| Event |
Impact on clinician resilience |
Applicability to Covid-19 |
Lessons learned |
Covid-19 (2019 – present)
Ongoing Covid-19 (SARS-CoV-2) global pandemic.
|
In a study of Health Care Workers
(HCW’s) in China, participants
experienced the following symptoms:
- 50.4% reported depression
- 44.6% reported anxiety
- 34.0% reported insomnia
- 71.5% reported distress1
|
|
- In the same study (of which 76.7%
of participants
were women) nurses,
women, frontline
HCW’s, clinicians
working in Wuhan, China, reported
more
severe measurements of all mental
health
symptoms than other HCW’s2
|
SARS (Severe Acute Respiratory Syndrome) (2002 – 2004)
SARS (SARS-CoV-1) caused 8096 cases world-wide with 774 deaths,3 and affected 29 different countries.
|
- 18% to 57% of HCW’s reported
significant emotional distress (surveyed
in Canada)4
- 93.5% of emergency medical staff
considered the SARS outbreak to be a
traumatic experience (surveyed in
Taiwan)5
- 70% of nurses developed their own PPE
(surveyed in Taiwan)6
- 89% of HCW’s who were in high-risk
situations reported symptoms of
psychological distress (surveyed in
Hong Kong)7
|
- Personal risk to HCW’s and first responders*
- Risk to general public
- Shortage of personal protective equipment (PPE)
- Increased exposure to trauma
- Large-scale fatalities
- Death of colleagues
- Longevity of the event
- Conflicting information on the virus
- Widespread collective grief
- Long lasting impact to HCW’s and first responders
|
- While high-risk staff were affected by
SARS, the primary determinants of
adverse outcomes were not exposure to
high-risk and high-intensity work
settings (or direct exposure to infected
patients). Rather, the duration of
perceived risk in HCW’s after SARS is
correlated with the severity of adverse
outcomes
- Identifying and supporting HCW’s who
are at a high risk for persistent
psychological consequences is possible
by identifying HCW’s whose perceived
risk has not returned to normal a few
months after the event8
|
HIV/AIDS (Human immunodeficiency virus/acquired immune deficiency syndrome) Epidemic (1981 – present)
Between 1981 and 2018, HIV/AIDS infected 74.9 million people, and resulted in 32.0 million deaths.9 It is most widespread in sub-Saharan Africa.
|
In a study of HCW’s in Malawi, 63% met the criteria for burnout; of those:
- 55% reported moderate-high emotional exhaustion
- 31% reported moderate-high depersonalization
- 46% reported low-moderate sense of professional accomplishment10
|
- Personal risk to HCW’s and first responders
- Risk to general public
- Shortage of PPE
- Increased exposure to trauma
- Large-scale fatalities
- Death of colleagues
- Longevity of the event
- Conflicting information on the virus
- Widespread collective grief
- Long lasting impact to HCW’s and first responders
|
- HCW’s were subject to the social stigma of HIV/AIDS in working closely with infected patients
- Many health care workers perceived a high occupational risk11 (e.g., accidental needle prick) but studies suggest the occupational risk of exposure to HIV/AIDS is low12
|
West-African Ebola Virus Epidemic (2013 – 2016)
The most widespread outbreak of Ebola affected Guinea, Liberia, and Sierra Leone. In total (in countries with widespread transmission) Ebola resulted in 28,652 infections and 11,325 deaths.13
|
In a study of HCW’s in Sierra Leone, those who worked directly with Ebola patients (nurses, red zone cleaners, blood-team members) had the following significant psychological symptoms:
- Obsession-compulsion
- Interpersonal sensitivity
- Paranoid ideation14
|
- Personal risk to HCW’s and first responders
- Risk to general public
- Shortage of PPE
- Increased exposure to trauma
- Large-scale fatalities
- Death of colleagues
- Longevity of the event
- Long lasting impact to HCW’s and first responders
|
- HCW’s were subject to the social stigma of Ebola in working closely with infected patients. Some were even physically assaulted: eight HCW’s in Guinea were killed for raising awareness on Ebola15
- In a study of Ebola in Liberia, resilience in staff was identified as an important attribute of a strong health care system (which requires long-term investment, and attention)16
|
Hurricane Maria (09/2017)
Maria was a deadly category five hurricane affecting Dominica, Puerto Rico, and St. Croix and resulted in an estimated 3000 deaths.17
|
A year after Hurricane Maria (in Puerto Rico):
- 49% of HCW’s experienced post-traumatic stress disorder (PTSD)
- 32% of HCW’s experienced anxiety18
|
- Personal risk to HCW’s and first responders
- Risk to general public
- Increased exposure to trauma
- Large-scale fatalities
- Widespread collective grief
- Long lasting impact to HCW’s and first responders
|
- Mental health and health care providers have higher rates of PTSD symptoms as compared to the general public in post-disaster settings. These rates typically range from 13% to 32% (as compared with 7.8% in the general public)19
|
September 11th Terror Attacks (09/11/2001)
Four coordinated attacks by terrorist group Al-Qaeda. Resulted in 2977 deaths,20 and thousands of injuries.21
|
- 12.9% of police officers22 who responded to the event still showed symptoms of PTSD 10 years later
- 72.4% of police officers who had PTSD also reported depression and anxiety
In a survey of those who were physically present23 during the world trade center towers attack:
- 13% still experienced symptoms of PTSD 14 years later
- 68% of those with PTSD also reported symptoms of depression24
|
- Personal risk to HCW’s and first responders
- Risk to general public
- Increased exposure to trauma
- Large-scale fatalities
- Widespread collective grief
- Long lasting impact to HCW’s and first responders
|
- 9/11 had long lasting impact on the mental and physical health of first responders, and those who were physically present at the event
|
