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The COVID-19 burden for health care professionals: Results of a global survey

Published:November 13, 2020DOI:https://doi.org/10.1016/j.ejim.2020.11.011

      Keywords

      At the end of December 2019, a novel coronavirus (SARS-CoV-2) started to spread in the city of Wuhan, Hubei province in China, first described as novel coronavirus [
      • Zhu N.
      • Zhang D.
      • Wang W.
      • Li X.
      • Yang B.
      • Song J.
      • et al.
      A novel coronavirus from patients with pneumonia in China, 2019.
      ,
      Viruses CSGotICoTo
      The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2.
      ]. Meanwhile, the current COVID-19 pandemic has hit every country on the globe.
      Health care systems have since varied significantly in their response to the immense challenges.
      With an online survey targeting the worldwide medical community (emergency medical service, nurses, physicians, sonographers, technicians) we sought to discover experiences, fears, and successful strategies for the expected second wave.
      The survey was open from April 24th, 2020 until June 24th, 2020. A total of 3,090 participants from 88 countries completed the survey, 49.4% were female, sample characteristics are presented in Table 1. During the worst times of the pandemic in their country, 238 (7.7%) reported to have suffered from a collapse of the system.
      Table 1Baseline characteristics of the participants and main results of the survey.
      TotalCollapse of the systemNo collapseP value
      Number of participants30902382850
      Country

       USA

       Germany

       India

       Austria

       Italy

       United Kingdom

       Others


      502 (16.2)

      216 (7)

      179 (5.8)

      171 (5.5)

      116 (3.8)

      106 (3.4)

      1800 (58)


      30 (12.6)

      3 (1.3)

      14 (5.9)

      6 (2.5)

      24 (10.1)

      7 (2.9)

      154 (64.7)


      472 (16.5)

      213 (7.5)

      165 (5.8)

      165 (5.8)

      92 (3.2)

      99 (3.5)

      1644 (57.7)
      0.74
      Male sex1565 (50.6)128 (53.8)1437 (50.4)0.32
      Age

       18-35

       36-45

       46-60

       >60


      819 (24.5)

      863 (27.8)

      1035 (33.5)

      373 (12.1)


      55 (23.1)

      62 (26)

      91 (38.3)

      30 (12.6)


      763 (26.8)

      800 (28)

      944 (33.1)

      343 (12)
      0.18
      Profession

       Sonographer

       Cardiologist

       Internist

       ICU doctor

       ER doctor

       General practitioner

       Other doctor


      643 (20.8)

      577 (18.7)

      382 (12.4)

      242 (7.8)

      129 (4.2)

      165 (5.3)

      557 (18)


      50 (21)

      38 (16)

      31 (13)

      31 (13)

      7 (2.9)

      14 (5.9)

      42 (17.7)


      593 (20.8)

      538 (18.9)

      351 (12.3)

      211 (7.4)

      122 (4.3)

      151 (5.3)

      515 (18.1)
      0.95
      Workplace

       Tertiary hospital

       Local hospital

       Private hospital

       Secondary care

       Primary care


      956 (30.9)

      766 (24.8)

      550 (17.8)

      225 (7.3)

      309 (10)


      85 (35.7)

      49 (20.6)

      40 (16.8)

      16 (6.7)

      27 (11.3)


      869 (30.5)

      717 (25.2)

      510 (17.9)

      209 (7.3)

      282 (9.9)
      0.27
      Have you personally been tested?

       Yes (pos)

       Yes (neg)

       No


      114 (3.7)

      840 (27.2)

      2134 (69.1)


      22 (9.2)

      65 (27.3)

      151 (63.4)


      92 (3.2)

      775 (27.2)

      1983 (69.6)
      0.006
      Do you know a colleague who tested positive?

       Yes 

       No


      1888 (61.1)

      1200 (38.8)


      185 (77.7)

      53 (22.3)


      1703 (59.8)

      1147 (40.2)
      <0.001
      Do you know a colleague who died from COVID-19?

       Yes

       No


      560 (18)

      2528 (82)


      97 (40.8)

      141 (59.2)


      463 (16.2)

      2387 (83.8)
      <0.001
      Have you observed patients who were harmed by measures not by COVID19

       Yes

       No


      1793 (58)

      748 (24.2)


      152 (63.9)

      47 (19.7)


      1640 (57.5)

      701 (24.6)
      0.13
      What is your greatest fear during pandemic

       Falling ill/dying from COVID

       Financial losses

       Losing family member

       Pandemic cannot be controlled

       Negative impact on my career

       No fear


      414 (13.4)

      394 (12.8)

      1259 (40.7)

      696 (22.5)

      81 (2.6)

      246 (8)


      35 (14.7)

      22 (9.2)

      97 (40.8)

      57 (23.9)

      11 (4.6)

      16 (6.7)


      379 (13.3)

      372 (13.1)

      1161 (40.7)

      638 (22.4)

      70 (2.5)

      230 (8.1)
      0.75
      Have you observed patients who tested negative but actually were positive

       No

       Few (1-5)

       Many (>5)


      1094 (35.4)

      1108 (35.9)

      886 (28.6)


      70 (29.4)

      62 (26.1)

      106 (44.5)


      1024 (35.9)

      1046 (36.7)

      780 (27.4)
      <0.001
      The pandemic is having an impact on the life of all, but particularly on those in the first line of the defense, the health care professionals (HCP). In this global survey, a total of 92% of the participants reported to have fears related to the pandemic, most (41%) are afraid of losing a family member, 22.5% worry there might be no control over the pandemic, 13.4% are afraid to fall ill or die themselves, and 12.8% are afraid of private financial losses. Interestingly, there was no difference in fears between those countries where high incidence rates were reported and those where there were few COVID-19 cases.
      However, not only the psychological burden is high for HCP. When comparing those with a collapse of the system and those without, 9% vs. 3% (p=0.006) of the participants tested positive themselves, 78% vs. 60% (p<0.001) know a colleague who tested positive, and 41% vs. 16% (p<0.001) know a colleague who died from COVID-19.
      At this time, most countries are preparing for or are already experiencing the second wave. Therefore, it is essential to learn the lessons from those who went through an extreme first wave. This survey confirms the unreliability of a negative COVID-19 test. A total of 64% of the participants reported of personal experience with false-negative tests, 44% of those from countries hit hard by the pandemic reported to have seen more than five patients with an initially negative test who turned positive during their stay at the hospital. A negative test must not be considered a safe rule-out of COVID-19 if clinical suspicion is high.
      The pandemic of a hazardous and highly contagious virus is a medical disaster. The medical community is the group which is directly in contact with COVID-19. Therefore, their firsthand experience and opinion should have a loud voice in policy making and public health discussions: A total of 86% reported that they consider social distancing important to tackle the pandemic (Fig. 1). At the same time, 58% reported that they have seen patients who had a serious health hazard not due to COVID-19 but due to the lockdowns. During reduction of service or lockdowns, concepts must be implemented to ensure the medical service for those with chronic and acute diseases other than COVID-19.
      Fig 1:
      Fig. 1Answer to the question “how important do you consider social distancing?”. A total of 159 (5.1%) participants chose “rather not important”, 267 (8.6%) were undecided, and 2664 (86.2%) answered “important” or “very important”.

      Declaration of Competing Interest

      All authors have read and approved submission of the manuscript and have no conflict of interest to disclose.

      References

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        • Yang B.
        • Song J.
        • et al.
        A novel coronavirus from patients with pneumonia in China, 2019.
        N Engl J Med. 2020; 382: 727-733
        • Viruses CSGotICoTo
        The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2.
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