Lived-in experiences of health care professionals affected with COVID-19

ABSTRACT

Background and Objective:

Healthcare providers (HCPs) were vital during the COVID-19 pandemic. The healthcare providers affected by COVID-19 underwent various life changing events while continuing their profession during the pandemic. This study is aimed to explore the lived-in experiences of HCPs affected by COVID-19 at a tertiary care Mental Health Institute in India.

Materials and Methods:

The sampling method was purposive. Twenty two HCPs (eight nursing educators, seven nursing officers, five contractual cleaning workers, and two laboratory technicians) participated in the interviews conducted by the researchers to obtain the lived-in experiences of HCPs who have recovered from COVID-19. Researchers used a sociodemographic form and an interview guide to collect the data. Interviews were audio recorded and analyzed by using Atlas-ti-9 software.

Results:

All the participants were female, and they revealed various physical, psychological, and social issues faced by HCPs while balancing home and workplace. Thematic data analysis resulted in the emergence of two themes and 11 subthemes related to life changing events.

Conclusion:

The findings concluded that although the healthcare providers had working experience in the field of mental health, they too experienced mild psychological issues like anxiety, depression, and fear of death because of this pandemic situation.

INTRODUCTION

The World Health Organization announced COVID-19 as a pandemic in March 2020. Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.[1] The 115,000 deaths of healthcare providers are the equivalent of a commercial airliner crashing with no survivors every day for the past 17 months.[2] In India, official data showed more than 87,000 healthcare workers had been infected with COVID-19, with just six states—Maharashtra, Karnataka, Tamil Nadu, Delhi, West Bengal, and Gujarat—accounting for three-fourths (around 74%) of the case burden and more than 86% of the 573 deaths due to the infection. The officials and public health experts are concerned about the rise in COVID-19 infections and even deaths of healthcare providers in particular states, as it can jeopardize India’s fight against the pandemic.[3]

The safety and health of the frontline nurses are critical to ensure safe and quality nursing care to patients and are vital in the quest to overcome the COVID-19 crisis or future pandemics.[4] Implementing various protocols to be followed by the healthcare providers as per the advisory boards at workplaces was very confusing during lockdown periods. Timely planning and intervention can help India protect its health warriors for a longer and stronger fight against the upcoming health calamity.[5] In this hospital, the healthcare authorities have made necessary arrangements for accommodation and food during quarantine, transportation, providing support for childcare, accessibility of medical care to them and their family if they get infected with COVID-19, and psychological counselling services for quarantined frontline workers.

The lived-in experiences of healthcare providers who have recovered from COVID-19 infections are essential to recognize the significant life changing events and challenges they face in their personal and professional lives. The present study’s findings may help to formulate new guidelines and plan interventional strategies for the healthcare providers during health crises.

MATERIALS AND METHODS

The study was reviewed and approved by the Institute’s Ethics Committee (Ref. No- NIMH/EC(BEH.Sc.DIV) MEETING/2021 Dated- 19/07/2021). Twenty two healthcare providers who have recovered from COVID-19 infection consented to participate in the study.

Data collection

In-depth interviews were conducted with 22 healthcare providers (eight nursing educators, seven nursing officers, five contractual cleaning staff, and two laboratory technicians) about their lived-in experiences after recovering from COVID-19 infection and interviews were audio-recorded. The researchers included the socio-demographic variables of age, sex, years of experience, type of family, number of bedrooms attached bathrooms, the experience of COVID duty, and type of isolation during COVID-19 infection.

Data analysis

The frequency, percentage, mean, and standard deviation of socio-demographic variables were calculated. Atlas-ti version 9 was used to transcribe the data by repeated listening of the audio recordings of the in-depth interviews of the participants.

RESULTS

Most healthcare providers (n = 16; 72.72%) were aged 40-50 years, and all were female staff. Most of the participants, around 16 members (72.72%), had working experience of 20-30 years, and eight members (36%) did COVID duty. Almost 20 members (91%) are from nuclear families and are living in double-bedded houses with attached bathrooms (68%), and 10 members (45.4%) were at home in isolation. Only two (9%) were living in joint families. Twelve members (54.5%) were in institutional isolation where they were employed [Table 1].

Table 1.

