Protecting our healthcare workers during the COVID-19 pandemic.

Currently, there are 1.2 million physician Healthcare Workers (HCWs) in the United States (US), 20% over the age of 55 [2]. Similarly, in the hospital setting, there are 2 million registered nurses, with 22% are over the age of 55 and of the 1.2 million registered nurses employed outside of the hospital, 29% are over the age of 55 [1]. According to the CDC, older adults are at higher risk of infection and complications related to COVID-19, particularly those over the age of 65, the age group that currently comprises 8 out of 10 US deaths from COVID 19 [2]. All ages are susceptible to COVID-19, with close contact with an infected individual [3]. Given this assessment, physicians, nurses and other staff risk their personal health each time they tend to COVID-19 patients and this is made worse by the shortage of PPE (Personal Protective Equipment). Lack of PPE and inadequate social distancing are the two modifiable risk factors that if addressed through the implementation of enforced physical distancing, increasing the availability of PPEs, and proper guidelines would significantly reduce transmission rates and help save lives [4,5]. In March 2020, Italy reported over 2600 HCWs were infected, devastating their already worn-down workforce [6]. Observing the wreckage ensuing across the globe, it is imperative to better prepare and care for our HCWs.

Many hospitals and states have not yet released their number of HCWs testing positive for COVID 19. Those who have released their numbers include hospitals from Washington State, Massachusetts and Alabama. The number of US HCWs confirmed infected with COVID 19 is over 800 [[7], [8], [9], [10], [11]]. As more states release their numbers, the amount is expected to rise, possibly dramatically, as more states are issuing tests to their HCWs in high risk exposure situations [12]. Additionally, there is an ever-growing list of HCWs from across the globe who have lost their lives due to COVID-19 [[13], [14], [15]]. As the number of HCWs infected and dying continue to rise, so our providers continue to diminish.

The physical and psychological well-being of our HCWs are being tested as patient loads continue to increase and fellow co-workers become infected with COVID-19, contributing significantly to burnout among healthcare workers [[16], [17], [18]]. The effects of this increase in workload in the dangerous atmosphere of this pandemic are the decline in the mental health of our HCW [16,17]. Throughout this pandemic HCWs have had to self-isolate from their own families for fear of transmitting the virus to their loved ones [17]. There will be guilt when a family member becomes infected. Our HCWs are bravely living in a constant state of psychological stress founded in fear; fear of transmitting the virus and stress of the unknown aspects of this virus. The long-term effects of stress can result in post-traumatic stress disorder, anxiety and depression [19]. Thus, it is imperative to employ productive strategies to care for the mental health of our HCW.

The mental health needs of our providers must be addressed with the same priority of their physical health. Keeping our HCWs updated on the latest information diminishes the fear of uncertainty and negative emotions associated with the virus [20]. This entails frequent information sessions on the specific details of the virus, practicing ethical decision making, and how to effectively use hospital resources [19]. By ensuring that the entire team maintains the same understanding of information and protocols, a certain amount of order can be maintain to curtail the negative impacts of this crisis. Additionally, establishing break time will allow for HCWs time to take care of themselves. Another recommendation centers on creating healthcare staff reserves to relieve those on duty before exhaustion and strain sets in resulting in anxiety and depression, affecting the quality of healthcare delivery. This can be done in several ways, including incorporating outside registered nurses into the hospital system, re-employing HCWs who recently retired, and adding in the newly matched fourth year medical students. As this crisis progresses it is imperative to continue to evaluate the well-being of our HCW and implement effect measures to care for their mental health.

This global crisis has fostered fear among healthcare workers. Healthcare workers are scared for their co-workers, their families, their friends, our communities and our country. Despite this fear, they continue to fight on the frontlines to execute their job while in a persistent state of survival mode in order to protect everyone around them. In order to win this war against COVID 19, we must come together on a united front to support those on the frontlines. While our healthcare workers continue to fight, we must help them fight off any potential short or long-term effects during and after the COVID19 pandemic. This requires the implementation of accessible counseling services and effective measures to care for their mental well-being in order to preserve their health.