This research article will give insights regarding how health professionals were affected by COVID-19 and coped with the situation. The data below shows the varied mental health struggles workers faced during the pandemic as well as different ways to help them manage themselves.

Introduction:

Covid-19 was first discovered in Wuhan, China in late 2019. The virus was just emerging and much of the information has been unknown. Later, it turned into a global pandemic, affecting 118,000 people in more than 110 countries. By March 13, 2020, a national emergency was declared by the president all over the United States of America. The overall COVID-19 cases reached more than 25 million and the death toll started rising. Even being the most developed country in the medical field and having advanced technology, the USA failed to administer proper preventative methods and ranked no.1 as the country with the highest number of COVID-19 cases [⁴]. Scientists around the world have been racing around the clock to find out more information such as its genome sequence and what it’s truly capable of. On the other hand, health professionals have been immensely occupied with the amount of pressure they have. The price of caring for highly infectious patients is a great burden for many frontline medical workers. This pandemic is causing a mental health crisis amongst health professionals[¹]. A study from the Columbia University Irving Medical Center And New York found that 57% of medical workers experienced acute stress and 48% exhibited depressive symptoms [³]. First responders have been working tirelessly for months as hospitalizations, the number of cases, and the number of deaths hit a record high. The sheer number of patients they had to take care of at the end of life has been overwhelming, to say the least[¹]. Doctors and nurses have compared working in I.C.U.s to fighting on a battlefield. People are starting to experience a level of trauma that is familiar to many who have served in the military. With constant lives on the line, nurses and doctors sacrifice their own lives to save others [²]. This research article will discuss how it has affected health professionals and what measures should be taken to prevent mental health decline.

Method

A semi-structured interview survey guide was created with the aim of quantitative and qualitatively measuring the mental health status of health professionals. In addition, the interview was designed to learn about how health professionals have dealt with the stress of the pandemic situation. They were recruited through electronic forms sent to possible participants. The majority of the study focused on frontline medical workers, especially doctors.

Results and Discussion

The current global pandemic has posed burdens for everyone, but none of these difficulties are to be compared with the ones health care workers faced. The majority of the survey focused on the psychological impact of COVID-19, including stress, depression, and anxiety rates. The study conducted also evaluated physical health quality and burnout. We have provided a summary of the survey study below.

Occupation of Health professionals:

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Out of 100%, 70.8% of the people who responded are Doctors. The second highest response is from pharmacists, who contribute about 8.3% of the total. Other responses were from Registered nurses, Nurse practitioners, Front desk receptionists, Medical technicians, Hospital administrators, support workers, Physical therapists, Counselors, and Occupational therapists. All these occupations are considered frontline workers or first responders.

Specific Job Profile:

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Most health professionals were either doctors or nurses. Many of these jobs involve them working at hospitals or clinics, e.g., jobs at Texas medical center. They work in highly infected areas, working alongside COVID-19 patients. These work professions are considered high-risk professions during this pandemic.

Challenges faced in everyday work life:

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Response to this question varies from person to person. People faced different challenges in the everyday workforce such as lack of staff, time and personal constraints, regular workload, and everyday stress. These problems mainly surface from the usual workload they face regularly. All these challenges are faced by everyone in day-to-day life.

New problems faced after Pandemic:

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One of the main problems health professionals faced during the pandemic was the lack of resources. When the pandemic first swept our country in the spring months of 2020, there were massive shortages of PPE kits, ventilators, and testing kits. There was also a much higher demand for health professionals needed in hospitals and clinics. When an unknown virus has taken over the country, frontline workers must take the best actions to ensure safety for the public. Other problems that were faced after the pandemic started were a decrease in businesses, increased workload due to pandemic, increased demand for contactless transactions, curbside pick up and drive-thru, fear of getting exposed to patients. The issues they faced during the pandemic were drastically different from what they had been facing before this disaster.