Sociodemographic variables

Sociodemographic variable	Frequency	Percentage	Mean	SD
Age
20-30 years	01	04.54	44.63	6.94
30-40 years	01	04.54
40-50 years	16	72.72
50-60 years	04	18.18
Sex
Female	22	100	-	-
Male	0
Years of experience
<10 years	02	9.09	20.9	6.33
10-20 years	03	13.63
20-30 years	16	72.72
30-40 years	01	4.54
Type of family
Nuclear	20	91	-	-
Joint	02	09
No. of Bedrooms with attached bathrooms
One
Two	07	31.81	-	-
>2	15 0	68.18
COVID Duty
Yes	08	36.3	-	-
No	14	63.6
Isolated at
Home	10	45.4	-	-
Institutional	12	54.5

The two major themes emerged were (1) physical problems and (2) psychological problems. These two significant themes have 11 subthemes discussed under various headings.

1. Physical Problems: The first central theme was physical problems expressed by healthcare providers during the COVID-19 infection. Under this theme, three subthemes emerged. These are (a) signs and symptoms, (b) maintenance of physical health with the comorbidities, and (c) major source of infection.

   1. Signs and symptoms:

      Our study has revealed that major physical problems experienced by healthcare providers with COVID-19 infection are headache, fever, body pains, cold, cough, breathlessness, and loss of taste and smell.

      One participant in the study has expressed that she had experienced.

      “Severe headache (unexplained) and fever – 005”

      Another person expressed her difficulty below.

      “Nose block, severe cough, and I was very much worried about nose block and difficulty while breathing, and I was checking oxygen saturation very often – 013”

      Another healthcare provider expressed the same difficulty as

      “I had severe breathlessness, and I felt I may die. I ran to the hospital to take HRCT”-011”.

   2. Maintenance of physical health with the comorbidities:

      Maintenance of physical health was challenging for those with comorbidities of diabetes mellitus, hypertension, asthma, and immunocompromised. Apart from caring for themselves, caring for their spouses and other family members was challenging for the study participants. One participant talked about her experience of COVID-19 infection along with diabetes,

      • “My mother and myself are diabetic. We were only doing all the household work and felt easy fatiguability, so we felt tough”-016.

      Another person with hypertension expressed that,

      “Nothing has happened to me while I was affected with COVID-19 infection, although I am a BP patient”- 026.

      One healthcare provider who is a known asthmatic expressed that,

      “Whenever somebody reminds her about her asthma during COVID-19 infection, she used to feel very frightened and used to be more precautious”-024.

      One participant was suffering from mixed connective tissue disorder, and she expressed that.

      “I was vaccinated with two doses of COVID-19 vaccine as I am a person whose immune system was not normal, and I am a person with mixed connective tissue disorder, and for me, COVID-19 infection was just like a common cold, whereas my family members who were not vaccinated suffered a lot”- 006.

   3. Source of Infection: The healthcare providers followed COVID-19–appropriate behavior at home and the workplace throughout the pandemic. The primary source of infection was from family members and the workplace; for some healthcare providers, the source was unknown. One of the participants expressed that,

      “It is not that all the family members were affected by COVID-19 at a time. It was a lengthy process first, my husband after his isolation of 14 days, next my younger son, afterward elder son, and later myself. So, the infection was revolving within our family”-009.

      The healthcare provider working in a laboratory setting has expressed that,

      “We handle samples of various patients for various diagnostic purposes, and my colleagues at the workplace got positive for COVID it has spread to everybody.”-013.

      One of the healthcare workers who did COVID-19 duty expressed that,

      “During COVID duty, one of my colleagues became positive knowing that I went for a check-up as I was in close contact with her and found to be positive.”-020.

2. Psychological Problems: The second theme that emerged from our study was psychological problems expressed by healthcare providers when they were affected by COVID-19 infection. Subthemes that emerged under this theme were (a) initial reaction toward their positive COVID-19 report, (b) worries during isolation, (c) difficulties during the lockdown, (d) experience at the workplace, (e) problems faced related to services of healthcare systems, (f) fear of death of self and family members, (g) dilemma about vaccination, and (h) post-COVID complications.

   • a.Initial reactions toward positive COVID-19 report: The healthcare provider’s initial response to the positive COVID-19 report revealed that they prepared themselves and their family members and were isolated as soon as they were symptomatic. Despite proper preparedness for the pandemic, the healthcare workers were very anxious, worried, and shocked as soon as they received their report as positive.

     One participant said:

     “Though I know I am prone to get COVID-19 infection, as soon as I received my COVID-19 Positive report, I was breathless and felt I may die. After some time, I realized that my colleagues had all recovered. I also will recover such type of mixed-up feelings”. -007.

