Health Care Workers’ Safety and Health as Assets in the Fight Against COVID-19

This article was exclusively written for The European Sting by Ms. Silmi Zahra, currently working a medical clerkship in Hasan Sadikin General Hospital, Padjadjaran University, Indonesia. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Health care workers (HCWs) are the “soldiers”, fighting the COVID-19 pandemic by saving many patients. However, HCWs must be in a good health and use the adequate personal protective equipment (PPE).¹ Front-line HCW has twelve times higher risk of being infected with COVID-19 compared to general community. (adjusted HR 11 · 61, 95% CI 10 · 93–12 · 33)²

In the early pandemic in China, many HCWs were infected with COVID-19 due to inadequate PPEs, improper effective personal protection application, long exposure to COVID-19 patients, long working hour and lack of training in the use of PPEs.³

For HCWs to work safely, the PPEs must be easily accessible, fit to the user, and proper in use and disposal. Infection prevention and control such as hand hygiene, equipment and environment decontamination, as well as screening are important. All HCWs must receive training and information related to occupational health and safety.⁴

WHO stated that early in the pandemic, the prices of surgical masks have increased six-fold, N95 masks have tripled and surgical gowns have doubled. Many countries experienced PPE limitations.⁵ Lack of PPEs for fighting the pandemic is one of the biggest threats, so that PPEs must be used effectively. For instance, to limit the use, N95 respirators must be preferred for high-risk HCWs than for public and low-risk HCWs. Other strategies could be; minimal use of PPEs to avoid too many wastes, and reusing PPEs such as N95 respirator after UVGI decontamination.⁶

Moreover, HCWs must be ensured free from COVID-19 on a regular basis. Weekly screening for HCWs and other risk groups using PCR is estimated to reduce transmission of COVID-19 by 25-33% compared with self-isolation.⁷

Long working-hour and high workload can cause fatigue, psychological stress, and poor mental health. Those affect health and quality of care provided by HCWs.⁸ Institution of Occupational Safety and Health (IOSH) recommends shift-dividing, rotated (morning-afternoon-night), and provided at least 48 hours free for HCWs between shifts.⁹

For the mental health, several things must be considered. HCWs could be thanked as recognition. Managers must pay special attention to HCWs with black and minority ethnic (BAME) backgrounds, and HCW juniors or HCWs who are inexperienced but have worked beyond the expected competence. Those experienced traumatic event should be actively monitored, especially who have higher risks of developing mental health problems. Managers should help HCWs to understand their experiences and not to blame anyone for everything happened during that time.¹⁰

It’s necessary to consider not to involve old HCWs. There is a severe outcome of COVID- 19 in old HCWs. ¹¹ Furthermore, the median age of general practitioners/emergency room doctors died until April 15, 2020, is 67 years.² Therefore, they could participate in the lower-risk services (e.g. telemedicine or handling non-COVID-19 patients).

In conclusion, to ensure HCWs safety and health during pandemic, it’s necessary to pay special attention to the availability of PPEs and training in the effective and efficient use of PPEs, as well as working hour and workload, mental health, and age of HCWs involved.

References

1. Loeppke R, Boldrighini J, Bowe J, Braun B, Eggins E, Eisenberg B et al. Interaction of Health Care Worker Health and Safety and Patient Health and Safety in the US Health Care System. Journal of Occupational and Environmental Medicine. 2017;59(8):803-813.
2. Nguyen L, Drew D, Graham M, Joshi A, Guo C, Ma W et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health. 2020;.
3. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. Journal of Hospital Infection. 2020;105(1):100-101.
4. Peters M, Marnie C, Butler A. Policies and procedures for personal protective equipment: Does inconsistency increase risk of contamination and infection?. International Journal of Nursing Studies. 2020;:103653.
5. Burki T. Global shortage of personal protective equipment. The Lancet Infectious Diseases. 2020;20(7):785-786.
6. Boškoski I, Gallo C, Wallace M, Costamagna G. COVID-19 pandemic and personal protective equipment shortage: protective efficacy comparing masks and scientific methods for respirator reuse. Gastrointestinal Endoscopy. 2020;92(3):519-523.
7. Grassly N, Pons-Salort M, Parker E, White P, Ainslie K, Baguelin M et al. Report 16: Role of testing in COVID-19 control. Imperial College London [Internet]. 2020 [cited 25 August 2020];. Available from: https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-04-23-COVID19-Report-16.pdf
8. WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic [Internet]. Who.int. 2020 [cited 25 August 2020]. Available from: https://www.who.int/news-room/detail/28-04-2020-who-calls-for-healthy-safe-and-decent-working-conditions-for-all-health-workers-amidst-covid-19-pandemic
9. Managing the effects of shift work on health – Covid-19 | IOSH [Internet]. IOSH. 2020 [cited 25 August 2020]. Available from: https://iosh.com/coronavirus/returning-safely/people/managing-the-effects-of-shift-work-on-health/
10. Jansson M, Rello J. Mental Health in Healthcare Workers and the Covid-19 Pandemic Era: Novel Challenge for Critical Care. Journal of Intensive and Critical Care. 2020;6(6):1-3.
11. Burrer S, de Perio M, Hughes M, Kuhar D, Luckhaupt S, McDaniel C et al. Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020. MMWR Morbidity and Mortality Weekly Report. 2020;69(15):477-481.

About the author

Hanna Silmi Zahra is currently working a medical clerkship in Hasan Sadikin General Hospital, Padjadjaran University. In 2018/2019, she held NORE Assistant For Outgoing (NAFO) position in Standing Committee on Research Exchange (SCORE) CIMSA. She has interest in pediatric hematology/oncology and biomolecular theurapeutic intervention in cancer.