AUCTORES
Globalize your Research
Editorial
*Corresponding Author: Pankaj Bansal, Mayo Clinic Health System. 1400 Bellinger Street, Eau Claire, WI.
Citation: B Sonani, P Bansal, A Cusick, A Goyal. (2020) Impact of COVID-19 on Healthcare Workers. International Journal of Clinical Case Reports and Reviews. 3(3); DOI: 10.31579/2690-4861/047
Copyright: 2020 Pankaj Bansal, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 18 August 2020 | Accepted: 04 September 2020 | Published: 07 September 2020
Keywords: covid-19; healthcare workers
Since its origin in the Wuhan province in China in December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has impacted 213 countries and as of August 8, 2020, there have been 19,187,943 cases and 716,075 deaths due to the coronavirus disease 2019 (COVID-19) worldwide. In the United States alone, there have been more than 160,000 deaths due to COVID-19. The pandemic has impacted people of all age groups, socioeconomic status, and industrial sectors, although the healthcare workers, who are on the frontlines, have been particularly impacted hard.
Since its origin in the Wuhan province in China in December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has impacted 213 countries and as of August 8, 2020, there have been 19,187,943 cases and 716,075 deaths due to the coronavirus disease 2019 (COVID-19) worldwide [1]. In the United States alone, there have been more than 160,000 deaths due to COVID-19 [2]. The pandemic has impacted people of all age groups, socioeconomic status, and industrial sectors, although the healthcare workers, who are on the frontlines, have been particularly impacted hard. Healthcare workers are defined as anyone engaged in actions whose primary intent is to enhance health and include not only the health service providers such as physicians, nurses, and technicians, but also others including health management support staff such as administrators, clerical workers, accountants, craft and trade workers, etc [3]. They serve as the first wall of defense against the pandemic; however, the pandemic has led to significant emotional, mental, physical, and financial strain on healthcare workers.
Risk of infection
Healthcare workers, especially the health service providers are at the highest risk of getting infected due to their direct exposure to the COVID-19 virus while providing care to the sickest patients. As of August 10th, There were 128,933 infections and more than 600 deaths among healthcare workers due to COVID 19 infection.2 Despite this risk, healthcare workers across the globe have shown admirable courage without taking a step back in providing care to patients with COVID-19. As with the general population, several healthcare workers have underlying health conditions and belong to the “high-risk” category for severe COVID-19 infection compared to others. While some work sectors may have the option of “work-from-home” to decrease the risk of exposure in the high-risk workers, health service providers rarely have such luxury. Telemedicine is still an evolving science that is still not widely available and may not be an appropriate substitute for direct or face-to-face patient contact in all encounters, especially those involving management of patients in intensive and critical care units. Further, there is a global shortage of healthcare workers, and often it is not possible to find a replacement for them.
Personal protective equipment (PPE) such as face masks, surgical masks, N95 respirator masks, gowns, and eye protection have been recommended by the Centers for Disease Control (CDC) with guidance for appropriate use in healthcare workers in order to prevent infection [4]. However, the demand for PPE has risen several-fold with the rapid spread of COVID-19, leading to a nation-wide shortage of PPE. To conserve the available PPE, healthcare workers have had to resort to practices such as reusing the same PPE for several days. Several health facilities have had to establish procedures to recycle and reuse the PPE.
Regardless of underlying health conditions and a shortage of PPE, healthcare workers have continued to provide direct care to patients with COVID-19, while risking themselves from getting infected. Better availability of telemedicine shall be encouraged to be used in appropriate circumstances, which could help to prevent the avoidable risk of exposure in health service providers. Production of PPE shall be escalated to overcome shortages in areas hardest hit by the COVID-19.
Emotional and mental stress
Healthcare workers are at significant risk of mental and emotional stress due to several reasons including long working hours, separation from family, and a higher risk of infection. Several studies have shown an increased prevalence of depression, anxiety, burnout, insomnia in healthcare providers since the onset of the pandemic [5-7]. The risk has been especially higher amongst women, healthcare workers who have been infected, and those living in areas with higher incidence rates of the infection [7, 8].
Besides the risk of getting infected themselves, healthcare workers face the additional risk of spreading the infection to their family members. This stress is significantly higher in those with family members in the high-risk category such as elderly and/or immunocompromised family members. To decrease this risk, several healthcare workers have to self-isolate while they continue to provide care to those infected with COVID-19. Further, if infected, healthcare workers have to self-quarantine for several days. If hospitalized due to the infection, they are isolated from their family, while in constant fear of the outcomes, especially given the lack of a definite therapeutic option so far. This family separation in addition to the long work hours can cause mental and physical exhaustion.