     Another participant expressed that:

     “I prepared my mind while giving sample that my report would be positive. But I am worried about my family members as I must take care of both pediatric and geriatric age groups”. -005.

   • b.Worries during Isolation: Isolation was a bitter experience for most healthcare providers as most of our participants were females. Managing work and family was a big task. Staying alone in institutional isolation was a risk compared to home isolation. In our study, healthcare providers experienced a lot of psychological issues while they were isolated.

     One participant said:

     “I have two -a year-old kid. I was isolated for the first time from my child, and my husband has to take care of my kid. He has hidden all my photos as my kid was crying by seeing my photos”. -020.

     Another participant expressed that:

     “Children were sad. They thought their father would die, and I could not console them. I took the help of the clinical psychology team for counseling my kids.”- 013.

     Fear of death was there, and healthcare workers prayed for themselves and humanity during isolation to eliminate this pandemic.

     One participant said:

     “I was afraid of death, and I used to sing devotional songs, and tips from the clinical psychology department helped me to come out of that fear.”- 024.

   • C.Difficulties during lockdown: Complete lockdown was announced throughout the nation, creating chaos among the public. Healthcare professionals were the ones who were working round the clock to fight the pandemic. They had experienced a plethora of experiences during lockdown at the home, workplace, and in the neighbourhood.

     One healthcare provider has expressed that,

     “At home, there were no helpers for household work, and we stopped the maids. It was very tiresome for me to take care of household chores after the heavy-duty at the hospital”- 06.

     Another participant said,

     “Managing children at home was very difficult, though they had online classes, continuous monitoring them while attending classes was another extra work for us”- 013.

     At the workplace, one participant has expressed that,

     “There were no leaves to the health care providers, and if they get infected, they have to avail their leave and stay at home, and like this, I finished all my leaves”-019.

     Another healthcare provider stated that,

     “They gave quarantine leave which was very helpful”- 005.

     One participant expressed that,

     “I was a second person who got infected, so they sanitized my seat, and table, etc.; after post COVID when I joined to duty, people used to go out whenever I coughed, which was embarrassing for me”- 008.

     Experience with the neighbourhood: There were many stigmas related to the coronavirus transmission in the initial period. The people with a history of international travel were in quarantine for at least 14 days, and those residing in the apartments were very cautious with the families who returned abroad. Some healthcare providers reported that their neighbourhood behaved strangely toward them by demanding to vacate the house.

     One of the cleaning staff expressed that:

     “My neighbors were standing away from me, including my close friends, as soon as they realized that I am working at the hospital, and they used to move out”- 022.

     Another participant expressed that:

     “My neighbors always shut the door and did not open the doors at all, and whenever they see my child, they will run away.” (laughing) -013.

   • D.Experience at the workplace: Workplaces became the battlefields for healthcare providers. Although the hospital was not a COVID Care Center, the hospital services were on, and the patients came for care from different parts of the country. All the COVID-positive inpatients were screened initially before admission. The employers set no clear rules for the healthcare providers infected with the COVID-19 virus. There are many dilemmas about isolation, admission, medication supply, availability of a bed, and the staff’s behavior at COVID care centers.

     One of the participants said:

     “Private hospitals charged more when I admitted my husband, and it was around 50000/- per day, which was very high, and I struggled financially”– 019.

     Another participant has expressed that:

     “Every moment was anxious; I was in a dilemma to admit my mother or to take care of her at home. I was totally confused at that stage”-002.

     The organization planned some facilities to serve the healthcare providers. The healthcare providers used the facilities, like supplying medications, administering the vaccine, and providing transportation to attend to their duties.

     One of the participants said:

     “As soon as I tested positive, my hospital people called me and sent the medicine Kit”-004.

     The healthcare provider’s opinion about the vaccination was a mixed response. Few had reasonable opinions about the vaccine and said they were privileged to get vaccinated.

     One of the participants expressed that:

     “Because of vaccination only, I feel I am surviving now.” – 013.

     Another participant has expressed that:

     “Vaccination gave me confidence in recovering from COVID.”- 017.

     Although the vaccine was considered a boon by some healthcare providers, few still have dilemmas about whether to get vaccinated.

     One participant said:

     “I feel that there is no evidence for the effectiveness of vaccination”- 002.

