here has been wide recognition of the value of enabling access to longer courses of medications and
multi-month refills, particularly among Human immunodeficiency virus (HIV) and Tuberculosis (TB)
programs;
In the context of COVID-19, the use of community health workers, health extension workers, and
other technologies that facilitate home-based care present important opportunities to continue
providing services outside healthcare facilities;
Various technical guidance pieces have highlighted the role of dedicated clinic spaces for COVID-19
patients to reduce exposure risks among already vulnerable patient groups and help allay fears
about seeking needed services during this crisis.
https://jme.bmj.com/content/47/5/318
https://bmjleader.bmj.com/content/5/2/130
Burnout among nurses and physicians was already a concern in most countries, but now with COVID19 executives stress the need to address the well-being of staff is more than ever critical. In Norway,
a national committee was established to secure sufficient amounts of personal protective
equipment in advance for frontline staff, so they did not have to worry about infection risk. Frontline
staff should not only be protected against the infection, but also against the stress and uncertainty.
Hospitals are now actively expanding their psychological services to support their staff. Executives
understood early on that this crisis is going to be different than a critical incident (eg, major car
accident, natural disaster), and will have long lasting effects. The leadership at Cambridge University
Hospitals reached out to people in humanitarian relief to learn from them how they sustain working
in similar stressful conditions and used their input to strengthen the current support structures and
processes for its staff.
Resource allocation based on data-driven models
To estimate required surge capacity during potential future waves and its implications for nonCOVID-19 care, hospitals are scaling up their ability in using data-driven approaches for resource
allocation. For example, infectious diseases specialists in Cambridge University Hospitals worked
with the hospital’s operations, finance and strategy teams—supported by engineers from the
University of Cambridge—to create a statistical model for predicting and tracking actual bed activity
and capacity, and to identify and optimally allocate staff, beds and theatres to increase capacity in
non-COVID-19 services as COVID-19 hospitalisations begin to fall. This is particularly important as the
hospital has lost more than 10% of its inpatient capacity from reducing occupancy on some wards
and creating spaces for staff to don and doff personal protective equipment. The statistical model
collects real-time data and is constantly fed with new epidemiological data from other countries. A
similar model to inform planning and bed capacity within each hospital has been developed in
Norway, with central and regional coordination to manage patient flow and equally spread the
burden across hospitals, particularly for patients with COVID-19 with intensive care needs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162741/
The physical and psychological well-being of our HCWs are being tested as patient loads continue to
increase and fellow co-workers become infected with COVID-19, contributing significantly to
burnout among healthcare workers [[16], [17], [18]]. The effects of this increase in workload in the
dangerous atmosphere of this pandemic are the decline in the mental health of our HCW [16,17].
Throughout this pandemic HCWs have had to self-isolate from their own families for fear of
transmitting the virus to their loved ones [17]. There will be guilt when a family member becomes
infected. Our HCWs are bravely living in a constant state of psychological stress founded in fear; fear
of transmitting the virus and stress of the unknown aspects of this virus. The long-term effects of
stress can result in post-traumatic stress disorder, anxiety and depression [19]. Thus, it is imperative
to employ productive strategies to care for the mental health of our HCW.
The mental health needs of our providers must be addressed with the same priority of their physical
health. Keeping our HCWs updated on the latest information diminishes the fear of uncertainty and
negative emotions associated with the virus [20]. This entails frequent information sessions on the
specific details of the virus, practicing ethical decision making, and how to effectively use hospital
resources [19]. By ensuring that the entire team maintains the same understanding of information
and protocols, a certain amount of order can be maintain to curtail the negative impacts of this
crisis. Additionally, establishing break time will allow for HCWs time to take care of themselves.
Another recommendation centers on creating healthcare staff reserves to relieve those on duty
before exhaustion and strain sets in resulting in anxiety and depression, affecting the quality of
healthcare delivery. This can be done in several ways, including incorporating outside registered
nurses into the hospital system, re-employing HCWs who recently retired, and adding in the newly
matched fourth year medical students. As this crisis progresses it is imperative to continue to
evaluate the well-being of our HCW and implement effect measures to care for their mental health.
This requires the implementation of accessible counseling services and effective measures to care
for their mental well-being in order to preserve their health.
https://www.frontiersin.org/articles/10.3389/fpubh.2020.577499/full 6
The protection of HCWs and appropriate training are of paramount importance in the fight against
COVID-19. We hope our protocol of measures, which successfully controlled COVID-19 infection in
our orthopedics department, can help HCWs minimize the risks of infection in medical facilities
around the world
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30644-9/fulltext
Reports from medical staff describe physical and mental exhaustion, the torment of difficult triage
decisions, and the pain of losing patients and colleagues, all in addition to the infection risk.
As the pandemic accelerates, access to personal protective equipment (PPE) for health workers is a
key concern. Medical staff are prioritised in many countries, but PPE shortages have been described
in the most affected facilities. Alongside concerns for their personal safety, health-care workers are
anxious about passing the infection to their families.
But health-care workers, unlike ventilators or wards, cannot be urgently manufactured or run at
100% occupancy for long periods. It is vital that governments see workers not simply as pawns to be
deployed, but as human individuals. In the global response, the safety of health-care workers must
be ensured. Adequate provision of PPE is just the first step; other practical measures must be
considered, including cancelling non-essential events to prioritise resources; provision of food, rest,
and family support; and psychological support. Presently, health-care workers are every country's
most valuable resource.
Now more than ever, it's important for health systems and health care organizations to create and
ensure an infrastructure and resources to support physicians, nurses and care team members.
Child care services
PPE
Attention to emotional and mental well-being
Social support
https://preventepidemics.org/covid19/resources/protecting-hcw/
n a world that is already facing a dramatic shortage of HCWs—the World Health Organization (WHO)
estimates an additional 18 million HCWs will be needed in the next decade — failing to protect them
weakens health care systems, and moves us away from the goal of universal health care and the
broader vision outlined in the United Nations’ sustainable development goal 3: to ensure healthy
lives and promote well-being for all at
all ages.
https://www.sciencedirect.com/science/article/pii/S1876034120305955
Naturally, healthcare workers, who are most exposed to these aerosol droplets of the viral agent,
are most likely to contract the infection [8]. Given their increased exposure and risk of infection with
SARS-CoV-2, protecting the healthcare workers within the framework of the occupational and safety
regulations provides a vital means of protection of the general population. This protection must be
associated with the risk assessment procedures and specific preventive measures that include health
surveillance of the workers and the mandatory use of effective personal protective equipment (PPE)
[11]. Protecting healthcare workers is a priority, yet the lack of awareness and training, the shortage
of PPE, and the lack of point-of-care diagnostic tests for healthcare workers are important factors
contributing to the spread of the infection in healthcare settings [12].
The COVID-19 pandemic has created major disruptions of the global personal protective equipment
(PPE) supply chain, resulting in unprecedented shortages
Reasonable ethical disagreements can’t be solved invoking:
human rights
evidence
cost-effectiveness analysis