Korean J healthc assoc Infect Control Prev.  2023 Jun;28(1):50-63. 10.14192/kjicp.2023.28.1.50.

Guidelines for Infection and Burnout Prevention in COVID-19 Healthcare Workers

• Park SY
• Cheong HS
• Kwon KT
• Sohn KM
• Heo ST
• Lee S
• Chung US
• Lee SH

• KMID: 2543135
• DOI: http://doi.org/10.14192/kjicp.2023.28.1.50

Abstract

We developed the following guidelines as part of a 2020 research project supported by the Ministry of Health and Welfare, titled “Health impact assessment of healthcare workers (HCWs) undertaking coronavirus disease 2019 (COVID-19) treatment and management in Korea: Identifying problems and researching effective solutions” (HC20C0003). We created these guidelines to address serious problems posed by infection and burnout among HCWs during COVID-19 response measures throughout the extended pandemic period. We formulated the guidelines using a systematic review and collated them with the latest literature to present interventions for the prevention of infection and burnout among COVID-19 HCWs. These guidelines will shed light on the gravity of infection and burnout among COVID-19 HCWs and include potential prevention strategies.

Keyword

SARS-CoV-2; Health personnel; Mental health; Infection control

Reference

1. Korea Disease Control. Coronavirus (COVID-19), Republic of Korea. https://ncov.kdca.go.kr/en. (Updated on 5 March 2022).

2. Kim B, Park SY, Jung DS, Jung SI, Oh WS, Kim SW, et al. 2020; What should we prepare for the next coronavirus disease 2019 outbreak? A survey on the opinions of infectious diseases specialists in South Korea. Korean J Intern Med. 35:1270–8. DOI: 10.3904/kjim.2020.222. PMID: 32961636. PMCID: PMC7652668.

3. Jang Y, Park SY, Kim B, Lee E, Lee S, Son HJ, et al. 2020; Infectious diseases physician workforce in Korea. J Korean Med Sci. 35:e428. DOI: 10.3346/jkms.2020.35.e428. PMID: 33350186. PMCID: PMC7752260.

4. Kwon HH, Kim HI, Kwon KT, Hwang S, Kim SW, Kim Y, et al. 2022; Healthcare workforce response to the coronavirus disease outbreak in Daegu, Korea: a multi-center, cross-sectional survey. Infect Chemother. 54:298–307. DOI: 10.3947/ic.2022.0031. PMID: 35706078. PMCID: PMC9259921.

5. Billings J, Ching BCF, Gkofa V, Greene T, Bloomfield M. 2021; Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis. BMC Health Serv Res. 21:923. DOI: 10.1186/s12913-021-06917-z. PMID: 34488733. PMCID: PMC8419805.

6. Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A, et al. 2008; Incorporating considerations of resources use into grading recommendations. BMJ. 336:1170–3. Erratum in: BMJ 2008;336:0-c. DOI: 10.1136/bmj.39504.506319.80. PMID: 18497416. PMCID: PMC2394579.

7. Busch IM, Moretti F, Mazzi M, Wu AW, Rimondini M. 2021; What we have learned from two decades of epidemics and pandemics: a systematic review and meta-analysis of the psychological burden of frontline healthcare workers. Psychother Psychosom. 90:178–90. DOI: 10.1159/000513733. PMID: 33524983. PMCID: PMC8018214.

8. Park C, Hwang JM, Jo S, Bae SJ, Sakong J. 2020; COVID-19 outbreak and its association with healthcare workers' emotional stress: a cross-sectional study. J Korean Med Sci. 35:e372. DOI: 10.3346/jkms.2020.35.e372. PMID: 33107230. PMCID: PMC7590650.

9. Park SY, Kim B, Jung DS, Jung SI, Oh WS, Kim SW, et al. 2020; Psychological distress among infectious disease physicians during the response to the COVID-19 outbreak in the Republic of Korea. BMC Public Health. 20:1811. DOI: 10.1186/s12889-020-09886-w. PMID: 33246426. PMCID: PMC7691971.

10. Patel RS, Bachu R, Adikey A, Malik M, Shah M. 2018; Factors related to physician burnout and its consequences: a review. Behav Sci (Basel). 8:98. DOI: 10.3390/bs8110098. PMID: 30366419. PMCID: PMC6262585.