     Another participant has expressed that:

     “I did not go for vaccine though it was mandatory at the workplace as my homeopathy doctor asked me not to go for it.”- 008.

     The treatment protocols for COVID-19 were also frequently changing, and healthcare providers followed other systems of medicine like ayurveda and homeopathy.

     One participant has expressed that:

     “I did not take any medications as they were not proven”- 011.

     Another participant said:

     “I did not take any allopathy medicine at all”- 021.

   • E.Problems related to healthcare system services: Healthcare workers have expressed different opinions about the services they received during isolation. They discussed the hospital setup’s government officials tracking system and staff behavior.

     One participant has expressed about the tracking system of government officials like this:

     “There were continuous calls from local health authorities. Attending phone calls was a tough task for us. When they learned we were COVID positive, they labeled our house and checked whether we were restricted to the home, which was very annoying”- 016.

     Participants in our study expressed their views that the behavior of staff at the hospital was miserable, and they applauded the work done by them.

     One participant shared her experience when she went to the hospital:

     “When I went to a hospital, one doctor told me that he had not taken breakfast since morning and was tired. So, they were exhaustive.”- 006.

     Another participant appreciated the work done by the hospital staff:

     “They were doing a lot. However, limitation comes when they and their family members are falling ill, and the burden is more on them, and with all that, the way they were managing was excellent.”-004.

   • F.Fear of death: The healthcare providers in our study also expressed the fear of death of themselves and other family members due to the Coronavirus infection. Guilt and helplessness prevailed among the participants who lost their beloved ones. Getting back to normalcy was very tough for them, although they are in the health sector. They have chosen a spiritual path to overcome this frightful situation.

     One participant who lost her mother expressed that:

     “I lost my mother (in tears). It is a huge trauma for me both physically and psychologically. I cannot accept the loss of my mother”. -004.

     Another participant who lost her father expressed that:

     “I could protect my husband and children, but I could not save my father. I lost my father within 4 days of hospitalization”. -007.

     The pathetic situation when family members got admitted to the hospital and no one was allowed to stay with them was tragic. The situation at the COVID Care Centers was so scary as they saw the people dying adjacent to them.

     One participant expressed that:

     “When I took my husband to the hospital, that time only 2 deaths were there. Whenever he will not be answering the phone call that was the time, I was very tensed, and I suffered a lot”. -022.

     Another participant said:

     “One of my aunties had expired. I felt that if she had taken the vaccine, she would have survived”. -023.

     The healthcare providers chose a spiritual path to overcome the fear of death during the isolation.

     One participant said:

     “Fear of death was there. I used to sing devotional songs, and the tips given by clinical psychology people helped me to come out of it”. -024.

   • H.Post-COVID complications: The healthcare providers were delighted over their recovery from COVID-19 infection. Reuniting family members after 14 days of isolation was a great feeling, like a rebirth for them. Healthcare providers expressed that there were some post-COVID complications like malaise, breathing difficulty, and anxiety experienced after recovery.

     One healthcare provider expressed that.

     “There was tiredness even after 3-4 months after covid infection”- 016.

     Another participant in the study expressed that:

     “I am still feeling difficulty while walking” -013.

     Other symptoms experienced by the healthcare providers are urinary tract infection and anxiety for minor colds and coughs, and some of them were worried about reinfection of COVID-19 disease.

     One participant expressed that:

     “My mom had severe anxiety, which was to such an extent that, even if she has sneezing also, I have to take her to the hospital.” -006.

     Another participant said:

     “After I recovered from COVID-19 infection, thrice I got UTI which I never had before, and I am worried about reinfection”- 024.

   • I.Influence of media: Media played a significant role in communicating information about the COVID-19 disease to the public. The media telecasted information about the number of infections, death, and preventive measures for the spread of infection. At the same time, the hype shown by the media was very fearful and frightening for the public. Some participants have expressed that initially, they were watching the news for information, but now they stopped watching it as it created some fear and unpleasant situation.

     One participant said:

     “The way media portrayed small incidents as big was not good. It created fear while listening to the media. If fear is there, we cannot face any situation.”- 004.

     Another participant said:

     “Entire media was about COVID. Our response to the disease was very much affected, and we feel this can probably happen to us.” - 011.

