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The COVID-19 pandemic has impacted healthcare workers around the world both physically, and psychologically. Front-line healthcare workers are at increased risk of infection due to their frequency and magnitude of contact with COVID-19 infected patients.
In the early days of the pandemic, massive shortages of personal protective equipment (PPE), left many healthcare workers without proper protection. In many cases clinicians treating Covid patients were forced to reuse N95 respirators for extended periods of time, where the masks themselves began physically falling apart. Others were forced to create makeshift PPE, such as plastic bags and ski masks.
Even before the pandemic, healthcare workers were at higher risk for mental health problems due to a variety of factors, including long and inconsistent work hours, intense physical and emotional labor, and increased risk of disease and workplace violence. For front-line healthcare workers, the mental health impacts of the pandemic are staggering.
A 2022 WHO report found that "23 to 46 percent of healthcare workers reported symptoms of anxiety during the COVID-19 pandemic and 20 to 37 percent experienced depressive symptoms," and a 2020 Mental Health America survey found that 93% of U.S. healthcare workers reported being stressed out and/or overworked.
A 2021 systematic review and meta-analysis that looked at 65 studies including close to 100,000 healthcare workers from 21 different countries found that nearly 22% of healthcare workers experienced at least moderate levels of depression or post-traumatic stress disorder. And data from the National Institute for Healthcare Management found that 76% of healthcare workers reported exhaustion or burnout in September 2020, and almost 70% of physicians reported experiencing depression, with 13% saying that they had thoughts of suicide.
A study published in February 2023 found that even among healthcare workers who are not formally diagnosed as suffering from PTSD still experience critical health symptoms that could lead to other health problems such as sleep problems, fatigue, and headaches. The study found that while only 5% of healthcare workers in their sample met criteria for clinical levels of PTSD, more than half of healthcare workers reported sub-clinical levels of PTSD symptoms. And these sub-clinical levels of symptoms were significantly correlated to a variety of health impairments.
In October 2021 the WHO estimated that between 80,000 and 180,000 healthcare workers could have died from COVID-19 in the period between January 2020 to May 2021, with the 115,500 as the most likely number of fatalities. An April 2021 Kaiser Health News study found that more than 3,600 American healthcare workers died in the first 12 months of the pandemic.
The largest study on COVID-19 symptoms and death in U.S. healthcare workers was published in August 2022 in the journal Emerging Infectious Diseases. The study found that over the first three waves of the pandemic, (January 2020 - October 2021), 440,044 cases were recorded among U.S. healthcare workers, with 1,469 deaths. Almost one third of healthcare worker deaths occurred in June of 2020, during a nationwide surge in COVID-19 cases. At the same time, healthcare workers were dealing with insufficient personal protection, limited resources, overcrowded care units and heavy workloads from the influx of patients.
Emerging research also suggests that long COVID is hitting the healthcare system particularly hard. The system has lost 20% of its workforce over the course of the pandemic, with hospital under-staffing at hospitals resulting in burnout and fatigue among front-line medical professionals, according to recent employment data from the U.S. Bureau of Labor Statistics.
A January 2023 study by the New York State Insurance Fund (NYSIF) found that during the first two years of the pandemic, nearly 3/4 of their claims classified as Long COVID required continuous medical treatment or were unable to work for 6 months or more, and almost 20% were still out of the workforce more than one year after infection. Of those. Over 80% of COVID-19 related claims were from essential workers (defined as those in healthcare, law enforcement, or direct patient or consumer care), and 29% of those essential workers went on to to file Long COVID claims. Another study from the National Council on Compensation Insurance (NCCI) found that 25% of Long COVID claims were filed by healthcare workers, more than any other industry.
COVID-19 altered how and when we access medical care, and this significantly affected the most vulnerable populations the most. The pandemic brought to the forefront the long-standing inequities, in which already marginalized and vulnerable groups bear a disproportionate burden of the disease. Even in high-income countries with strong health systems, low-income, people of color, have worse access to healthcare, tend to live and work in conditions that increase risk of infection, and face greater overall risks of severe illness and death. But in low and middle income countries, where inequalities are often more pronounced, the pandemic set population health backward decades, if not more.
A large online cross-sectional survey conducted in spring 2020 and again in spring 2021 found that nearly 20% of survey respondents delayed medical care, and that compared to those in good health, those with poor health were significantly more likely to delay medical care and treatment. Another study published in September 2020 in MMWR found that by June 2020, 41% of Americans reported that they had delayed or avoided medical care and treatment due to concerns of COVID-19.
The September 2020 study in MMWR also found that by June 2020, approximately 12% of American avoided urgent or emergency care due to concerns about COVID-19. However, among certain high risk groups (unpaid caregivers, those with multiple underlying conditions, uninsured, BIPOC, young adults, and people with disabilities), had significantly higher prevalence of avoidance of either urgent or emergency care.
According to the September 2020 study in MMWR, nearly one third of Americans delayed routine medical care. The delays in routine medical care go both ways, for those at increased risk of infection, the avoidance of routine care and adhering to stay-at-home orders improved community mitigation efforts, however if routine care was delayed too long, it could mean chronic conditions may not be managed properly, new conditions may not be detected early, and immunizations may be missed; all of which can worsen long term health and outcomes.
On July 15, 2022 the WHO and UNICEF published official data showing that the COVID-19 pandemic led to the "largest sustained decline in childhood vaccinations in approximately 30 years." Vaccine coverage dropped in every region, and it will require monumental global efforts to bring immunization rates back to universal levels of coverage and prevent outbreaks. Due to decreased vaccination rates, even in high income countries, inadequate coverage of diseases like measles and polio have made a resurgence with a number of outbreaks around the world.
“This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, UNICEF Executive Director.
The COVID-19 pandemic impacted mental and behavioral health in two main ways; 1) the unprecedented stress caused by the pandemic lead to increased rates of anxiety, depression, substance abuse, and suicidal ideations, and 2) COVID-19 infections often result in cognitive or mental health issues, including brain fog, anxiety, mood disorders, and other neuropsychiatric complications.
In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%, according to a March 2022 scientific brief released by the World Health Organization (WHO). Due to concerns about increased mental health and psychosocial support needs, 90% of countries surveyed by the WHO included mental health services and support to their COVID-19 recovery plans.
This increased prevalence of mental health problems in 2020 coincided with severe disruptions to mental health services, leaving those who need care the most without it. Especially for those most vulnerable, especially in resource-limited countries, establishing adequate tele-mental health services continues to be a major challenge.
Even three years into the pandemic, a March 2023 KFF/CNN survey found that 90% of U.S. adults believe there is a mental health crisis in America. "The pandemic has affected the public’s mental health and well-being in a variety of ways, including through isolation and loneliness, job loss and financial instability, and illness and grief."