11. Theorell T. 2020; COVID-19 and working conditions in health care. Psychother Psychosom. 89:193–4. DOI: 10.1159/000507765. PMID: 32299083. PMCID: PMC7206352.

12. Dalmasso G, Di Prinzio RR, Gilardi F, De Falco F, Vinci MR, Camisa V, et al. 2021; Effectiveness of psychological support to healthcare workers by the occupational health service: a pilot experience. Healthcare (Basel). 9:732. DOI: 10.3390/healthcare9060732. PMID: 34198556. PMCID: PMC8231947.

13. Geoffroy PA, Le Goanvic V, Sabbagh O, Richoux C, Weinstein A, Dufayet G, et al. 2020; Psychological support system for hospital workers during the Covid-19 outbreak: rapid design and implementation of the Covid-psy hotline. Front Psychiatry. 11:511. DOI: 10.3389/fpsyt.2020.00511. PMID: 32670100. PMCID: PMC7326137.

14. Stratton E, Lampit A, Choi I, Calvo RA, Harvey SB, Glozier N. 2017; Effectiveness of eHealth interventions for reducing mental health conditions in employees: a systematic review and meta-analysis. PLoS One. 12:e0189904. DOI: 10.1371/journal.pone.0189904. PMID: 29267334. PMCID: PMC5739441.

15. Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. 2020; Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 369:m1642. DOI: 10.1136/bmj.m1642. PMID: 32371466. PMCID: PMC7199468.

16. Lee SH, Noh JW, Kim Y, Ryoo HW, Park KH, Park SY, et al. 2022; Expert consensus on measures to promote physical and psychological health among COVID-19-related healthcare workers in Korea using Delphi technique. Infect Chemother. 54:247–57. DOI: 10.3947/ic.2021.0137. PMID: 35706073. PMCID: PMC9259905.

17. Min HS, Moon S, Jang Y, Cho I, Jeon J, Sung HK. 2021; The use of personal protective equipment among frontline nurses in a nationally designated COVID-19 hospital during the pandemic. Infect Chemother. 53:705–17. DOI: 10.3947/ic.2021.0094. PMID: 34951529. PMCID: PMC8731245.

18. Chan AO, Huak CY. 2004; Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med (Lond). 54:190–6. DOI: 10.1093/occmed/kqh027. PMID: 15133143. PMCID: PMC7107861.

19. Blake H, Bermingham F, Johnson G, Tabner A. 2020; Mitigating the psychological impact of COVID-19 on healthcare workers: a digital learning package. Int J Environ Res Public Health. 17:2997. DOI: 10.3390/ijerph17092997. PMID: 32357424. PMCID: PMC7246821.

20. Lan J, Song Z, Miao X, Li H, Li Y, Dong L, et al. 2020; Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol. 82:1215–6. DOI: 10.1016/j.jaad.2020.03.014. PMID: 32171808. PMCID: PMC7194538.

21. Youakim S. 2007; Adverse reactions associated with respirator fit testing of healthcare workers in British Columbia, Canada: a review of compensation claim cases. Arch Environ Occup Health. 62:197–200. DOI: 10.3200/AEOH.62.4.197-200. PMID: 18458024.

22. Hu K, Fan J, Li X, Gou X, Li X, Zhou X. 2020; The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltimore). 99:e20603. DOI: 10.1097/MD.0000000000020603. PMID: 32541493. PMCID: PMC7302613.

23. Long H, Zhao H, Chen A, Yao Z, Cheng B, Lu Q. 2020; Protecting medical staff from skin injury/disease caused by personal protective equipment during epidemic period of COVID-19: experience from China. J Eur Acad Dermatol Venereol. 34:919–21. DOI: 10.1111/jdv.16388. PMID: 32441424. PMCID: PMC7280671.

24. Pacis M, Azor-Ocampo A, Burnett E, Tanasapphaisal C, Coleman B. 2020; Prophylactic dressings for maintaining skin integrity of healthcare workers when using N95 respirators while preventing contamination due to the novel coronavirus: a quality improvement project. J Wound Ostomy Continence Nurs. 47:551–7. DOI: 10.1097/WON.0000000000000713. PMID: 33201140. PMCID: PMC7678667.

25. Chowdhury MM, Bevan N, Ryan K. 2020; Covid-19: virtual occupational skin health clinics for healthcare workers. BMJ. 369:m2281. DOI: 10.1136/bmj.m2281. PMID: 32554389.

