Multi-channel protecting healthcare staff from COVID-19
Dear Editor
Since the first case report of the 2019 novel coronavirus disease (COVID-19) in December 2019 in Hubei, Wuhan, China, [1] the COVID-19 outbreak has infected more than 600 000 cases and spread to more than 200 countries outside of China worldwide. [2] COVID-19 has been declared a pandemic by the World Health Organization. To minimize the risk of person-to-person transmission and cross-infection, individuals who are confirmed and suspected to have been infected are strictly quarantined while public are also encouraged to stay at home. However, healthcare staff are on the front lines in this struggle to contain the epidemic. In China, upwards of 41 600 healthcare workers who are part of more than 400 medical teams from 30 provinces across the country converged on Hubei, the epicenter of this outbreak. [3,4] Among them, 66.47% are nursing staff, and 28.47% are physicians who are mainly from Respiratory Departments (24.6%), Intensive Care Units (19.3%), and General Internal Medicine (10.9%). [4] With the spread of the epidemic, experienced medical staff are lacking in some countries; UK appeals delaying non-urgent care and calls doctors back from leave and retirement to deal with covid-19. [5]
Medical healthcare workers at the frontline of this epidemic are facing enormous physical and mental pressures from the greater likelihood of burnout from overwork, the burden of possible mental health problems, and being infected. By February 24, 2020, a total of 3,387 Chinese healthcare workers had been infected with COVID-19, with 2,055 confirmed cases and 22 deaths. [4] On February 1, 2020, the World Health Organization reported the first case of a COVID-19-infected healthcare worker from outside China (in France) who cared for two suspected COVID-19 patients. These healthcare workers are resolved to protect the city, protect our homeland, protect every countryman, and protect every individual around the world. They are being hailed as “heroes in harm’s way.” Healthcare workers can become infected during the entire stage of the epidemic when they merely use conventional protection measures or can be infected by limitation protection and personal protective equipment (PPE) in many countries. To prevent more frontline personnel from COVID-19 exposure, below we offer recommendations for healthcare workers.
First, healthcare workers are encouraged to be alert to early symptoms of an outbreak in their common clinical work and regularly follow updates on the epidemic and always remain cautious. Case definitions are still progressing. Not all patients present at hospitals or clinics with typical or severe symptoms. Healthcare workers need to comprehensively learn about dynamic cases and reliable first-hand epidemic information. Additionally, appropriate infectious control precautions should be taken while in contact with patients. [6]
Second, healthcare workers are highly encouraged to obtain access to adequate PPE. The timely global supply of healthcare staff and personal protective equipment is urgently needed. Based on WHO modelling, an estimated 89 million medical masks are required for the COVID-19 response each month. For examination gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month. WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries, but supplies are rapidly depleting. [6] On the other hand, the sharing of clinical information including characteristics of infected cases and published research papers is necessary. Authoritative and accurate translations of these research articles into different languages will benefit not only healthcare workers who are proficient in Chinese and English but also those who are not. International and national mutual assistances including healthcare staff and PPE are essential.
Third, proactive infection control systems need to be set up. Even after multiple training sessions and emergency drills, many frontline healthcare workers might become nervous when they come in close contact with patients and overlook or omit important steps of infection control. A proactive infection control system (i.e., an observational system) could be helpful to provide real-time monitoring and rapid correction if necessary. Such observers of infection control assist healthcare workers in real time to maintain normal operations, supervise the implementation of disinfection, ensure the sufficient support of protective materials, arrange specimens for inspection, and mitigate healthcare workers’ anxiety when they treat patients. [7]
Fourth, healthcare workers should take care of their own mental health. Frontline healthcare workers face enormous pressures that can induce anxiety, insomnia, depressive symptoms, and posttraumatic stress symptoms. These mental health problems can affect healthcare workers’ efficiency, hinder their battle against the epidemic, and influence individuals’ overall wellbeing. [8] Multi-channel mental health support and care for these brave medical workers will make a valuable contribution to winning this campaign against COVID-19.
Tens of thousands of healthcare workers are devoting themselves to this “war without smoke” to save lives while being at risk of sacrificing their own. Authorities have released a document that lists measures to strengthen protection and care for medical workers as part of intense efforts to fight against the COVID-19 outbreak. [9] UK employers have a legal obligation under the Health and Safety at Work Act 1974 to protect staff from harm. [10] Protecting healthcare workers worldwide from COVID-19 infection is imperative for their own safety, to safeguard continuous patient care, and to curb further transmission.
