Protecting the psychological well‐being of healthcare workers affected by the COVID‐19 outbreak: Perspectives from China

The novel coronavirus (COVID‐19) pneumonia quickly spread globally and triggered a devastating and deadly outbreak in China and hence globally. According to the National Health Commission of the People's Republic of China (2020), as of April 20, 2020, the accumulated number of confirmed cases of novel coronavirus rose to 83,817 across 31 provincial regions in mainland China and the Xinjiang Production and Construction Corps, with 4,636 deaths; this number has since been revised upward. To a large extent, China has brought the outbreak under control. However, the COVID‐19 pandemic circulates worldwide and have been kept increasing rapidly currently outside China. As of April 20, the accumulated number of confirmed cases of novel coronavirus rushed to 2,404,555 worldwide, with 165,227 deaths (John Hopkins University, 2020). Undoubtedly, the large and unprecedented COVID‐19 outbreak has posed a great threat to both public health and safety and has become a major global public health issue. It is imperative for the international community to strengthen communication, act with unity, and work together in a collective response. Unfortunately, this has not been the case thus far.

More than 100,000 healthcare workers in China have been on the front lines of the fight against the COVID‐19 outbreak. In the fight against the outbreak of COVID‐19, a virus characterized by great infectivity and scientific uncertainties, healthcare workers have been infected with the disease and even died. Health workers are at higher risk of contracting the disease, being exposed to a higher viral load than others. They may have also experienced the fear of being infected or transmitting the virus to their families, friends, or colleagues (Xiang et al., 2020). Thus, healthcare workers, in particular those providing direct care for patients with confirmed or suspected COVID‐19 pneumonia, are vulnerable to mental health problems. The mental well‐being of healthcare workers is critical to overcoming the outbreak of this virus and psychological support for healthcare workers is an integral aspect of relief efforts and should not be overlooked. Based on our experience and previous work, we would like to provide some recommendations regarding psychological support for healthcare workers for the international community during the ongoing outbreak of COVID‐19.

Transparent information, clear communications, and adequate medical supplies and support materials are essential. The extent of the pandemic and scientific uncertainties of the virus have kept the public as well as healthcare workers in a state of fear and panic. Accurate and transparent information provided through regular and accurate updates about the COVID‐19 outbreak is essential (Xiang et al., 2020). Healthcare workers and the public should be provided with updates regarding the treatment process, progress of studies, and health to ease their sense of uncertainty and fear.

The potentially life‐threatening occupational exposure faced by healthcare workers in the face of shortages or inadequacy of personal protective equipment is a major cause of stress in the COVID 19 pandemic (Dawei et al., 2020). A study from Central China Hospital, Wuhan, among 138 hospitalized patients with COVID‐19 pneumonia, 40 healthcare workers (29%) were affected by cross‐infection while providing care to patients confirmed or suspected of being infected in hospitals (Dawei et al., 2020). In Italy, one of the worst‐hit countries, more than 10,000 healthcare workers have been reported being infected, with 69 deaths (Anaao Assomed, 2020). The effectiveness of protective gear has helped to relieve the psychological distress experienced by healthcare workers (Tam et al., 2004). Thus, assuring the needs of healthcare workers on the front lines is of prime importance. An adequate supply of protective items, sufficient food, and support materials, as well as Medicare, Medicaid, and policies supporting all healthcare workers and their families, are imperative (Tam et al., 2004). Healthcare workers also need to feel supported by their management and trust that management has their best interests at heart.

Psychological support and crisis intervention tailored to healthcare workers are needed to alleviate psychological distress. Healthcare workers caring for patients diagnosed with COVID 19 are at a higher risk of developing psychological distress. Taking preventive measures and providing psychological interventions tailored to these healthcare workers can positively affect this distress (Naushad et al., 2019). To date, the Chinese authorities have taken numerous decisive measures to help relieve mental stress related to the ongoing coronavirus outbreak. These measures have included releasing the notification of basic principles for emergency psychological crisis interventions for COVID‐19 pneumonia, providing telephone‐based and internet‐based counseling services and platforms, and providing psychological guidance and services specifically tailored to healthcare workers (National Health Commission of China, 2020).

Regular clinical screening of psychological distress for healthcare workers, especially those working in hospitals providing care to patients diagnosed with COVID 19, is needed to identify those at high risk and direct to treatment services. As we look back at the SARS and other biological outbreaks and disasters, bereaved individuals and their families are most vulnerable to severe mental health problems. Thus, early psychological assessments, additional medical and social support, and continued long‐term interventions are extremely important for healthcare workers who have suffered bereavements of their colleagues and in their own families.

Preventative interdisciplinary and competency‐based disaster training programs for healthcare workers can be effective in improving readiness and mitigating the negative impacts of major incidents (Bajow et al., 2018). Stress or trauma experienced by healthcare workers during the disaster can affect cognitive and technical performance, as well as trigger more preexisting mental health disorders. Implementing psychological skills training programs in advance offers a practical and easy way to improve the performance of healthcare workers under stress (Lauria et al., 2017). Training programs that teach preventive and coping strategies regarding trauma or disaster should be developed and incorporated into regular or preliminary courses for healthcare workers’ routine and continued education, especially for junior medical workers and nurses. These training programs for healthcare workers should include critical topics, such as how to recognize early signs and risk factors of psychological distress, emotion management, coping strategies for stress, peer support for colleagues, and available resources for social and professional support.

Overall, healthcare workers, and in particular those providing care for patients with confirmed or suspected COVID‐19, are, as a group, the most vulnerable to mental health disorders. However, to date, the mental wellbeing of healthcare workers affected by the COVID‐19 outbreak has not drawn enough attention worldwide. The mental wellbeing of healthcare workers should be a fundamental goal and critical aspect of public health and safety. Therefore, promptly establishing and implementing a long‐term psychological relief mechanism that integrates psychological assessment, treatment, support, training, and services for healthcare workers should be one of the most crucial and pressing missions within the health emergency response to the COVID‐19 outbreak. As COVID‐19 is an uneven epidemic at the global level, countries and communities have different contexts and require a tailored response; our experience can only be seen as a reference for the international community and not as a complete solution.