26. Choudhury A, Singh M, Khurana DK, Mustafi SM, Ganapathy U, Kumar A, et al. 2020; Physiological effects of N95 FFP and PPE in healthcare workers in COVID intensive care unit: a prospective cohort study. Indian J Crit Care Med. 24:1169–73. DOI: 10.5005/jp-journals-10071-23671. PMID: 33446967. PMCID: PMC7775948.

27. Jose S, Cyriac MC, Dhandapani M. 2021; Health problems and skin damages caused by personal protective equipment: experience of frontline nurses caring for critical COVID-19 patients in intensive care units. Indian J Crit Care Med. 25:134–9. DOI: 10.5005/jp-journals-10071-23713. PMID: 33707889. PMCID: PMC7922454.

28. Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. 2006; Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand. 113:199–202. DOI: 10.1111/j.1600-0404.2005.00560.x. PMID: 16441251. PMCID: PMC7159726.

29. Battista RA, Ferraro M, Piccioni LO, Malzanni GE, Bussi M. 2021; Personal Protective Equipment (PPE) in COVID 19 pandemic: related symptoms and adverse reactions in healthcare workers and general population. J Occup Environ Med. 63:e80–5. DOI: 10.1097/JOM.0000000000002100. PMID: 33298757. PMCID: PMC7864606.

30. Williams J, Cichowicz JK, Hornbeck A, Pollard J, Snyder J. The physiological burden of prolonged PPE use on healthcare workers during long shifts. https://blogs.cdc.gov/niosh-science-blog/2020/06/10/ppe-burden. (Updated on 10 June 2020).

31. Sprecher AG, Caluwaerts A, Draper M, Feldmann H, Frey CP, Funk RH, et al. 2015; Personal protective equipment for filovirus epidemics: a call for better evidence. J Infect Dis. 212 Suppl 2:S98–100. DOI: 10.1093/infdis/jiv153. PMID: 25821225. PMCID: PMC4564541.

32. World Health Organization. Occupational safety and health in public health emergencies: a manual for protecting health workers and responders. https://www.who.int/publications/i/item/9789241514347. (Updated on 23 May 2018).

33. National Response Team (US). Guidance for managing worker fatigue during disaster operations. https://www.cdc.gov/niosh/topics/oilspillresponse/pdfs/NRT-Fatigue-for-Emergency-Workers.pdf. (Updated on 30 April 2009).

34. Jones Y, Durand V, Morton K, Ottolini M, Shaughnessy E, Spector ND, et al. 2020; Collateral damage: how COVID-19 is adversely impacting women physicians. J Hosp Med. 15:507–9. DOI: 10.12788/jhm.3470. PMID: 32804615. PMCID: PMC7518136.

35. Çağlar A, Kaçer İ, Hacımustafaoğlu M, Öztürk B, Öztürk K. 2022; Symptoms associated with personal protective equipment among frontline health care professionals during the COVID-19 pandemic. Disaster Med Public Health Prep. 16:987–90. DOI: 10.1017/dmp.2020.455. PMID: 33208212. PMCID: PMC7985640.

36. Centers for Disease Control. COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#health-care-personnel. (Updated on 8 December 2022).

37. EpiCentro. COVID-19 integrated surveillance data in Italy. https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-dashboard. (Updated on 8 December 2022).

38. Kim JH. Number of nurses confirmed COVID-19, followed by doctors, dentists, and oriental doctors. Medical Tribune. http://www.medical-tribune.co.kr/news/articleView.html?idxno=101211. (Updated on 16 July 2021).

39. Gómez-Ochoa SA, Franco OH, Rojas LZ, Raguindin PF, Roa-Díaz ZM, Wyssmann BM, et al. 2021; COVID-19 in health-care workers: a living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. Am J Epidemiol. 190:161–75. Erratum in: Am J Epidemiol 2021;190:187. DOI: 10.1093/aje/kwaa191. PMID: 32870978. PMCID: PMC7499478.

40. Suárez-García I, Martínez de Aramayona López MJ, Sáez Vicente A, Lobo Abascal P. 2020; SARS-CoV-2 infection among healthcare workers in a hospital in Madrid, Spain. J Hosp Infect. 106:357–63. DOI: 10.1016/j.jhin.2020.07.020. PMID: 32702465. PMCID: PMC7371579.

