Needs, Perceptions and Acute Stress of Healtcare Workers Caring for COVID-19 Patients in South America

Coronavirus 2019 disease - of recent appearance - has become a global public health problem
due to its rapid spread, since 11 March declared by WHO as a pandemic. It represents a real
challenge for health systems, which at first lack information to organize the response to
this situation, effective treatments to combat this lethal infection and with health
personnel lacking the necessary security in their daily work to minimize the risk of
contagion. The COVID-19 pandemic has caused, up to July 21, more than 609,000 deaths
worldwide, 28,422 in Spain. The number of professionals suffering from COVID-19 is high. In
Spain it accounts for more than 20% of the total number of people infected.

In this way, health professionals have been taking on a notable role without hardly any
intention of doing so. Situations of constant uncertainty and emotional distress have posed a
risk to patients and to the quality of care, making health professionals the second most
affected by SARS-CoV-2 (COVID-19), which also requires special biosecurity and protection
measures.

In a global survey, 52% of the 2711 health workers included reported that at least 1 standard
PPE piece was out of stock. For example, in the United States, the Food and Drug
Administration and the Centers for Disease Control and Prevention have taken several steps to
optimize the use of PPE due to its scarcity. Although professionals in Germany consider that
they have been well prepared for the pandemic, there are substantial differences in the
availability of PPE depending on the health professional and the setting (outpatient or acute
care hospitals). In Spain, 54% of primary health care workers reported that they were not
adequately trained to use PPE. No similar studies we found in the local context of South
American countries.

Although the incidence of the pandemic has expanded differently in different geographical
areas of each country, most hospitals and health centres around the world have had to
reorganise themselves to prioritise the care of COVID-19 patients, breaking with their usual
work dynamics. To this cause of work stress must be added the uncertainty in which decisions
have had to be made and the lack of resources both to treat patients adequately and to
protect against possible contagion. Reactions of compassionate fatigue, post-traumatic
stress, and moral damage have been observed among health professionals, which has depended on
the expansion of the pandemic, available means, and individual differences in stress
response.

These types of responses and reactions to this crisis are natural and affect all staff and
all professional levels, including care support staff (IT, supplies, cleaning, etc.). The
opposite would be difficult to explain. However, the key question is not the number of
professionals who have been emotionally affected as a result of their care work, a
circumstance that is aggravated in this crisis but is inherent to the work they do, but
rather how many are unable to recover, how their resilience is evolving or to what extent
they are able to cope with a possible new outbreak.

Most studies have analysed the emotional responses in a short period of time (approximately
one week) coinciding with a specific stage of the crisis. However, studies on community
coping with catastrophic situations have described that the psychological response evolves
over time resulting in: impact phase, heroic (intensification of efforts), honeymoon
(optimism), disillusionment (fatigue) and restoration (recovery pre-crisis levels).
Therefore, it is expected that the effects of the pandemic on the psychological and emotional
well-being of health professionals will vary as the pandemic evolves.