DISCUSSION

Healthcare providers lived experience during the COVID-19 infection revealed many problems they faced while caring for themselves and their family members. The COVID-19–positive HCPs were predominantly nurses and young females with a mean age of 42 years. It is likely due to persistent and prolonged exposure of nurses while working in COVID-19 facilities.[5] In our study, all the participants were female aged between 40 and 50 years (72%) and their family members, especially children and old age people affected more during isolation. Forty five point four percent of healthcare providers preferred home isolation as they were asymptomatic and with minor headaches, fever, and body pain symptoms. The majority (68.18%) resided with adequate facilities for isolation, like two bedrooms with attached bathrooms.

There were a lot of dilemmas and uncertainties regarding the treatment options. The environment, both working and family environment, has adopted new normal behaviors. For example, the healthcare providers working in the laboratories and posted for COVID duty were following isolating techniques like sleeping separately or staying in institutional isolation until the end of COVID duty before they were affected with COVID-19 infection.

Some healthcare providers said they prepared their families well to tackle the situation. Children learn new skills like cooking, staying alone, and leaving the mother at night times during the period of institutional isolation (54.5%). The healthcare providers living in nuclear families (91%) isolated from their kids lied to their younger children that they had been posted for a special duty. Separating from family members, especially young children, during isolation was a primary concern for healthcare providers. There was evidence of psychological distress from participants feeling isolated—either as an individual (often due to short staffing and high workload) or as a department—struggling to get support from other clinical divisions.[6]

The source of infection was predominantly from the workplace (36.3%), as they were doing COVID-19 duties at wards and laboratories. A significant percentage (27.4%) was from the transmission from colleagues who were positive for COVID-19 infection. The practice of universal masking at all times is challenging, and inevitable breakdowns have occurred during mealtimes and in shared accommodations.[7] Although they knew their risk of becoming infected, some healthcare providers prepared themselves and their families to combat the situation. However, they were worried and helpless when they got a COVID-19–positive report.

Although the healthcare providers had working experience of 20-30 years (72.72%) in the field of neuro and mental healthcare, after recovery from COVID-19 infection, they expressed psychological issues like worry, anxiety (separation), fear of death (both self and their family members), confusion about treatment options, hospitalizations, and scared to see the news and number of cases increasing day by day and number of deaths. Participants in the study who lost their dear ones were in tears and expressed that it took a long time to recover from guilt. Several nurses were in tears, talking about patients dying without their loved ones.[8] Some people availed the Clinical Psychology services to counsel their children and for themselves to cope with the crisis. Some expressed that they were more spiritual by performing family prayers and praying for their dear and near ones.

The media’s disclosure of health information about COVID-19 may influence public perceptions and behavior. Media should ensure appropriate, timely, and actionable coverage to encourage individuals to respond appropriately. India has been particularly affected by a large COVID-19 caseload.[9] In our study, the healthcare providers stopped watching the news as the number of cases and deaths mentioning on the TV channel may provoke their anxiety. The high level of contagiousness of the virus and the consequent lockdown imposed by the authorities have eliminated the possibility of promoting the work-life balance, spending free time with family and friends, and practicing hobbies and leisure activities after work, inducing a severe deprivation of social support that is a relevant protective factor for mental health.[10] Reunion with the family after isolation was pleasant for healthcare workers and family members.

The lived-in experience of healthcare providers during the first wave was horrible as there were the death of dear ones and the impact of lockdown on children’s education and the jobs of spouses working in the private sector. The psychological burden and overall wellness of HCPs have received heightened awareness, with research continuing to show high rates of burnout, psychological stress, and suicide.[11] Initial stigma about COVID-19 infection among the public has made healthcare providers did not reveal they are positive reports to the neighborhood. They hesitated to ask for help, and the strict rules imposed by government authorities on home isolation were somewhat problematic. Conversely, some healthcare providers were treated as heroes in their families and communities as they could get over COVID-19 infection.[12] Interim guidance on prevention, identification, and management of health worker infection in the context of COVID-19 states that a blame-free system for managing health worker exposures to COVID-19 should be in place to promote and support reporting of exposures or symptoms. Organizations providing healthcare should have paid sick leave policies for health workers that are nonpunitive, not associated with any financial disincentives, confidential, flexible, and consistent with public health guidance. In this study, participants’ workplace experience was satisfactory as the administration provided special quarantine leave and other facilities for isolation.

CONCLUSION

The lived-in experiences of healthcare providers who have recovered after COVID-19 infection revealed that they faced various physical and psychological problems. Although they are in the healthcare field, they, too, required some psychological interventions when they were affected by COVID-19 infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.