Lessons From the First Wave of COVID-19: Work-Related Consequences, Clinical Knowledge, Emotional Distress, and Safety-Conscious Behavior in Healthcare Workers in Switzerland

Abstract

The coronavirus disease (COVID-19) imposes an unusual risk to the physical and mental health of healthcare workers and thereby to the functioning of healthcare systems during the crisis. This study investigates the clinical knowledge of healthcare workers about COVID-19, their ways of acquiring information, their emotional distress and risk perception, their adherence to preventive guidelines, their changed work situation due to the pandemic, and their perception of how the healthcare system has coped with the pandemic. It is based on a quantitative cross-sectional survey of 185 Swiss healthcare workers directly attending to patients during the pandemic, with 22% (n = 40) of them being assigned to COVID-19-infected patients. The participants answered between 16th June and 15th July 2020, shortly after the first wave of COVID-19 had been overcome and the national government had relaxed its preventive regulations to a great extent. The questionnaire incorporated parts of the "Standard questionnaire on risk perception of an infectious disease outbreak" (version 2015), which were adapted to the case of COVID-19. Clinical knowledge was lowest regarding the effectiveness of standard hygiene (p < 0.05). Knowledge of infectiousness, incubation time, and life-threatening disease progression was higher, however still significantly lower than regarding asymptomatic cases and transmission without physical contact (p < 0.001). 70% (95%-confidence interval: 64-77%) of the healthcare workers reported considerable emotional distress on at least one of the measured dimensions. They worried significantly more strongly about patients, elderly people, and family members, than about their own health (p < 0.001). Adherence to (not legally binding) preventive guidelines by the government displayed patterns such that not all guidelines were followed equally. Most of the participants were faced with a lack of protective materials, personnel, structures, processes, and contingency plans. An increase in stress level was the most prevalent among the diverse effects the pandemic had on their work situation. Better medical equipment (including drugs), better protection for their own mental and physical health, more (assigned) personnel, more comprehensive information about the symptoms of the disease, and a system of earlier warning were the primary lessons to be learned in view of upcoming waves of the pandemic.

Keywords: COVID-19; clinical knowledge; healthcare workers; mental health; prevention; risk perception; stress; work situation.

FIGURE 1

Daily new confirmed COVID-19 cases for Switzerland and effective reproductive number (Re) as estimated and depicted by the Swiss Federal Institute (ETH) Zürich (1st March until 23rd December 2020). Graph retrieved from: https://ibz-shiny.ethz.ch/covid-19-re-international/ (ETH, 23rd December 2020).

FIGURE 2

Emotional distress and risk perception of healthcare workers in a survey from Switzerland, June 16th until July 15th 2020 (n = 185). (A) Emotional distress as measured on a four-point Likert scale in response to the question “how worried do you feel because of the possibility of [the respective scenario]?”. (B) Risk perception as measured on a four-point Likert scale. The participants were asked “would COVID-19 be a threat” in the respective regard “if no extraordinary measures were undertaken in Switzerland other than the usual measures against influenza (i.e., no prohibition of social gatherings/events, no lockdown, no extraordinary measures in hospitals)?” (A,B) C-19 stands for COVID-19.

FIGURE 3

Travel plans given the first wave of the COVID-19 pandemic compared to without the pandemic according to healthcare workers in a survey from Switzerland, June 16th until July 15th 2020 (n = 185). Participants were asked “will you travel abroad for private reasons before the end of 2020?” and “would you have traveled abroad for private reasons before the end of 2020 if the COVID-19 pandemic had not occurred?”, respectively.

FIGURE 4

Cause of the outbreak of the COVID-19 pandemic according to healthcare workers in a survey from Switzerland, June 16th until July 15th 2020 (n = 185). Participants were asked “what is the cause of the outbreak of the COVID-19 pandemic?”