New routines during COVID-19:

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After analyzing the responses, it was found that most of them say that they have to wear an N-95 mask, examination gloves, maintain 6 feet of distance, temperature screen every patient, clean their hands with sanitizer, wash hands regularly, use PPE kits, and screen their temperature before entering the hospital. Just like the general public, health care workers are taking many safety precautions to avoid possible infection. Working in a risky environment like hospitals, healthcare workers must make sure that they follow safety measures and not risk their lives and their families.

Impact on regular working hours:

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The majority of the responses to this question are that this situation did impact their regular working hours. Many had to work longer shifts in emergency rooms and I.C.U.s to take care of hospitalized patients as well as treat the regular patients. Overworking can cause fatigue and stress disorders and cause less emphasis on personal health and well-being.

Change in mental health due to pandemic:

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Our survey showed that around 67% of the health professionals we surveyed did feel a change in their mental health. The other 33% of people did not feel a change in their mental health. The majority of the people who faced changes in their mental health were experiencing unwanted changes. While working in stressful situations during these times, health workers reported symptoms, including depression, anxiety, traumatic stress, avoidance, and burnout. Medical workers had to stay more alert and cautious during the outbreak to prevent possible infection. This eventually led to anxiety and fear that took a toll on their mental health.

Mental health challenges:

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Most of the health professionals have experienced additional stress as a challenge, anxiety, fatigue, fear that they will also get infected, and changes in mood due to working for longer hours. These were the major mental health challenges that affected their work productivity as well as overall well-being. The main mental health challenge faced is additional stress. This is primarily sourced from the workload as well as the current circumstances of the pandemic everyone is facing.

Factors contributed to mental health challenge:

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Health professionals are working day and night to help patients with COVID-19 and due to this, many are facing changes in their mental health. Some of the reasons for the change in mental health are dramatic changes in lifestyle, social and physical isolation, and loss of family or loved ones. But the most common factor is unwanted changes in daily life. These reasons are sufficient enough to worsen mental health status.

Change in physical health:

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Responses to this question are similar to each other. They are facing fatigue as the major change which is affecting their physical health. Over-eating, and lack of physical activity are also physical changes to observe. A lack of sleep and proper rest is primarily due to long hours of work. A negative change in mental health can also result in unwanted changes in physical health and vice versa. This is because physical health and mental health correspond to each other.

Impact on the overall efficiency of job:

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Working day and night, the stress and anxiety are subdued to increase. This results in a change in work ethics, concentration skills, and efficiency. They have to respond to unforeseen and demanding medical challenges, while also facing massive shortages in workers and necessary equipment. Working with what they have and coping with their mental health challenges, health professionals continue to strive through their daily lives. Taking care of patients isn’t an easy feat nor is facing the current circumstance of the pandemic.

Coping up with challenges:

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All health professionals mostly choose to spend time with family, exercise, take care of kids, be strong and positive, and help colleagues. They have to cope with the challenges they are facing as they are the first responders to any emergency in the pandemic.

Mental health change over time:

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When asked if their mental health changed over a course of time, around 50% of the responses were “yes”, 20% of the responses were “no”, and 10% of the responses were “I am not sure.” Many responded that their mental health worsened as months of the pandemic went on. This is a result of the number of cases, hospitalizations, and deaths surging. As time went on, the I.C.U.s filled with more patients and the number of deaths increased. This is a horrific scene to picture for many medical frontline workers. Many families have reached to a wrongful death attorney as they believe that many of their loved ones passed away due to the neglect of staff as the hospitals were overwhelming full.

Feelings towards COVID-19 patient:

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Working as a first responder or frontline worker, it is very difficult to handle such situations. Doctors and nurses who work in Covid I.C.U.s have to face the patient’s family, make them feel secure. Aside from this, they have to give them the reality check which is very difficult for them to do. It is quite difficult and emotional to see patients suffering as well as their families. Mostly everyone to this question responded that they felt upset to see an immense number of patients being hospitalized and dying due to the same cause. Some feel helpless in the situation, knowing that they cannot completely defeat the invisible enemy.

