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  • Writer's pictureShaiklal Basha, Lead Consultant, TranscendOrg

Caring For the Frontline In Times of COVID-19

Updated: Jun 16, 2020

The rapid spread of SARS-CoV-2 has placed the health systems around the world under severe stress. Understandably, there has been much focus on the effect of the pandemic on the health of the population, as well as the consequences of the potential loss of life due to an overwhelmed public health infrastructure.

However, the effects on frontline medical practitioners have also been equally severe. Healthcare workers are one of the groups at the greatest risk of infection. A recent study by the Indian Journal of Psychiatry says that even in normal times, around 30% of Indian doctors experience depression and almost 80% face the risk of burnout in the early stages of their career. Therefore, even in normal circumstances, healthcare workers show above-threshold levels of stress. “Around 25%, as compared to 15-18% in the general population," says Radhika Bapat, a Pune-based clinical psychologist. This holds true not only for doctors but for the entire caregiving team—ward boys, nursing staff, ambulance drivers, sanitation workers, etc. “You can only imagine what the levels must be like right now. Treating COVID-19 is not just physical, but emotional labour as well," she adds.

Stress due to Bio-security Measures

Healthcare workers who are called upon to assist or treat those with COVID-19 may experience stress related to:

  • Physical strain of using protective equipment (dehydration, heat, exhaustion)

  • Isolation (restrictions on touching others, even after working hours)

  • Constant vigilance in adhering to infection control measures

  • Pressures regarding following clinical protocols (lack of spontaneity)

Stress of Disease Transmission

Stress due to infection control is a significant concern that can be exacerbated by:

  • Common flu and cold symptoms being mistaken for COVID-19

  • An extended symptom-free incubation period

  • A relatively higher mortality rate as compared to influenza

  • Differences between public health priorities and wishes of patients regarding adherence to quarantine protocols

Multiple Personal Demands

The complexity of responding to COVID-19 scenarios may result in conflicting personal and professional demands, including:

  • Continued workload demands conflating with COVID-19 treatment protocols

  • Frequent changes in treatment related protocols

  • Fears about infection and implications for self, patients, and family

  • Inner conflict due to competing personal and professional needs

Stigma Related Stress

Healthcare workers can be affected by both internal and external stigma related to the COVID-

19 virus and its impact, such as:

  • Fear of contact with those treating COVID-19 patients

  • Self-stigma about voicing their needs and fears

  • Misconceptions by neighbourhood/society leading to isolation


A strong service-orientation, time pressures, difficulties in acknowledging or recognizing their own needs, social stigma, and fear of being removed from their duties during a crisis may prevent staff from requesting support even if they are experiencing stress. Given this, employers should be proactive in encouraging supportive care in an atmosphere free of stigma, coercion, and negative consequences.


Self-care for healthcare workers can be complex and challenging, given that people in these roles prioritize the needs of others over their own. Therefore, a self-care strategy should be multi- faceted and phased out properly to support the sense of control and contribution of healthcare providers, without making them feel unrealistically responsible for the lives of patients. The need for service providers to inculcate a spirit of fortitude, patience and hope can be enabled by:

  • Self-monitoring and pacing

  • Creating a constructive routine for personal self-care activities that they enjoy, such as spending time with friends, family and children—online or over the phone, exercising diligently, etc.

  • Working in partnerships or in teams

  • Ensuring brief relaxation/stress management breaks

  • Regular peer consultation and supervision

  • Ensuring accurate information for making decisions

  • Keeping anxieties conscribed to actual threats

  • Focusing their efforts on what is within their power

At the same time, they should avoid:

  • Working too long by themselves without checking in with colleagues

  • Feeling that they are not doing enough

  • Excessive intake of sweets and caffeine

Fighting Stress through Preparedness

Healthcare providers are accustomed to participating in frequent formal and informal trainings. Additional organizational efforts to build clinical competency during the outbreak can provide a measure of stress reduction. Service providers need to be trained in a variety of related subjects that include:

  • Epidemiology

  • Infection prevention and control

  • Biomedical Waste Management

  • Use of Personal Protective Equipment

  • Quarantine and isolation

  • Laboratory sample collection and testing

  • Clinical management of COVID-19

  • ICU care and ventilation management

In order to increase their sense of self-efficacy, frontline workers should participate in experiential simulated learnings such as:

  • Practicing response roles

  • Handling mass fatalities

  • Understanding surge-related triage decision trees

  • Practicing CPR on COVID patients

Staff in healthcare facilities may also want to meet with leaders to discuss the importance of stress management and psychosocial support for the workforce. Discussions could include the possibility of frontline stress control teams, appropriate work/rest schedules, and support for the needs of providers' family members. It is important that the channels of communication with the management and supervisory staff are always kept open.


After caring for those with COVID-19—especially quarantined patients—a readjustment period should be expected. Healthcare providers will need to commit to making personal reintegration a priority. This includes:

  • Seeking out and sharing social support, which may need to occur virtually

  • Increasing supervision, consultation, and collegial support

  • Scheduling time off work for gradual re-integration into personal life

Avoiding negative coping strategies such as:

1. Use of alcohol, illicit drugs, or excessive amounts of prescription drugs

2. Suddenly making big life changes

3. Keeping too busy

4. Viewing helping others as more important than self-care

5. Not wanting to talk about work experiences with others

Stress is a normal part of life. It gets exacerbated if presenting situations are not appropriately handled. It is important for healthcare providers to look out for signs of stress and take preventive as well as remedial measures to alleviate it. If stress persists for longer than two to three weeks and interferes with functioning, healthcare workers should consider participating in formal mental health treatment programs.

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