41. Wu Z, McGoogan JM. 2020; Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 323:1239–42. DOI: 10.1001/jama.2020.2648. PMID: 32091533.

42. The Lancet. 2020; COVID-19: protecting health-care workers. Lancet. 395:922. DOI: 10.1016/S0140-6736(20)30644-9. PMID: 32199474.

43. Abbas M, Robalo Nunes T, Martischang R, Zingg W, Iten A, Pittet D, et al. 2021; Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control. 10:7. DOI: 10.1186/s13756-020-00875-7. PMID: 33407833. PMCID: PMC7787623.

44. Sikkema RS, Pas SD, Nieuwenhuijse DF, O'Toole Á, Verweij J, van der Linden A, et al. 2020; COVID-19 in health-care workers in three hospitals in the south of the Netherlands: a cross-sectional study. Lancet Infect Dis. 20:1273–80. Erratum in: Lancet Infect Dis 2020;20:e215. DOI: 10.1016/S1473-3099(20)30527-2. PMID: 32622380. PMCID: PMC7332281.

45. Labetoulle R, Detoc M, Gagnaire J, Berthelot P, Pelissier C, Fontana L, et al. 2020; COVID-19 in health-care workers: lessons from SARS and MERS epidemics and perspectives for chemoprophylaxis and vaccines. Expert Rev Vaccines. 19:937–47. DOI: 10.1080/14760584.2020.1843432. PMID: 33107353.

46. Dimcheff DE, Schildhouse RJ, Hausman MS, Vincent BM, Markovitz E, Chensue SW, et al. 2021; Seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among Veterans Affairs healthcare system employees suggests higher risk of infection when exposed to SARS-CoV-2 outside the work environment. Infect Control Hosp Epidemiol. 42:392–8. DOI: 10.1017/ice.2020.1220. PMID: 32962771. PMCID: PMC7578654.

47. Schneider S, Piening B, Nouri-Pasovsky PA, Krüger AC, Gastmeier P, Aghdassi SJS. 2020; SARS-Coronavirus-2 cases in healthcare workers may not regularly originate from patient care: lessons from a university hospital on the underestimated risk of healthcare worker to healthcare worker transmission. Antimicrob Resist Infect Control. 9:192. DOI: 10.1186/s13756-020-00848-w. PMID: 33287908. PMCID: PMC7719852.

48. Chen Y, Tong X, Wang J, Huang W, Yin S, Huang R, et al. 2020; High SARS-CoV-2 antibody prevalence among healthcare workers exposed to COVID-19 patients. J Infect. 81:420–6. DOI: 10.1016/j.jinf.2020.05.067. PMID: 32504745. PMCID: PMC7270786.

49. Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. 2020; Risk factors of healthcare workers with coronavirus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis. 71:2218–21. DOI: 10.1093/cid/ciaa287. PMID: 32179890. PMCID: PMC7184482.

50. Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, et al. 2020; Healthcare workers & SARS-CoV-2 infection in India: a case-control investigation in the time of COVID-19. Indian J Med Res. 151:459–67. DOI: 10.4103/ijmr.IJMR_2234_20. PMID: 32611916. PMCID: PMC7530442.

51. Liu M, Cheng SZ, Xu KW, Yang Y, Zhu QT, Zhang H, et al. 2020; Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study. BMJ. 369:m2195. DOI: 10.1136/bmj.m2195. PMID: 32522737. PMCID: PMC7284314.

52. Stubblefield WB, Talbot HK, Feldstein LR, Tenforde MW, Ur Rasheed MA, Mills L, et al. 2021; Seroprevalence of SARS-CoV-2 among frontline healthcare personnel during the first month of caring for patients with COVID-19-Nashville, Tennessee. Clin Infect Dis. 72:1645–8. DOI: 10.1093/cid/ciaa936. PMID: 32628750. PMCID: PMC7454447.

53. Korea Centers for Disease Control. Response guideline of healthcare facilities for COVID-19. https://ncov.kdca.go.kr/duBoardList.do?brdId=2&brdGubun=28. (Updated on 8 December 2022).

54. He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, et al. 2020; Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 26:672–5. Erratum in: Nat Med 2020;26:1491-3. DOI: 10.1038/s41591-020-1016-z. PMID: 32770170. PMCID: PMC7413015.

