COVID-19 Combat Fatigue among the Healthcare Workers: The Time for Retrospection and Action.

The present pandemic caused by the novel coronavirus has battered the healthcare infrastructure all around the globe. The doctors, nurses, and healthcare staff-the COVID warriors-have plunged themselves in line of fire to keep the population safe and alive. Around 87,000 healthcare workers (HCWs) have been infected and 573 have died till August in India alone. With no sight of pandemic ebbing anytime soon and patient load in hospitals refusing to come down, combat fatigue has set in these HCWs. The very people whose life mission is caring for others are on the verge of collective collapse physically and emotionally. There is an urgent need to retrospect the problems faced by the HCWs in the previous months, recognize, and preventive measures initiated at the earliest to prevent further loss and burnout among these battle-hardened frontline soldiers. How to cite this article: Rajhans PA, Godavarthy P. COVID-19 Combat Fatigue among the Healthcare Workers: The Time for Retrospection and Action. Indian J Crit Care Med 2021;25(1):3-5.

“The stress is all consuming. Intubating patients, administering CPR, even just breathing the same air as the stricken. Then there are the tears: from the sick, their families, their colleagues. Next patient. Next after next after next.

For the health care workers on the front lines of the coronavirus pandemic, the strain comes in an unrelenting wave of nexts. Across the globe, they live with exhaustion, fear even guilt—without “beginning or end.”

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Never in the recent memory has the world witnessed an event like the present pandemic caused by the novel coronavirus, which has battered the healthcare infrastructure all around the globe. Caught unawares, armed with limited knowledge of the virus, grappling poor health infrastructure, severe PPE shortages and other medical resources, stigma of spreading the virus, vacillating public support, and timid government response. The doctors, nurses, and healthcare staff—the COVID warriors—have plunged themselves in line of fire to keep the population safe and alive.

In the present edition, a study titled “Weathering the storm: Psychological impact of COVID-19 pandemic on clinical and nonclinical healthcare workers (HCWs) in India”[2] is being published. The author's evaluated questionnaire-based responses of 313 clinical and nonclinical HCWs to assess the psychological impact of the pandemic on these workers. They noticed high prevalence of mild to moderate symptoms of clinical insomnia, anxiety, depression, and stress among the HCWs, while no significant difference was noticed in psychological morbidity between clinical and nonclinical health workers. These findings echo the condition of HCWs working all around the globe.[3-7]

Faced with an invisible adversary, there is array of emotions being faced by these warriors every day from being angry to anxious to frustrated, helplessness and despair to a small ray of hope of better tomorrow. As one of my colleague puts it,

“Ever since the pandemic was declared, the virus is the first thing on my mind when I wake up and the last thing when I get into the bed exhausted, it has been the same each day after day for the past 10 months. Every time I attend a patient, touch something or talk to anyone, there is a fear of unknowingly infecting myself, my family members, my colleagues, my patients or even a stranger passing by. The pandemic may end soon, but the scars of responsibility will keep haunting me.”

Around 87,000 HCWs have been infected and 573 have died till August in India alone.[8] With no sight of pandemic ebbing anytime soon and patient load in hospitals refusing to come down, combat fatigue has set in these HCWs. The very people whose life mission is caring for others are on the verge of collective collapse physically and emotionally.

India being a resource-limited country with low budgetary allocation for health care, unequal distribution of healthcare resources in urban and rural areas, and poorly equipped government hospitals coupled with factors like scarcity of medical supplies including critical medical equipment like ventilators, oxygen etc., unavailability of adequate quantity of safety gear and of reliable quality, scarcity of trained medical personnel, unpredictable work schedules, increased workload, exposure to infection and fear of spreading infection to loved ones, sudden and prolonged lockdown leading to economic uncertainty, and limited knowledge of the new disease have all added up.

The public perception has also been vacillating, from lauding the role of HCWs to ostracizing them with fears of spreading the virus. Increased incidence of abuse and violence against the HCWs have been reported in the past few months; the ebbing point was when a neurosurgeon was denied a burial fearing risks of infection. Sensationalist posts on the social media and incessant media trials against the hospitals and HCWs are generating mistrust among the public on the efforts being done by these workers and are doing more harm to these overstretched soldiers.

Bracing for the Next Wave

As visible signs of fresh wave of pandemic are fast emerging due to tiredness and callous attitude among the public owing to ongoing festive season and waning pandemic patience, there is a urgent need to retrospect the problems faced by the HCWs in the previous months, recognize, and preventive measures initiated at the earliest to prevent further loss and burnout among these battle-hardened frontline soldiers.

Health care is considered the noblest of all professions. It takes years of hard work and training to produce skilled professionals. Medical equipment like ventilators and PPE could be manufactured with extra efforts, but these skilled professionals can't be produced overnight. With the present situation akin to a war and no end at sight, these warriors need to be trained for mental, physical, and emotional fitness apart from clinical skills and armed with suitable and adequate PPE.

All the stakeholders, including government, media, hospitals, associations like National Medical Council, Indian Nursing Council, and professional societies like ISCCM, IMA, ISA etc., need to come forward with multifaceted steps to combat this situation on priority. Few steps that could be done on priority include:[9-13]

By the government

Legislation for ensuring safety of HCWs and their families

Job and economic safety

Due recognition for their work

Ensure provision of adequate safety equipment including PPE

Vaccination of all HCWs on priority

By the hospitals

Resilient leadership—emphasize the role of HCWs, demonstrate courage to face challenges, and take decisions

Monitor health of workers and their families

Pep talks, spread word of positivity through messages, broadcasts, banners, etc., around the hospital

Modern technology for pandemic preparedness including simulation training, social media tools for real-time communication

Relevant and up-to-date information on the virus.

Ensure provision of PPE in adequate quantity and standards

Helpline for psychological first aid

Healthcare workers

Understand limitations—shred the idea of invincibility

Lead a balanced life and develop a hobby

Keep yourself physically fit by yoga, meditation, etc.

Plan for financial security

Avoid addiction

Talk freely with colleagues, work together as a team, identify any changes in coworkers, and support them

Families of HCWs

Be proud of your family member's role in taking care of COVID-19 patients during this outbreak

Maintain regular communication with the HCWs understanding their time constrains

Understand the new normal and explain to children the possibility of temporary separation, new set of rules within the house, separate bedrooms, etc.

Form self-help, support groups and communication with family members of other HCWs

Identify any signs of distress including sleep disturbance, food intake in the HCWs, and try to talk to them

Plan for financial goals and tasks reducing further stress on these workers

By the media (conventional and social media)

Highlight the untiring efforts of the HCWs, their sacrifices, success stories

Educate the public about the disease and prevention including mask hygiene and social distancing.

Dispel myths and misconceptions surrounding the disease.

Generate cooperation, empathy, and support from the society toward these warriors

In the ongoing war against the pandemic, these frontline workers don't need glorified obituaries in newspapers but a recognition that they too are human beings who are prone to stress and strain. Apart from symbolic gestures like clapping and cheering, they need recognition for enormous work they are doing, financial stability, and assurance of safety of themselves and their family members. It is with our collective responsibility that we can fight this pandemic together. As our prime minister in his speech had quoted,[14]

“There is no force greater than our enthusiasm and spirit in this world. There is nothing in the world that cannot be achieved with this force. Let's come together to defeat corona and make India victorious.”