Focusing on health-care providers' experiences in the COVID-19 crisis

As of April 15, 2020, there have been 1 918 138 confirmed cases of coronavirus disease 2019 (COVID-19) globally, including 123 126 deaths, as reported by WHO. The outbreak is a public health emergency of international concern and could be a long-term challenge worldwide. An increasing number of health-care providers around the world are getting involved in the COVID-19 crisis. They have a crucial role and are making great contributions, but they also face great challenges.¹ The importance of health-care providers in this crisis is not in doubt, and awareness of what they are experiencing is vital.

The qualitative study by Qian Liu and colleagues² in The Lancet Global Health is a good way to understand what health-care providers in Wuhan, China, experienced in the early stages of the pandemic. The researchers explored sufficient information to show what Chinese health-care providers had experienced and found that they had an extraordinary sense of responsibility and a strong spirit of teamwork when treating patients with COVID-19. Despite facing physical and psychological challenges, such as physical exhaustion due to heavy workloads, a lack of personal protective gear, the fear of becoming infected and infecting others, and feeling powerless to handle patients' conditions, health-care providers showed amazing resilience. Moreover, this study provides a holistic picture of health-care providers' experiences for the international community and emphasises that sufficient personal protective equipment, reasonable work schedules, an effective communication environment, monitoring and supervision of infection control, and professional psychological support are necessary to improving the experiences of health-care providers.

The authors also acknowledge some limitations of the study. First, a phone interview method was used owing to the lockdown in Wuhan. Thus, non-verbal cues such as facial expressions, eye contact, and body movements, which are unique data resources for a qualitative study, were not recorded. Future studies should collect as much non-verbal information as possible, which could enrich the descriptions of health care providers' experiences. Second, the authors did not compare the experiences of nurses and physicians. Physicians, nurses, and other medical staff are all working together in the fight against COVID-19, but they have different duties and their experiences might differ from each other.³ Hence, we recommend expanding the sample size to improve the diversity and representativeness of the sample. Different research methods could also be used to build a more complete picture of health-care providers' experiences and compare the different experiences of nurses and physicians (as well as other groups, such as pharmacists and respiratory therapists), based on the previous study.

As the results of this study showed, as well as the results of similar studies of severe acute respiratory syndrome and Middle East respiratory syndrome,4, 5 frontline health-care providers face enormous pressure during outbreaks due to a variety of factors, including a high risk of infection, insufficient personal protective equipment, heavy workloads and manpower shortages, confusion, discrimination, isolation, patients with negative emotions, separation from their families, and burnout. These pressures can lead to mental health problems such as stress, anxiety, depression, insomnia, denial, anger, and fear, which not only affect health-care providers' attention, understanding, and decision-making ability, but could also have a lasting effect on their physical and psychological wellbeing after the COVID-19 crisis is over.6, 7 It reminds administrators that understanding frontline health-care providers' experiences, developing targeted intervention strategies, and establishing long-term mechanisms for psychological crisis prevention are necessary not only for protecting the physical and mental health of health-care providers, but also for better protecting patients and controlling the spread of the pandemic. Furthermore, health-care providers' experiences could change greatly at different stages of the pandemic, so provision of sustained and comprehensive support for health-care providers is necessary to safeguard their wellbeing.

In conclusion, focusing on health-care providers' experiences, understanding the similarities and differences between the experiences of different groups of health-care providers, developing targeted measures, and giving health-care providers sustained and comprehensive support are necessary to improving their physical and mental health during the COVID-19 pandemic.