Yimiao Gong, Yanping Bao, Yankun Sun, Jie Shi, Lin Lu*
*linlu@bjmu.edu.cn
Institute of Mental Health, Peking University Sixth Hospital and National Clinical Research Center for Mental Disorders (GY, YS and LL), Peking University Health Science Center (YB, and JS), Peking-Tsinghua Center for Life Sciences (LL), and PKU-IDG/McGovern Institute for Brain Research (LL), Peking University, Beijing 100191, China.
References
1. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet. Published online January 24, 2020. doi: 10.1016/S0140-6736(20)30185-9
2. Coronavirus disease 2019 (COVID-19) Situation Report – 69, on March 29, 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/2... (assessed March 30, 2020)
3. National Health Commission of the People’s Republic of China. 32,395 medical workers sent to novel coronavirus outbreak epicenter province. http://en.nhc.gov.cn/2020-02/20/c_76750.htm (accessed February 24, 2020)
4. Dingxiangyuan. COVID-2019 Daily. Do remember these 22 healthcare workers. https://mp.weixin.qq.com/s/aogUPt6wr-qkzlQghe45HA (accessed February 25, 2020)
5. Mahase E, Covid-19: UK could delay non-urgent care and call doctors back from leave and retirement, BMJ 2020;368:m854. doi: https://doi.org/10.1136/bmj.m854.
6. World Health Organization. Shortage of personal protective equipment endangering health workers worldwide, https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-pro... (assessed March 12, 2020)
7. Chen XJ, Tian JZ, Li GM, Li GW. Initiating of a new infection control system for the COVID-19 outbreak. Lancet Infec Dis. Published online February 18, 2020. doi: 10.1016/S1473-3099(20)30110-9
8. Kang LJ, Li Y, Hu SH, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. Published online February 5, 2020. https://doi.org/10.1016/S2215-0366(20)30047-X
9. Xinhua News. China rolls out measures to care for medical workers. http://www.xinhuanet.com/english/2020-02/23/c_138811210.htm (accessed February 24, 2020)
10. Rimmer A, Covid-19: What’s the current advice for UK doctors? BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m978 (Published 10 March 2020)
Rapid Response:
Multi-channel protecting healthcare staff from COVID-19
Dear Editor
Since the first case report of the 2019 novel coronavirus disease (COVID-19) in December 2019 in Hubei, Wuhan, China, [1] the COVID-19 outbreak has infected more than 600 000 cases and spread to more than 200 countries outside of China worldwide. [2] COVID-19 has been declared a pandemic by the World Health Organization. To minimize the risk of person-to-person transmission and cross-infection, individuals who are confirmed and suspected to have been infected are strictly quarantined while public are also encouraged to stay at home. However, healthcare staff are on the front lines in this struggle to contain the epidemic. In China, upwards of 41 600 healthcare workers who are part of more than 400 medical teams from 30 provinces across the country converged on Hubei, the epicenter of this outbreak. [3,4] Among them, 66.47% are nursing staff, and 28.47% are physicians who are mainly from Respiratory Departments (24.6%), Intensive Care Units (19.3%), and General Internal Medicine (10.9%). [4] With the spread of the epidemic, experienced medical staff are lacking in some countries; UK appeals delaying non-urgent care and calls doctors back from leave and retirement to deal with covid-19. [5]
Medical healthcare workers at the frontline of this epidemic are facing enormous physical and mental pressures from the greater likelihood of burnout from overwork, the burden of possible mental health problems, and being infected. By February 24, 2020, a total of 3,387 Chinese healthcare workers had been infected with COVID-19, with 2,055 confirmed cases and 22 deaths. [4] On February 1, 2020, the World Health Organization reported the first case of a COVID-19-infected healthcare worker from outside China (in France) who cared for two suspected COVID-19 patients. These healthcare workers are resolved to protect the city, protect our homeland, protect every countryman, and protect every individual around the world. They are being hailed as “heroes in harm’s way.” Healthcare workers can become infected during the entire stage of the epidemic when they merely use conventional protection measures or can be infected by limitation protection and personal protective equipment (PPE) in many countries. To prevent more frontline personnel from COVID-19 exposure, below we offer recommendations for healthcare workers.