55. Hogan CA, Gombar S, Wang H, Röltgen K, Shi RZ, Holubar M, et al. 2021; Large-scale testing of asymptomatic healthcare personnel for severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis. 27:250–4. DOI: 10.3201/eid2701.203892. PMID: 33256889. PMCID: PMC7774535.

56. Roberts SC, Peaper DR, Thorne CD, Sussman LS, Murray TS, Choi SJ, et al. 2021; Mass severe acute respiratory coronavirus 2 (SARS-CoV-2) testing of asymptomatic healthcare personnel. Infect Control Hosp Epidemiol. 42:625–6. Erratum in: Infect Control Hosp Epidemiol 2022;43:1312. DOI: 10.1017/ice.2021.9. PMID: 33487206. PMCID: PMC7853752.

57. Rivett L, idhar S Sr, Sparkes D, Routledge M, Jones NK, Forrest S, et al. 2020; Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. Elife. 9:e58728. DOI: 10.7554/elife.58728.sa1. PMID: 32392129. PMCID: PMC7314537.

58. Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. 2020; COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet. 395:1418–20. Erratum in: Lancet 2020;395:1422. DOI: 10.1016/S0140-6736(20)30917-X. PMID: 32305073. PMCID: PMC7162624.

59. Grassly NC, Pons-Salort M, Parker EPK, White PJ, Ferguson NM. 2020; Comparison of molecular testing strategies for COVID-19 control: a mathematical modelling study. Lancet Infect Dis. 20:1381–9. DOI: 10.1016/S1473-3099(20)30630-7. PMID: 32822577. PMCID: PMC7434438.

60. Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC. 2021; Frequency of routine testing for coronavirus disease 2019 (COVID-19) in high-risk healthcare environments to reduce outbreaks. Clin Infect Dis. 73:e3127–9. DOI: 10.1093/cid/ciaa1383. PMID: 33570097. PMCID: PMC7797732.

61. Lee U, Kim SE, Lee SY, Wi HN, Choi O, Park JW, et al. 2021; Source analysis and effective control of a COVID-19 outbreak in a university teaching hospital during a period of increasing community prevalence of COVID-19. J Korean Med Sci. 36:e179. DOI: 10.3346/jkms.2021.36.e179. PMID: 34155840. PMCID: PMC8216991.

62. Dye TD, Alcantara L, Siddiqi S, Barbosu M, Sharma S, Panko T, et al. 2020; Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study. BMJ Open. 10:e046620. DOI: 10.1136/bmjopen-2020-046620. PMID: 33380488. PMCID: PMC7780430.

63. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. 2020; Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 383:2603–15. DOI: 10.1056/NEJMoa2034577. PMID: 33301246. PMCID: PMC7745181.

64. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. 2021; Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 384:403–16. DOI: 10.1056/NEJMoa2035389. PMID: 33378609. PMCID: PMC7787219.

65. Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. 2021; Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 397:99–111. Erratum in: Lancet 2021;397:98. DOI: 10.3410/f.739172196.793581032. PMID: 33306989. PMCID: PMC7723445.

66. Paris C, Perrin S, Hamonic S, Bourget B, Roué C, Brassard O, et al. 2021; Effectiveness of mRNA-BNT162b2, mRNA-1273, and ChAdOx1 nCoV-19 vaccines against COVID-19 in healthcare workers: an observational study using surveillance data. Clin Microbiol Infect. 27:1699.e5–8. DOI: 10.1016/j.cmi.2021.06.043. PMID: 34265462. PMCID: PMC8275842.

67. Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, et al. 2021; Interim estimates of vaccine effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers - eight U.S. locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep. 70:495–500. DOI: 10.15585/mmwr.mm7013e3. PMID: 33793460. PMCID: PMC8022879.

68. Hall VJ, Foulkes S, Saei A, Andrews N, Oguti B, Charlett A, et al. 2021; COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet. 397:1725–35. DOI: 10.1016/S0140-6736(21)00790-X. PMID: 33901423.

69. Tartof SY, Slezak JM, Fischer H, Hong V, Ackerson BK, Ranasinghe ON, et al. 2021; Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study. Lancet. 398:1407–16. DOI: 10.1016/S0140-6736(21)02183-8. PMID: 34619098.