How they feel around COVID-19 patient:

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In reality, almost everybody feels unsafe and scared being around COVID-19 patients. Yet this is part of their job. They have accepted that this is their role and duty. Taking care of patients requires them to be brave enough to put patients’ lives before their own. The ones who do not work with COVID-19 patients still maintain a sense of fear because they know the virus exists everywhere, not just in hospitals. Putting their fears and worries aside, all health professionals continue to fulfill their roles respectively.

How the government handled the situation:

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Looking at the responses, it can be observed that almost all the responses are against the government. When asked if the government took the right steps to handle this pandemic, health professionals thought that the government did not handle the situation properly. The government could have handled the situation with more care and precaution. However, the government was unprepared for this sort of outbreak and failing to take the proper action cost many lives to be lost.

Feelings how the world considers them:

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Working as front-line workers or first-responders, health professionals should be proud of themselves. A life saved from Covid-19 requires others to accept the risk of self-sacrifice. Working day and night, doctors and nurses are doing 24 hours shifts to help patients recover and have a greater chance to battle the virus. Keeping health professionals’ mental health in a positive condition is very important because they are the ones who treat people when ill. They are the ones who stood up and are facing this pandemic.

Solutions: Tips for taking care of yourself

Disaster response is both a rewarding and demanding task. Witnessing human pain, the risk of personal injury, stressful workloads, life-or-death decisions, and isolation from families can all be sources of tension for emergency responders.
With the help of an injury lawyer you can gather all the legal advice you need. For responders to remain well and continue to assist in the crisis, stress reduction and management are important. Responders should take some precautions before, after, and during an emergency. Responders must be in good health to be able to think properly to care about others.

How to prepare for response:

• Study as much as you can about the part you will play.
• Explain to loved ones who might wish to touch you that you may be travelling or working long hours during the answer. Make a list of possible ways to deal with them. Keep their hopes in check, don’t put too much pressure on yourself [⁹].
• Talk to your boss about a schedule for filling any urgent pending job duties that aren’t relevant to the crisis when you’re busy with the answer.

Identifying Burnout and Secondary Traumatic Stress:

• Burnout- feelings of being overwhelmed and extreme exhaustion.
• Secondary traumatic stress- Stress responses and effects that occur as a result of exposure to another person’s negative events rather than actual exposure to a stressful incident.

Burnout and secondary traumatic stress can be prevented and reduced by using coping strategies such as taking breaks, consuming nutritious meals, walking, and using the buddy system. Recognize the symptoms of each of these diseases in yourself and other responders so that those who need rest or assistance will get it[¹⁰].
Signs of Burnout [⁷]:

1. Sadness, depression, or apathy
2. Easily frustrated
3. Blaming of others, irritability
4. Lacking feelings, indifferent
5. Isolation or disconnection from others
6. Poor self-care
7. Tired, exhausted, or overwhelmed

Signs of Secondary Traumatic Stress [⁷]:

1. Excessively worry or fear about something bad happening
2. Easily startled, or on guard all of the time.
3. Physical signs of stress
4. Nightmares or recurrent thoughts about the traumatic situations
5. The feeling that others’ trauma is yours.

Develop Buddy System:

Two responders work together in a buddy group to assist and track each other’s tension, workload, and protection [¹⁰].

• Get to know one another. Discuss your background, interests, activities, and family. Find out what each other’s strong and weak points are.
• Keep a close watch on one another. If at all possible, try to function in the same place. Set up check-in times for each other. Pay attention and share your thoughts and emotions. Recognize even modest victories and acknowledge difficult circumstances.
• Offer to assist with basic requirements including exchanging equipment and transportation. Keep an eye on each other’s workloads. Taking turns encouraging each other to take rest. Inform others about stress-relieving options (rest, routine sleep, exercise, and deep breathing) [⁹].

Selfcare techniques:

• Job shifts can be no more than 12 hours long.
• Act in groups and don’t spend too much time alone.
• Make a log entry.
• Discuss your thoughts and interactions with families, colleagues, bosses, and teammates.
• Breathing and calming exercises should be practised.
• And maintain a balanced diet, sleep, and workout routine.
• Know that it’s fine to set limits and say “no”.
• Avoid caffeine.

