Correspondence Address:
Dr. Jasmine Parihar
Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi - 110 001
India

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Coronavirus disease-2019 (COVID-19) pandemic has affected every aspect of human life in a short period. This pandemic has tested the readiness of the modern nation-states for a public health emergency and its social, psychological, and economic ramifications. Health-care providers (HCPs), the foremost warriors in this war against the coronavirus, are not immune to the pandemic's psychological effect. The mental health of HCPs has been neglected, especially in resource-constrained settings, despite increasing reports of this pandemic being an independent risk factor for psychological distress among HCPs with either the development of new psychiatric symptoms or worsening of preexisting illnesses.[1]

In recent reports, psychosocial problems have been observed in 23% of HCPs, with female HCPs being more affected than their male colleagues and nurses affected more than doctors.[2],[3] These include high rates of anxiety (23%-44%), stress (27.4%-71%), depression (50.4%), or insomnia (34.0%).[2] A study from Singapore has although reported a lower rate of psychological disorders in HCPs during the COVID-19 pandemic, with 14.5% having anxiety, 6.6% having stress, and 8.9% having depression.[4] Mathur et al. 's article has made a valuable addition to the magnitude of this problem in Indian HCPs.[5] In addition to providing rates of various psychological disorders in HCPs during this pandemic, the study also reports a significantly higher rate of stress and adjustment problems in those working in the government sector than the private sector, likely because of the government sector primarily dealing with COVID-19 patients. However, being an Internet-based survey, selection bias and low responder rates are the likely limitations of this study and hence, not truly representative of the whole population of HCPs.

The cause of this psychological burden on the HCPs is multifold and includes personal, professional, and social reasons. Concerns about the risk of infection to self and their families increased working hours, inadequate safety in the form of shortage or substandard personal protective equipment (PPE), discomfort due to perse wearing PPE or inability to access food, water or lavatory because of being in PPE for long hours, being in quarantine/isolation, and separation from families are some of the reasons for psychological distress among health professionals. It has been observed that those HCPs working in the frontline in COVID-19 or infectious disease wards, intensive care units, and emergency departments and are involved in the direct care of COVID patients are relatively more affected than others.[6] HCPs are also affected by social issues like stigmatization by the ill-informed neighbors and the public due to the perceived risk of infection. Rumors and misconceived facts regarding the pandemic have occasionally been propagated by misguided individuals, leading to poor cooperation between the public and HCPs, and even reports of harassment of HCPs.

Rapidly changing information and management guidelines based on the surge in the research related to COVID-19, uncertainty on the disease course, lack of definite treatment, and vaccine for the disease are other factors that HCPs have to grapple with. The HCPs need to keep themselves updated and find time for the same amidst their busy schedule. At the same time, with a significant drop in patients visiting the outpatient departments and routine surgeries and admissions, it has been noted that HCPs are not immune to job losses, deferred salaries, and pay cuts. On the other hand, the quality of patient assessment is also suffering with the upscaling of telemedicine services and a decline in walk-in patients.

Mortality and morbidity of fellow colleagues due to COVID-19 disease is another source of distress. India had reported the deaths of 382 doctors till now due to COVID as of news reports of September 17, 2020.[7] The worldwide count of COVID-related deaths in HCPs is not yet available.

Looking on the bright side, factors causing positive influence on HCPs during the pandemic include knowledge and acceptance of the possible inevitability of infection, support from family and colleagues, positive role models, validation and appreciation by peers and patients, positive caretaking experience, a sense of validation of existence.[8] In contrast, the factors associated with negative influence on HCPs include patients needing psychological, social, rehabilitative support in addition to medical management, lack of clear management plans, and stigma associated with this disease.[8] To combat this epidemic of psychological disorders emerging out of the COVID-19 pandemic, it is crucial to implement the mental health support system at all levels of healthcare with great sincerity. All HCPs should be sensitized to recognize the signs of depression, anxiety, stress, and suicidal tendencies in their colleagues. Some of these include a reduced performance at work, decreased interaction with colleagues, and frequent absenteeism. Departmental meetings to screen the team should be organized in addition to mental health awareness and stress management workshops. A dedicated team for managing HCPs with mental health issues should be appointed, and the confidentiality of the services should also be maintained. In India, the Ministry of Health and family welfare have launched protocols to promote mental health in HCPs.[9] Employment of multidisciplinary teams for managing psychosocial aspects and rehabilitation in COVID-19 patients can decrease the workload of HCPs. Further, personal support from family and friends can help prevent and combat these crises. Finally, disseminating responsible public health information in the community is imperative as HCPs cannot succeed by working by themselves in isolation from society at large.

Training the frontline workers with skills for effective management of COVID-19 cases, providing them with clear protocols and guidelines, and equipping them with adequate PPEs can increase the confidence of the HCPs. The timely action for mental health issues in HCPs can save lives and increase the efficiency of HCPs and improve their quality of life during this pandemic. The medical community and government should implement strategies to address this critical issue in the warriors of the COVID-19 pandemic.

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