70. MacDonald NE. 2015; Vaccine hesitancy: definition, scope and determinants. Vaccine. 33:4161–4. DOI: 10.1016/j.vaccine.2015.04.036. PMID: 25896383.

71. Duong MC, Nguyen HT, Duong BT. 2021; Who influences the public intention to get a COVID-19 vaccine and what are the public references and concerns? A population survey in Vietnam. Infect Chemother. 53:753–66. DOI: 10.3947/ic.2021.0122. PMID: 34979606. PMCID: PMC8731250.

72. Li M, Luo Y, Watson R, Zheng Y, Ren J, Tang J, et al. in press 2021; Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review. Postgrad Med J. DOI: 10.1136/postgradmedj-2021-140195. PMID: 37319159.

73. Chun JY, Kim SI, Park EY, Park SY, Koh SJ, Cha Y, et al. 2021; Cancer patients' willingness to take COVID-19 vaccination: a nationwide multicenter survey in Korea. Cancers (Basel). 13:3883. DOI: 10.3390/cancers13153883. PMID: 34359783. PMCID: PMC8345425.

74. Shekhar R, Sheikh AB, Upadhyay S, Singh M, Kottewar S, Mir H, et al. 2021; COVID-19 vaccine acceptance among health care workers in the United States. Vaccines (Basel). 9:119. DOI: 10.3390/vaccines9020119. PMID: 33546165. PMCID: PMC7913135.

75. Bagcchi S. 2020; Stigma during the COVID-19 pandemic. Lancet Infect Dis. 20:782. DOI: 10.1016/S1473-3099(20)30498-9. PMID: 32592670. PMCID: PMC7314449.

76. Brewis A, Wutich A, Mahdavi P. 2020; Stigma, pandemics, and human biology: looking back, looking forward. Am J Hum Biol. 32:e23480. DOI: 10.1002/ajhb.23480. PMID: 32790149. PMCID: PMC7435551.

77. Ransing R, Ramalho R, de Filippis R, Ojeahere MI, Karaliuniene R, Orsolini L, et al. 2020; Infectious disease outbreak related stigma and discrimination during the COVID-19 pandemic: drivers, facilitators, manifestations, and outcomes across the world. Brain Behav Immun. 89:555–8. DOI: 10.1016/j.bbi.2020.07.033. PMID: 32731007. PMCID: PMC7384410.

78. Koh D, Lim MK, Chia SE, Ko SM, Qian F, Ng V, et al. 2005; Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn? Med Care. 43:676–82. DOI: 10.1097/01.mlr.0000167181.36730.cc. PMID: 15970782.

79. Taylor S, Landry CA, Rachor GS, Paluszek MM, Asmundson GJG. 2020; Fear and avoidance of healthcare workers: an important, under-recognized form of stigmatization during the COVID-19 pandemic. J Anxiety Disord. 75:102289. DOI: 10.1016/j.janxdis.2020.102289. PMID: 32853884. PMCID: PMC7434636.

80. Devi S. 2020; COVID-19 exacerbates violence against health workers. Lancet. 396:658. DOI: 10.1016/S0140-6736(20)31858-4. PMID: 32891198. PMCID: PMC7470723.

81. Almutairi AF, Adlan AA, Balkhy HH, Abbas OA, Clark AM. 2018; "It feels like I'm the dirtiest person in the world.": exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia. J Infect Public Health. 11:187–91. DOI: 10.1016/j.jiph.2017.06.011. PMID: 28676285. PMCID: PMC7102804.

82. Muhidin S, Vizheh M, Moghadam ZB. 2020; Anticipating COVID-19-related stigma in survivors and health-care workers: lessons from previous infectious diseases outbreaks - an integrative literature review. Psychiatry Clin Neurosci. 74:617–8. DOI: 10.1111/pcn.13140. PMID: 32889754.

83. Ramaci T, Barattucci M, Ledda C, Rapisarda V. 2020; Social stigma during COVID-19 and its impact on HCWs outcomes. Sustainability. 12:3834. DOI: 10.3390/su12093834.

84. Chaiuk TA, Dunaievska OV. 2020; Fear culture in media: an examination on coronavirus discourse. J Hist Cult Art Res. 9:184–94. DOI: 10.7596/taksad.v9i2.2636.

