The psychosocial impact of Covid-19 emergency on healthcare workers

Over the last weeks, many countries worldwide have been facing a public health emergency due to the current Covid-19global pandemic. As a result of the mitigation strategies adopted by governments, both the social and work environment is changing rapidly. This is not only a medical phenomenon, but it also has humanitarian, economic and work-related impacts.

The H-WORK project coordinated by the University of Bologna will address the impact of Covid-19 on mental health in public health institutions with specific actions at the two health intervention sites: implementation of a tailor-made organisational response including psychological support through digital solutions, regular follow-up of workers and specific support for their return to work. One of the main objectives of the Consortium will be the development of a tailor-made online solution for the specific Corona stress reduction programme. The H-WORK Consortium partners will also try to map the perceived work stress and overloading of team members. Besides, the overall assessment of the intervention process and the economic evaluation foreseen by the project through the HET protocol will shed light on working mechanisms that can facilitate the adoption of organisational practices to assist managers, supervisors and healthcare workers during emergencies. The resulting recommendations should be included in the assessment protocol (HAT) and integrated into the relevant organisational health policies. The overall objective is to provide technical guidance on good practices and procedures to establish systems that can reduce occupational exposure, stress and risk reduction; (and promote the health and well-being of healthcare workers and other professionals involved.


A new occupational disease

Covid-19 has been defined as the first new occupational disease of this decade. Consistently, the Occupational Safety and Health Administration has classified workers’ exposure to the virus, showing doctors, nurses, paramedics, and the frontline healthcare workers in general to be at greater risk of infection. Additionally, some backline professional groups are facing serious risks of infection, such as police officers, food store personnel, home care assistants and all those workers maintaining essential services. Nevertheless, the pandemic, more or less directly, has involved all types of workers, forcing people to work from home and deeply affecting the way they normally manage their daily work. All these occupational groups need to be protected not only by good infection control practices but also through adequate social and mental health support, which should not go overlooked.


New stress factors for workers

Several specific stress factors linked to the current epidemic are affecting the general population, such as the risk of being infected and infecting others, or being separated from loved ones, the risk of not being able to work during isolation or, worse, of being fired from work. This scenario becomes even more worrying when it comes to frontline workers and caregivers who may experience additional stressors. Healthcare workers are facing higher job demands, including long working hours, an increased number of patients and keeping up to date with best practices as information about Covid-19 develops. Further, the main critical strains entail stigmatisation of those working with Covid-19 patients, strict biosecurity measures hindering or reducing professional autonomy, physical isolation making it difficult to provide comfort and support to patients and colleagues, and constant attention to procedures to be followed. Particularly, the intense work schedules and social stigma reduce the capacity of healthcare practitioners to exploit social support from colleagues or relatives as a coping strategy. Being increasingly worried about their children being at home alone (due to school closures) without appropriate care and support can profoundly affect mental health and work performance (e.g., absenteeism).


A strong psychological impact of quarantine

Studies have already been conducted to explore the psychosocial impact of current health emergencies and possible organisational strategies to be implemented for better management. Results highlighted the immediate psychological impact on health workers, showing that about 30%, 24%, and 14% reported symptoms of stress, anxiety, and depression respectively. Gender, work experience, and mental health background were found to be risk factors. The impact is even greater when considering that quarantine itself predicts symptoms of acute stress disorders among hospital staff. Healthcare workers are significantly more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration, and hesitation, reduced work performance or consideration of resignation.


Long-lasting effects

In terms of long-lasting effects of quarantine on healthcare workers, alcohol abuse or dependency symptoms were positively associated with having been quarantined. After quarantine, many participants continued to engage in avoidance behaviours. Quarantined healthcare workers had more severe symptoms of post-traumatic stress than the general population, they felt greater stigmatisation, exhibited more avoidance behaviours, reported greater lost income, and were consistently more affected psychologically. Stigmatisation by others results in different human and professional relationships than before: avoidance, isolation, fear, and suspicion are some of the most frequent aspects. Families can push people to leave their jobs, which is considered too dangerous, thus creating further tensions in one’s life. People are often unable to return to work after quarantine because employers have expressed fears of contagion.


New organisational measures to react

On the other hand, organisational measures such as rational work shift reorganisation, sufficient logistical support, and comfortable accommodation were considered to be protective factors. Also, up-to-date and accurate information on the health situation and appropriate protective equipment is associated with the lower psychological impact of the epidemic and lower stress, anxiety, and depression. An example of organisational response to the epidemic-related psychological crisis is provided by the West China Hospital. This intervention model integrates Internet technology within the whole process and combines early intervention with later rehabilitation. Physicians, psychiatrists, psychologists, and social workers are working together on the web-based platforms to carry out effective interventions to patients, their families, and the medical staff. Psychological, emotional and educational support is also provided through online tools, such as apps, telephone helpline, and WeChat platform.