COVID-19 carries a high mortality in hospitalized patients, and to mitigate the risk of infection, most healthcare facilities do not allow visitors and family members to visit the patients. At times, healthcare workers are the only ones present alongside a patient dying of the COVID-19, leading to a feeling of helplessness and despair, especially with the rising number of deaths. Rates of post-traumatic stress disorder (PTSD) and burnout were already high amongst the healthcare workers, and COVID-19 has furthered this concern [9]. Suicide rates are higher in physicians than in general populations and have been reported in physicians providing care to patients infected with COVID-19 owing to this added stress [10, 11]. Those with underlying mental illnesses such as depression are at a higher risk of developing anxiety and depression symptoms due to this stress [8].
The mental health of the caregivers needs to be tended to, and several hospitals have established virtual support sessions and 24/7 helplines to help overcome and prevent burnout and stress in the healthcare workers [12]. As with the rest of the population, the healthcare workers are not prompt in seeking help during or even after developing mental and emotional stress. Studies have shown that providing healthcare workers with adequate break times, recognition of their work by their administration, and implementing strict infection control guidelines have a positive impact on their psychological support and benefit [13]. Symptoms of PTSD and depression may last for several months to years, and those with adverse psychological effects of the pandemics shall be provided with long-term support.
Financial strain
The Healthcare industry has suffered major financial losses due to mitigation guidelines implemented to reduce transmission of COVID 19 infection and to ensure equipment and hospital capacity. To offset these financial losses, several healthcare workers were either furloughed or lost their employment. The Healthcare industry lost close to 1.4 million jobs in April 2020 according to the Bureau of Labor Statistics [14]. Although the unemployment rate is improving since April 2020, it is still not at the level it was in February 2020. In July 2020, 126,000 jobs were added to the healthcare sector, however, overall employment in healthcare is still down by 797,000 compared to February 2020 level [15]. Loss of employment leads to loss of health insurance in several individuals, thus impacting their ability to seek medical care in case of emergencies as well as routine care. Further, several healthcare systems announced a reduction in salary and productivity bonuses for healthcare workers [16]. A decline in routine and elective procedures led to a loss of revenue for physicians and hospitals. These financial losses have threatened the sustainability of several hospitals and medical offices. Rural and primary-care practices have been especially more vulnerable [17]. Lastly, healthcare workers who are continuing to provide care to patients with COVID-19 often have to work for extended hours. In addition to a reduction in incomes, they have had to face secondary additional expenses such as finding additional resources for childcare.
The government has taken several measures as an attempt to offset some of these losses. State and Federal level financial aid has been provided to hospitals and physicians who endured financial losses due to the decline in elective procedures and to those who suffered unemployment due to the pandemic [18]. The Center for Medicare & Medicaid Services (CMS) approved telemedicine reimbursements for phone and video visits [19]. However, these efforts may not suffice long-term, especially as the virus continues its spread.
Immigration and visa uncertainties
Almost 25% of all practicing specialists in the United States are international medical graduates, many of whom are on non-immigrant visas such as H1-B and J1 [20, 21]. Healthcare workers on non-immigrant visas face a unique uncertainty during the current unprecedented times [22]. If these workers become disabled, lose their employment, or die while taking care of patients with COVID-19, they lose their visa status and are not eligible for long-term disability. Further, loss of visa status of the primary visa holder in the family leads to loss of immigration status for their spouse and children leaving them with no choice other than leaving the country. These concerns have furthered the stress in the immigrant healthcare worker community.
The United States Congress has introduced several bills trying to address these concerns.23,24 Time is of the essence, and although encouraging, these steps need urgent attention of the elected officials and representatives in order to support the immigrant physicians, who are indispensable in the current unprecedented times.
Conclusion
COVID-19 poses serious and multifaceted impacts on the healthcare workers, including their physical well-being, emotional and mental health, and financial status. Immigrant healthcare workers further face fears of visa and immigration uncertainties. Immediate actions by the healthcare facilities and government agencies are needed to address these concerns, to keep this frontline workforce intact so that they can continue to fight the battle against this pandemic.
Author contributions
All authors have made substantial contributions to the creation of this manuscript including writing the initial manuscript, literature review, and reviewing, and revising the final version. The final manuscript has been reviewed and approved by all authors.
Financial disclosure and conflict of interest statement
We confirm that the authors have no financial disclosures, competing interests, and conflict of interest. The study has not received any financial support or other benefits from commercial sources for the work reported on in the manuscript. The manuscript represents the original work of the authors and identical or similar work has not been published or submitted for publication elsewhere.
Data sharing statement
There is no data in this work.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
