Impacts of COVID-19 on Health Care Workers

This blog is part of a series relating to the economic impacts of the COVID-19, novel coronavirus pandemic of 2020.

As coronavirus continues to spread across the world, nurses and doctors are on the front lines fighting against the pandemic. Many health care workers have fallen ill with COVID-19 and millions more are feeling the physical, psychological and emotional strain of battling the deadly virus on a daily basis.

In thinking about the effect the coronavirus pandemic will have on the general public, the imminent threat to the lives and physical wellbeing of health care workers is a clear concern. Those who work in emergency rooms (ERs) and intensive care units (ICUs) run the risk of exposure if treating a coronavirus patient. Sometimes the threat is not apparent until much later, with several patients posthumously diagnosed with COVID-19. Health care practitioners are often engaged in very intimate and high risk activities while treating patients, such as intubation and collecting samples of sputum, a mucus produced by diseased lungs. The use of personal protective equipment (PPE), including masks, gloves, goggles, gowns, disinfectant wipes and face shields, helps doctors and nurses stay safe while treating patients with infectious diseases. However, due to the severity of the coronavirus pandemic, many medical facilities are reporting vast shortages of PPE. In the United States, the union National Nurses United reported that only 30% of nurses work at a facility with sufficient PPE to handle a possible outbreak of coronavirus. Nurses and doctors have to ration PPE in an effort to conserve dwindling resources. Elissa Schechter-Perkins, a Boston-based emergency room physician, recalled reusing N95 masks, particle-filtering respirators designed for single use, between patients and across days. While Australia has not yet reached mass shortages of PPE, health care professionals are bracing for supplies to run out by the end of April, when “the brunt” of the pandemic occurs. Brendan Murphy, Australia’s Chief Medical Officer, said the summer’s bushfire crisis significantly reduced the stockpile of N95 masks. While more equipment has been ordered, it is important for the public to do their part to flatten the curve and help keep the healthcare system from being overloaded.

As of now, the number of health care workers who test positive for coronavirus varies widely between countries. Within China, transmission between health care workers was not reported to be a major source of infection, with only 3.8% of health care workers testing positive for coronavirus. Italy and Spain, however, report 9% and 12%, respectively. While there is virtually no data for the American context as no information has been released by the Centre for Disease Control, unions or medical associations, the Ohio Department of Health reported that 17% of the state’s coronavirus cases are health care workers. If we look at the SARS epidemic of 2003, which was caused by a different strain of coronavirus, 21% of cases worldwide were health care workers. We can thus likely expect the number of health care workers who test positive for coronavirus to increase as the virus spreads and testing becomes more available.

Aside from the physical repercussions, health care workers are faced with enormous psychological and emotional burdens from battling the pandemic. With a lack of confidence in government leadership and a dwindling amount of resources, many health care workers are feeling an impending sense of doom and hopelessness each day the virus continues to spread.   Nurses across the globe say their lives and sacrifices are not valued by their governments or the public. Following the death of Kious Kelly, an assistant nurse manager at Mount Sinai West hospital in New York City, a fellow nurse took to Facebook to express her anger. “We do not have enough PPE, we do not have the correct PPE, and we do not have the appropriate staffing to handle this pandemic. And I do not appreciate representatives of this health system saying otherwise on the news. The public needs to know that we are not prepared, that this is serious, that they need to stay home to flatten the curve. How many more of my friends have to get sick, have to die, for the world to take this seriously?!”

Treating patients with coronavirus entails more than just performing medical procedures. Carley Rice, a nurse in Albany, GA, recalled making a FaceTime call for a dying patient to their family in order for them to exchange goodbyes. Emergency physician David Zodda described the harrowing experience of intubating his colleague, a “young, healthy ER doc like me”. Additionally, many nurses and doctors have to make the difficult choice between temporarily separating from their families or risking their families getting sick. Dr. Enrique Lopez of Georgia and Dr. Dave Macintyre of Las Vegas describe isolating themselves from their families by stripping down and sleeping in their garages at night to avoid cross-contamination. An anonymous nurse from Seattle declared, “I’ll live in my car if I have to. I’m not getting my family sick.” This separation from loved ones leaves vulnerable and emotionally-shattered workers with virtually no support network and no one to turn to after a long day. Additionally, many medical workers are feeling increasingly anxious about contracting coronavirus after seeing its effects on even the healthiest patients. An emergency nurse at Northwell Health Hospital in Great Neck, New York, explained, “everyone is pretty much terrified of being infected… At the beginning, my mentality was, ‘Even if I catch it, I’ll get a cold or a fever for a couple of days. Now the possibility of dying or being intubated makes it harder to go to work.” Such a dramatic increase in stress and anxiety can lead to weakened immune systems, making individuals more susceptible to illness.

As the coronavirus continues to spread across Australia, hospitals are bracing for difficult times, with the number of ICU patients expected to at least triple. Hospitals are nearing capacity for single-use rooms and will soon need to treat COVID-19 patients in wards or ICUs – a process known as “cohorting”. While the exact impact on health professionals remains unknown, various states have reported specific cases among workers. Western Australia recently reported that five of their new 33 cases are health care workers, and one employee from Mersey Community Hospital in Tasmania has been diagnosed with coronavirus. Furthermore, four workers at Werribee Mercy Hospital in Victoria have tested positive for the virus. To help secure PPE for the impending influx of cases across the country, over 130 companies have stepped up to boost production of face masks, gloves, gowns, thermometers and goggles. Supplies from the emergency national medical stockpile have been released and soldiers have been sent to Med-Con, Australia’s only manufacturer of respiratory masks, to help with the demand. While Chris Moy, President of the Australian Medical Association, said the release of masks from the national stockpile “wasn’t even nearly enough”, efforts are continuing to ensure medical facilities are not faced with severe shortages as we have seen in Italy and the United States.

The coronavirus has come on the back of unprecedented smoke-related health burden following extreme bushfires in New South Wales, Queensland, the Australian Capital Territory and Victoria during the final quarter of 2019 and in the first of 2020. The bushfires were estimated to have caused more than 3,000 hospital admissions for cardiovascular or respiratory issues and 1305 emergency attendances for asthma. This was a period that also called upon health workers and other first responders to attend to the community needs with similar requirements of equipment including PPE and masks. The question that needs to be asked is how long can our health care workers continue to be expected to operate at extreme levels given bushfires and now a pandemic?

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