Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic | Anxiety Disorders | JAMA | JAMA Network
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April 7, 2020

Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic

Author Affiliations
  • 1Stanford University School of Medicine, Stanford, California
  • 2Icahn School of Medicine at Mount Sinai, New York, New York
JAMA. 2020;323(21):2133-2134. doi:10.1001/jama.2020.5893

The coronavirus disease 2019 (COVID-19) pandemic has become one of the central health crises of a generation. The pandemic has affected people of all nations, continents, races, and socioeconomic groups. The responses required, such as quarantining of entire communities, closing of schools, social isolation, and shelter-in-place orders, have abruptly changed daily life.

Health care professionals of all types are caring for patients with this disease. The rapid spread of COVID-19 and the severity of symptoms it can cause in a segment of infected individuals has acutely taxed the limits of health care systems. Although the potential shortage of ventilators and intensive care unit (ICU) beds necessary to care for the surge of critically ill patients has been well described, additional supplies and beds will not be helpful unless there is an adequate workforce.1,2

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    2 Comments for this article
    Association Between Insufficient PPE and Depressive Symptoms
    Simon Ching Lam, PhD, RN, FHKAN | Squina International Center for Infection Control, School of Nursing, The Hong Kong Polytechnic University.
    The above viewpoint includes many important and valid requests from informants in line with what we observed in Hong Kong. For the concerns of “Protect me”, the shortage of Personal Protect Equipment (PPE) in clinical settings gave rise to the development of adverse mental status of frontline HCWs. (1)

    We our conducting a survey study of 300 healthcare workers (HCWs) (100 from Hong Kong and 200 from Guangdong, China) asking about their mental status and working environment (this study is still on progress). Most of demographic characteristics between two groups were similar: clinical experience, gender distribution, marital status, and
    number of contacts with COVID cases. The preliminary results indicate more depressive symptoms in Hong Kong (37%) than in Guangdong (11%) HCWs by the measurement of Patient Health Questionnaires-9 (PHQ-9; range = 0-36, cutoff of 10 for depression). The perception of insufficiency of PPE provided by the working organizations of Hong Kong HCWs was 60% while that of Guangdong counterpart was only 25.5%. HCWs did not perceive that they are under sufficient and appropriate “protection”. Surprisingly, over 50% of HCWs in Hong Kong indicated they were dissatistfied with the infection control training provided by the working organization vs only 3.5% HCWs in Guangdong. These findings also reflect the importance of one of the requests, “Prepare me”. However, a representative from one of the hospitals claimed that the PPE storage was enough for 3-months of usage, which he regarded as “sufficient”. This contradictory opinion may reflect simply mistrust or communication gap. The above preliminary findings and the responses from hospital representative has been broadcasted in local news programme (https://news.tvb.com/programmes/newsmagazine/5e881867335d196c3e7aacca/%E9%9D%9E%E5%B8%B8%E6%8A%97%E7%96%AB).

    Sufficient PPE (hardware), training (software) and communication (caring) would be fundamental and essential for fighting against the COVID epidemics, particularly in clinical settings. Taking care of mental status of HCWs is vital to sustain their adequate capacities for this outbreak over an extended time period.

    1. Chang D, Xu H, Rebaza A, Sharma L, & Cruz CSD. Protecting health-care workers from subclinical coronavirus infection. The Lancet Respiratory Medicine, 2020; 8(3), e13.
    Psychological Interventions for Front-line Health Care Workers
    Emma Yun-zhi Huang, DPH, MPH | Alumni, Macau University of Science and Technology
    Thank you for this comprehensive summary of the five requests from health care workers to their organization (i.e., hear me, protect me, prepare me, support me, and care for me) and of the messages and actions health care professionals desire from their leaders (i.e., honor me). China was the first country facing the outbreak of COVID-19 in the world. Moreover, the epidemic occurred during the most important festival of China – Chinese Festival, which means to all Chinese people to be together with family members. The Chinese government advocated that all health care workers in China volunteer to aid Hubei provinces to relieve the health care worker shortages in the area. Moreover, within one month after the COVID-19 outbreak, the China National Disease Control Bureau issued a principle guideline for psychological intervention for COVID-19, which covers four classes of population. Front-line health care workers were the first population which should receive the most attention and support, and the third-class population were relatives, friends, and colleagues of health care workers. Chinese scholars have also conducted many psychological studies on health care workers (around 10% of published articles of COVID-19 were related psychological studies of medical staffs in the CNKI database).

    Providing psychological intervention for front-line health care workers included: (1) professional training for stress reduction, (2) reminder of proper diet, rest and sleep, (3) supporting environment providing from family members, friends and colleagues for health care workers, (4) providing professional assistance and counselling when occurring emotional anxiety. The above guideline has been issued on the government website at 

    Moreover, the mass media in China positively reported news about health care workers and continually attracted social support from the public. The heroic image of health care workers was one important social support, which reflected the request of ‘honor me’.