The ongoing pandemic of the novel coronavirus is unprecedented in many ways. While the circumstances of Covid-19 continue to present unique challenges for health care workers, we can learn from, and set appropriate expectations for the impact that Covid-19 will have on clinician resilience based on key historical events. This table compiles data on the adverse outcomes that prior events have had on clinician resilience, details applicability, and lessons learned for each.
*The bullets that are bolded in the “Applicability to Covid-19” column are the most relevant applicable aspects of the event.
1 “Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019,” JAMA Network,https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229
3 “SARS Basic Fact Sheet,” CDC, https://www.cdc.gov/sars/about/fs-sars.html
4“Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak,” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291360/
5“The psychological effect of severe acute respiratory syndrome on emergency department staff,” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658141/
6“Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome,” Science Direct,
7“Psychological Effects of the SARS Outbreak in Hong Kong on High-Risk Health Care Workers,” NIH, https://pubmed.ncbi.nlm.nih.gov/15283534/
8“Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak,” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291360/
9“Global HIV & AIDS Statistics – 2019 Fact Sheet,” UNAIDS, https://www.unaids.org/en/resources/fact-sheet
10“Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi,” PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192983
11“Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho,” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642438/
12“HIV and Occupational Exposure,” CDC, https://www.cdc.gov/hiv/workplace/healthcareworkers.html
13“2014-2016 Ebola Outbreak in West Africa,” CDC, https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html
14“Prevalence of psychological symptoms among Ebola survivors and healthcare workers during the 2014-2015 Ebola outbreak in Sierra Leone: a cross-sectional study,” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355054/
15“Psychosocial effects of an Ebola outbreak at individual, community and international levels,” WHO,
16“Beyond the crisis: did the Ebola epidemic improve resilience of Liberia’s health system?,” Oxford Academic, https://academic.oup.com/heapol/article/32/suppl_3/iii40/4621473
17“A Year After Hurricane Maria, Puerto Rico Finally Knows How Many People Died,” The Atlantic, https://www.theatlantic.com/politics/archive/2018/08/puerto-rico-death-toll-hurricane-maria/568822/
18“Many responders in emotional distress one year after hurricane in Puerto Rico, study finds,” Illinois New Bureau, https://news.illinois.edu/view/6367/807893
20“September 11 Terror Attacks Fast Facts,” CNN, https://www.cnn.com/2013/07/27/us/september-11-anniversary-fast-facts/index.html
21“9/11 death and injury toll still rising,” USA Today, https://www.usatoday.com/story/news/2015/09/09/911-death-and-injury-total-still-rising/71943340/
22First Responders to the attacks, comparable with health care workers.
23All of those who were physically present; includes civilians, first responders, etc.
24“PTSD in Survivors of 9/11,” Psychology Today, https://www.psychologytoday.com/us/blog/media-spotlight/201810/ptsd-in-survivors-911
|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:|
|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.
|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:|
|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:|
|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):|
|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
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