85. Wu P, Liu X, Fang Y, Fan B, Fuller CJ, Guan Z, et al. 2008; Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. 43:706–12. DOI: 10.1093/alcalc/agn073. PMID: 18790829. PMCID: PMC2720767.

86. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. 2012; Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry. 53:15–23. DOI: 10.1016/j.comppsych.2011.02.003. PMID: 21489421. PMCID: PMC3176950.

87. Gómez-Durán EL, Martin-Fumadó C, Forero CG. 2020; Psychological impact of quarantine on healthcare workers. Occup Environ Med. 77:666–74. DOI: 10.1136/oemed-2020-106587. PMID: 32522757.

88. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. 2020; The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 395:912–20. DOI: 10.1016/S0140-6736(20)30460-8. PMID: 32112714. PMCID: PMC7158942.

89. Sim MR. 2020; The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 77:281–2. DOI: 10.1136/oemed-2020-106567. PMID: 32238444.

90. Seong SJ, Kim HJ, Yim KM, Park JW, Son KH, Jeon YJ, et al. 2021; Differences between the psychiatric symptoms of healthcare workers quarantined at home and in the hospital after contact with a patient with Middle East Respiratory Syndrome. Front Psychiatry. 12:659202. DOI: 10.3389/fpsyt.2021.659202. PMID: 34335322. PMCID: PMC8322759.

91. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. 2020; A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 48:592–8. DOI: 10.1016/j.ajic.2020.03.018. PMID: 32334904. PMCID: PMC7141468.

92. Lee SH, Juang YY, Su YJ, Lee HL, Lin YH, Chao CC. 2005; Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry. 27:352–8. DOI: 10.1016/j.genhosppsych.2005.04.007. PMID: 16168796. PMCID: PMC7132375.

93. Park HJ, Lee OC. 2019; Ethical awareness and decision-making of healthcare providers in response to pandemic influenza - focused on Middle East Respiratory Symptom Coronavirus -. Crisisonomy. 15:19–29. DOI: 10.14251/crisisonomy.2019.15.1.19.

94. Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. 2020; Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care. 9:4904–10. DOI: 10.4103/jfmpc.jfmpc_674_20. PMID: 33209820. PMCID: PMC7652135.

95. Lu W, Wang H, Lin Y, Li L. 2020; Psychological status of medical workforce during the COVID-19 pandemic: a cross-sectional study. Psychiatry Res. 288:112936. DOI: 10.1016/j.psychres.2020.112936. PMID: 32276196. PMCID: PMC7195354.

96. Urooj U, Ansari A, Siraj A, Khan S, Tariq H. 2020; Expectations, fears and perceptions of doctors during Covid-19 pandemic. Pak J Med Sci . 36(COVID19-S4):S37–42. DOI: 10.12669/pjms.36.COVID19-S4.2643. PMID: 32582312. PMCID: PMC7306962.

97. Şahan E, Tangılntız A. 2022; State and trait anxiety among medical staff during the first month of COVID-19 pandemic: a sample from Turkey. Int J Psychiatry Med. 57:338–56. DOI: 10.1177/00912174211042698. PMID: 34435896. PMCID: PMC9209882.

98. Xu J, Liu X, Xiao Y, Fang X, Cheng Y, Zhang J. 2021; Effect of EAP psychological intervention on improving the mental health of medical workers under the novel coronavirus epidemic in China. Front Public Health. 9:649157. DOI: 10.3389/fpubh.2021.649157. PMID: 34395355. PMCID: PMC8355514.

99. Shanafelt T, Ripp J, Trockel M. 2020; Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 323:2133–4. DOI: 10.1001/jama.2020.5893. PMID: 32259193.

100. Kim JS, Choi JS. 2016; Factors influencing emergency nurses' burnout during an outbreak of Middle East respiratory syndrome coronavirus in Korea. Asian Nurs Res. 10:295–9. DOI: 10.1016/j.anr.2016.10.002. PMID: 28057317. PMCID: PMC7104920.

101. Seo YE, Kim HC, Yoo SY, Lee KU, Lee HW, Lee SH. 2020; Factors associated with burnout among healthcare workers during an outbreak of MERS. Psychiatry Investig. 17:674–80. DOI: 10.30773/pi.2020.0056. PMID: 32631034. PMCID: PMC7385211.