Important things to remind yourself:

• Taking breaks is not self-indulgent.
• Survivor’s wishes should not take priority over their own needs and well-being.
• Working nonstop does not suggest that you can give your best effort.
• Some can assist with the answer.

Conclusion

The coronavirus pandemic is still taking a toll on hospital workers leading to new mental health practices being implemented to help them cope. Mental health and disability experts say caring for first responders is key to better productivity from them. Over time, everyone becomes vulnerable and will start to break down. This reckoning of how unguarded all medical workers are to the virus, being overwhelmed by it, and death. Doctors grapple with these feelings but never have they become so tangible until now. At the end of the day, health professionals are there for everyone; they show up every day to take care of the public and that is 90% of the battle. It is this sense of being in a marathon for frontline medical workers; It is a relentless pace that doesn’t let up for all of these months. First-line responders need to practice self-care as a part of their daily routines. It should be embraced by the medical and behavioural health communities that become a part of their jobs. The need for self-care must be stressed and encouraged to be a priority for everyone.

References

1. Nelson, Bryn, and David B. Kaminsky. \”COVID‐19\’s Crushing Mental Health Toll on Health Care Workers.\” American Cancer Society Journals. September 04, 2020. Accessed July 01, 2021. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncy.22347 .
2. Science Daily. \”COVID-19 Sparks 12-fold Increase in Remote Delivery of Mental Health Care across the US.\” ScienceDaily. September 02, 2020. Accessed July 01, 2021. https://www.sciencedaily.com/releases/2020/09/200902161705.htm .
3. Read, In Health Care5 Min, 2020 The Chicago Schoolon June 4, 2021 Career DevelopmentHealth Care·May 12, 2021 Career DevelopmentHealth Care·May 6, and 2021 Career DevelopmentHealth Care·April 21. \”The Impact and Implications of COVID-19 on Health Care Workers.\” Insight Digital Magazine. July 20, 2020. Accessed July 01, 2021. https://www.thechicagoschool.edu/insight/health-care/covid-19-health-care-workers/ .
4. Centers for Disease Control and Prevention. \”Emergency Responders: Tips for Taking Care of Yourself.\” Centers for Disease Control and Prevention. March 19, 2018. Accessed July 01, 2021. https://emergency.cdc.gov/coping/responders.asp .
5. Oakland County Michigan. \”Health Care Providers & First Responders.\” Health Care Providers & First Responders | Mental Health. Accessed July 01, 2021. https://www.oakgov.com/covid/best-practices/mental-health/Pages/health-workers-first-responders.aspx .
6. Science Daily. \”Lockdown Study Reports Surge in Health Anxieties.\” ScienceDaily. August 04, 2020. Accessed July 01, 2021. https://www.sciencedaily.com/releases/2020/08/200804085920.htm .
7. VA.gov: Veterans Affairs. “Provider Strategies for Coping with Burnout and Secondary Traumatic Stress.” September 23, 2018. Accessed July 01, 2021. https://www.ptsd.va.gov/professional/continuing_ed/provider_burnout_strategies.asp .
8. Dept of Health – Carroll County Health Department. Accessed July 01, 2021. https://cchd.maryland.gov/coronavirus-and-mental-wellness-for-first-responders/ .
9. Valley Oaks Health. \”Guidance for First Responders Combatting the COVID Pandemic – Valley Oaks Health.\” Valley Oaks Health – The Journey to Life\’s Peaks, Starts at Valley Oaks. March 26, 2020. Accessed July 01, 2021. https://valleyoaks.org/health-hub/guidance-for-first-responders-combatting-the-covid-pandemic/ .

About the author

Dhanya Janga is a student at JFK Memorial High School in Iselin, NJ. The field of science has always fascinated her to no extent and believes that there are always endless opportunities to explore. She has found a passion for scientific research in biology and is passionate about studying medicine. Outside of school, Dhanya enjoys volunteering in clinics and participating in STEM competitions.