First, healthcare workers are encouraged to be alert to early symptoms of an outbreak in their common clinical work and regularly follow updates on the epidemic and always remain cautious. Case definitions are still progressing. Not all patients present at hospitals or clinics with typical or severe symptoms. Healthcare workers need to comprehensively learn about dynamic cases and reliable first-hand epidemic information. Additionally, appropriate infectious control precautions should be taken while in contact with patients. [6]
Second, healthcare workers are highly encouraged to obtain access to adequate PPE. The timely global supply of healthcare staff and personal protective equipment is urgently needed. Based on WHO modelling, an estimated 89 million medical masks are required for the COVID-19 response each month. For examination gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month. WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries, but supplies are rapidly depleting. [6] On the other hand, the sharing of clinical information including characteristics of infected cases and published research papers is necessary. Authoritative and accurate translations of these research articles into different languages will benefit not only healthcare workers who are proficient in Chinese and English but also those who are not. International and national mutual assistances including healthcare staff and PPE are essential.
Third, proactive infection control systems need to be set up. Even after multiple training sessions and emergency drills, many frontline healthcare workers might become nervous when they come in close contact with patients and overlook or omit important steps of infection control. A proactive infection control system (i.e., an observational system) could be helpful to provide real-time monitoring and rapid correction if necessary. Such observers of infection control assist healthcare workers in real time to maintain normal operations, supervise the implementation of disinfection, ensure the sufficient support of protective materials, arrange specimens for inspection, and mitigate healthcare workers’ anxiety when they treat patients. [7]
Fourth, healthcare workers should take care of their own mental health. Frontline healthcare workers face enormous pressures that can induce anxiety, insomnia, depressive symptoms, and posttraumatic stress symptoms. These mental health problems can affect healthcare workers’ efficiency, hinder their battle against the epidemic, and influence individuals’ overall wellbeing. [8] Multi-channel mental health support and care for these brave medical workers will make a valuable contribution to winning this campaign against COVID-19.
Tens of thousands of healthcare workers are devoting themselves to this “war without smoke” to save lives while being at risk of sacrificing their own. Authorities have released a document that lists measures to strengthen protection and care for medical workers as part of intense efforts to fight against the COVID-19 outbreak. [9] UK employers have a legal obligation under the Health and Safety at Work Act 1974 to protect staff from harm. [10] Protecting healthcare workers worldwide from COVID-19 infection is imperative for their own safety, to safeguard continuous patient care, and to curb further transmission.
Yimiao Gong, Yanping Bao, Yankun Sun, Jie Shi, Lin Lu*
*linlu@bjmu.edu.cn
Institute of Mental Health, Peking University Sixth Hospital and National Clinical Research Center for Mental Disorders (GY, YS and LL), Peking University Health Science Center (YB, and JS), Peking-Tsinghua Center for Life Sciences (LL), and PKU-IDG/McGovern Institute for Brain Research (LL), Peking University, Beijing 100191, China.
References
1. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet. Published online January 24, 2020. doi: 10.1016/S0140-6736(20)30185-9
2. Coronavirus disease 2019 (COVID-19) Situation Report – 69, on March 29, 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/2... (assessed March 30, 2020)
3. National Health Commission of the People’s Republic of China. 32,395 medical workers sent to novel coronavirus outbreak epicenter province. http://en.nhc.gov.cn/2020-02/20/c_76750.htm (accessed February 24, 2020)
4. Dingxiangyuan. COVID-2019 Daily. Do remember these 22 healthcare workers. https://mp.weixin.qq.com/s/aogUPt6wr-qkzlQghe45HA (accessed February 25, 2020)
5. Mahase E, Covid-19: UK could delay non-urgent care and call doctors back from leave and retirement, BMJ 2020;368:m854. doi: https://doi.org/10.1136/bmj.m854.
6. World Health Organization. Shortage of personal protective equipment endangering health workers worldwide, https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-pro... (assessed March 12, 2020)
7. Chen XJ, Tian JZ, Li GM, Li GW. Initiating of a new infection control system for the COVID-19 outbreak. Lancet Infec Dis. Published online February 18, 2020. doi: 10.1016/S1473-3099(20)30110-9
8. Kang LJ, Li Y, Hu SH, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. Published online February 5, 2020. https://doi.org/10.1016/S2215-0366(20)30047-X
9. Xinhua News. China rolls out measures to care for medical workers. http://www.xinhuanet.com/english/2020-02/23/c_138811210.htm (accessed February 24, 2020)
10. Rimmer A, Covid-19: What’s the current advice for UK doctors? BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m978 (Published 10 March 2020)
Competing interests: No competing interests