Table.

Abraham Maslow’s hierarchy of needs⁴⁶ for frontline clinician stressors and potential solutions in the COVID-19 era.

Maslow’s Level of Need	Examples	COVID-19 Concerns	Recommended Strategies
Level 1: physiologic	Food, sleep, physical and mental health	Extra workload demands around COVID-19 preparation and treatment Physical strain of protective equipment (dehydration, heat, exhaustion) Housing needs during isolation/quarantine periods Inadequate or disrupted sleep patterns Physical symptoms of COVID-19 disease for health care workers who contract the virus	Individual Time for basic bodily care and refreshment/relaxation and stress-management breaks Avoid maladaptive behaviors with negative physiologic effects (eg, excessive alcohol, prescription drugs) Physical health and fitness (exercise programs, walking outside, mobile applications) Online mental health technologies (telepsychiatry, mobile applications, PTSD Coach) Administrative Provision of respite for staff members requiring isolation (eg, housing, child care) Supplementation of readily available water and nutritious food while on clinical duty Careful attention to individual work schedules to maximize rest and sleep between shifts Facilitation of testing and treatment for individuals who develop symptoms or become ill Virtual wellness and information town halls Early and confidential recognition, detection, and referral for treatment of psychiatric symptoms (eg, cognitive-behavioral therapy)
Level 2: safety	Personal security, financial security, resources	Fears of personal safety around infection and lack of adequate personal protective equipment Lack of clarity around viral transmissibility (airborne versus droplet) Concerns for job security and potential debt, especially if an individual becomes infected with COVID-19 Feelings of being undersupported and underequipped to provide safe care	Individual Peer consultation and supervision of PPE donning/doffing Administrative Alternative strategies to produce/distribute PPE (local manufacturers, donations, recycling) Clear and consistent messaging and shared decisionmaking with health care workers regarding infection rates, risk, and strategies to minimize risk Contingency plans for health care workers who cannot work during quarantine period or if they fall ill after contracting COVID-19 to provide job and financial security without negative consequences
Level 3: love and belonging	Friendship, family, social connectedness	Possible separation from family members Risk of exposure to loved ones, especially those who are at high risk Physical isolation from friends, colleagues	Individual Increase peer social support with regular contact with colleagues, family, and friends Seek out and share social support virtually Administrative Acknowledgment and affirmation of health care worker stressors and concerns Creation of specialized collaborative partnerships or teams focusing on COVID-19 Online-based group support networks and mental health checks Resources for significant others and family members of health care workers to support their loved ones during epidemic
Level 4: esteem	Respect, status, self-determination/control, fairness	Pressure to serve as source of definitive information for nonmedical family and friends Constant pressure to maintain clinical acumen with increasing volume and acuity Ethical challenges in triaging resources (ventilators, staffing, bed capacity)	Individual Limit worries to actual (rather than anticipatory) threats Foster a spirit of patience, fortitude, tolerance, and hope Channel concerns through productive output (scholarly efforts, peer coaching, teaching, educational materials on COVID-19) Administrative Create specialized ethics teams/protocols for information and mentorship in decisionmaking Use patient-centered resources for difficult decisions Highlight exemplary behavior and celebrate individual contributions and efforts Create clear, transparent, fair, equitable, and accessible policies
Level 5: self-actualization	Desire for higher achievement	Tension between public health priorities and individual patient care Advocacy for larger systems changes to minimize effects of the epidemic	Individual Focus on efforts within one’s individual control Accept situations one cannot change Contribute to productive efforts for change Administrative Sharing of information across institutions/systems Peer mentorship for clinical, administrative, and academic duties related to COVID-19 Creation of volunteering, innovation, and service opportunities to support response efforts (eg, creation of new devices/tools, clinical strategies)

PPE, Personal protective equipment.