This review collates evidence on the health impacts of COVID-19 on HCWs. Our findings suggest HCWs are susceptible to various health consequences due to the COVID-19 pandemic. For those with COVID-19 infections, the most common symptoms were fever and cough, which were similar to those seen in the community. Several risk factors were identified; long duty hours, working in the high-risk department, lack of PPE, diagnosed family member, unqualified hand-washing, and improper infection control. Furthermore, prolonged PPE usage led to skin damage, with the nasal bridge being the most common site. Battling COVID-19 on the frontline makes HCWs vulnerable to psychological distress. Finding shows high levels of depression, stress, anxiety, distress, anger, fear, insomnia, and post-traumatic stress disorder in the HCWs. Females and nurses were disproportionately affected more from mental health consequences. Frontline female nurses work in close contact with patients for longer working hours, which may result in fatigue, stress, and anxiety. However, this finding warrants for further research to better prepare for the future.
Worldwide, COVID-19 has affected large numbers of frontline HCWs. As of March 2020, COVID-19 has infected more than 3000 HCWs in China only [30]. A similar situation was witnessed in previous outbreaks of Ebola virus disease (EVD), Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) [31,32,33,34,35]. Figures from Sierra Leone, Liberia, and Guinea showed approximately 6–8% of Ebola infection amongst the HCWs [35], SARS infected approximately 1000 HCWs, and 1.4% deaths occurred in China only [36]. Early COVID-19 studies indicate a worrisome situation of morbidity and mortality [16, 20]. The fact that healthcare workers are at increased risk of infection by COVID-19 will further exacerbate the existing shortage of skilled workforce, as most health systems and EDs are running at their full capacities [18, 20, 30, 37].
During outbreaks, the HCWs experience considerable stress. In a Chinese study during the Ebola outbreak, HCWs reported extreme somatization, depression, anxiety, and obsession-compulsion [38]. During the MERS outbreak, a Saudi study reported almost two-third of HCWs felt at risk of getting infected with MERS CoV and felt unsafe at work [39]. These findings are consistent with previous SARS situations in which HCWs reported high levels of fear of contagion and infecting family members, emotional disturbance, uncertainty, and stigmatization [40, 41]. Risk factors for mental health include overwhelming situations, social disruption of daily life, feeling vulnerable, at risk of getting infected, fear of transmitting the disease to families, and loved ones [11]. Previous outbreaks showed that HCWs suffer significant stress, and a similar outcome is expected in COVID-19.
One of the major challenges faced in controlling this pandemic is the extreme shortage of PPEs [18]. A highly infectious pandemic challenges already compromised health systems with resultant shortages in supplies and PPEs. For instance, during the Ebola outbreak, many countries faced PPE shortages [35, 42]. In a pandemic, ensuring emergency medical supplies is pertinent to national public health emergency response systems [18]. Therefore, it is pertinent to establish an emergency reserve medical supplies program to ensure the provision of supplies based on needs, type, quality, and quantity.
Pandemics exert significant psychological impacts on HCWs, highlighting the need for appropriate psychological support, interventions, and staff support measures. COVID-19-specific psychological interventions for medical staff in China included psychological intervention support teams, psychological counselling, availability of helpline, establishment of shift systems in hospitals, online platforms for medical assistance, incentives, providing adequate breaks and time offs, providing a place to rest and sleep, leisure activities such as yoga, meditation and exercise, and motivational sessions [15, 16]. Protecting the well-being of HCWs, through appropriate measures is a crucial tool in national emergency public health response to fighting the outbreaks. If timely measures are not taken, although the disease will subside eventually, a new surge of patients suffering from psychological morbidity will emerge.
Strengths and limitations of the study
The scoping review applied systematic and vigorous search strategy as per the study objective. The study presents a summary the recent scientific evidence and could strengthen the response for the current and future outbreaks. Given the rapidity of the pandemic, studies present here have a relatively short follow-up period. Also, our review included only studies published in the English language and may have missed findings published in other languages. The incidence of health impacts of COVID-19 on HCWs are not documented due to methodological limitations of studies, especially difficulty in finding the actual denominator data. Lastly, interventional studies are relatively scarce.
