Covid-19 Case Study Examples

THE IMPACT AND IMPLICATIONS OF COVID-19 ON HEALTH CARE WORKERS

Coronavirus disease 2019 or Covid19 was initially introduced in Wuhan City in December 2019. The virus expanded in Hubei Province and other parts of China. By February, 2020 this virus got spread globally in different parts of the countries like the USA, UK, Germany, India, France etc. According to Yamamotoet al.(2020), by April 18, it was considered as the global pandemic as this virus got spreader in 198 countries, affecting 2.4 million people and causing death to 150,000 people. It continued to get spread all over the globe by infecting people and causing deaths. Some countries controlled the spread of Covid19 by taking proper precautions which was initiated by the World Health Organization (WHO) and compulsory made to follow those safety precautions. The Government made every person follow certain safety protocols and took some major steps.

Health Workers (HCWs) were considered as the highest risk group, which was getting infected the most. According to the statistics 3387 health workers were infected and 22 (0.6%) health workers died in China (ncbi.nlm.nih.gov, 2020). The death rate and infected rate started increasing in different countries like Spain, Italy, France etc. Facing this challenge, the health workers still continued to serve the patients by wearing PPE kits, and by taking different kinds of training to cure the patients.

Coronavirus pandemic has affected the health workers both mentally and physically. The health workers bear the highest risk of getting infected because they come in direct contact with the infected patients. In the initial stage the health workers took the maximum risk to serve and cure the patients without any protection or equipment. Later after many days PPE kits were introduced, which was worn by the health workers to protect themselves from getting infected while serving and curing the coronavirus infected patients. As mentioned by Xionget al.(2020), the Health workers also got mentally affected with a lot of stress and tension because there was no specific medicine introduced to cure this disease. It was not only challenging for the health workers but also every single person to have to come up with this situation. The entire system globally in context of income, health everything started getting weak.

The health workers faced a lot of mental stress because there was no specific vaccine or medicine to cure the patients, there was less productivity with high turnover rates. It was very difficult for the health workers to cope up with the current situation, patients, families and themselves. As stated by Spinelli &Pellino (2020), it was very challenging for the health workers to have a healthy and balanced work lifestyle because there were a lot of issues like billing issues, lack of treatment issues, patient satisfaction issues, etc.

To get back to normal life, the health workers had to cope up and adjust with the current pandemic situation. The importance of this study was to chalk out the current scenario impacting the health and safety of the health workers in this coronavirus.

There were many researchers who researched the impact of coronavirus on the sleep of the health workers. 180 medical staff were surveyed regarding the impact of health, stress, sleep which happened due to Covid19. It was found that due to stress and anxiety the health workers lacked in sleep. Therefore, the author suggested the health workers to share their experience in the social platform with different people, families, friends to reduce the stress and anxiety which will help them to get sufficient amounts of sleep.

In 2250 health workers, it has been discovered the symptoms of less sleep, anxiety and stress. The researcher compared the quality of sleep of health workers with the population and found out that health workers are experiencing less amount of sleep. 1306 (801) health workers were interviewed in China. The author here also compares the health workers with the non-health workers in terms of sleep and found that the health workers get less amount of sleep. The author also discovered that the female health workers face the maximum sleep disturbance compared to the male health workers. As outlined by Barneset al. (2017), sleeping disturbance affects the work life, as an individual is not able to concentrate on work, due to which there are behavioral changes. Behavioral changes like frequent mood swings, getting irate, getting angry on every issue, etc. Sleep is very important for every individual to stay healthy and balanced, especially for the health workers who are continuing to serve the patients, risking their own life (St-Onge et al. 2016). They are always working with coronavirus positive patients. Sleep not only keeps a person mentally healthy but also it keeps a person physically healthy. A proper quality sleep freshens up the mood of the person and it becomes easy for an individual to concentrate on its work without any stress or anxiety.

It is discovered that health workers are going through a lot of anxiety, depression, stress compared to non-medical health workers in China. There is a high risk of mental health in rural areas for females who have come in direct contact with the infected coronavirus patients. There were 1563 or 36.1% of health workers who were suffering from sleepless or insomnia symptoms (Malaysia et al. 2020). Due to lack of sleep or insomnia, it brought a high risk on education, working, and overthinking about the cause of these infections. It not only brings mental stress but also affects physically like body ache.

In comparison with the general population, the health workers are facing lot of challenges and pressure on handling the stress and anxiety while coming in contact with the coronavirus positive patient, due to high risk of lack of protection, lack of vaccine and medicine, lack of family support, lack of positive feedback and quarantine lifestyle. Due to these high risk factors the health workers are undergoing a lot of stress, depression, overthinking and anxiety. The mental health of the front liners is causing psychological disbalance. 29%-35% hospital health workers are suffering from emotional trauma. As highlighted by Liuet al.(2020), individuals or the 10% health workers who came in direct contact with the infected person, are likely to go through post traumatic symptoms of stress and anxiety.

To reduce this psychological imbalance, it is very important to provide proper support to the health workers so that they can serve the patients without stress and anxiety. The cross-section study discovered that maximum medical and hospital health workers are going through mental and psychological problems.

From my research, below I have mentioned how Saudi Government has taken steps to stabilize the current pandemic situation for both health workers and others.

The government has taken the initial step by announcing a support package to the private sectors by giving $61 billion. The package includes paying the due of the government of $18.6 billion and $13.3 billion each to the bank, and other private sectors. SAMA has announced plans to provide more $13.3 billion to the banking sectors so that they can provide credit facilities to the common people during this financial crisis.

Below are some of the more plans and steps taken by the government:

General

• Saudi government has decided to pay 60% of the salary to the employees of the private sectors for at least three months. Compensation to be paid according to the unemployment rate or insurance system.
• Six months wages will be reduced which will be adjusted with the less working hours, leaves, annual vacation and granting exceptional leaves. This plan was discussed with the employees and they agreed with it.
• A temporary benefit was introduced by the ministry that is off -labour-market in “Ajeer” portal for abroad recruitment. This portal will start giving businesses to excess workers.
• Employees who are working here can return back to their homeland by submitting an application to the Ministry of Human Resources and Social Development in which for one application 14 names can be added.
• Private sectors were supported by the Human Resource Development Fund by funding SAR 5.3bn for recruiting and training the nationals.
• Fines will be suspended for expat hiring.
• Providing safety steps to uplift the wages during this global pandemic.

Economic:

• On 20 March, the government of Saudi Arabia announced to give $18.6 billion as fiscal initiatives, which includes suspending the fines for expat hiring and extending the time limit for 3 months without any fines or charge.
• SMEs having 9 employees and workers or less are free from paying the expat levy for 3 years for 2-4 expatriates.
• On 14 March, the government of Saudi Arabia announced to give a package of SAR 50 billion (USD 13.3 billion) for SMEs. In this package the amount will be divided among the different departments of banks. First SAR 30 billion will be given to the bank and financial companies for delaying the repayment of loans from the SMEs in the next six months due to the financial crisis during this pandemic. Secondly from the package SAR 13.2 billion will be given to the SMEs in form of bank or financial loan to help them to continue and grow their business and their productivity. Thirdly global financial crisis in this pandemic the SMEs will get rid of the finance cost of SAR 6 billion which will be provided as the loan guarantee. Below there is a brief discussion of a few monetary programs which helped during this global pandemic financial crisis. They are as follows:

Deferred Payments Program

Deferred Payments Program

• Beneficiaries: Based on all the data of institutional Circular No. 381000064902, dated 16/06/1438 AH all the SMEs and other financial companies have been subjected to obtain supervision of monetary agencies.
• Funding bodies: Saudi Arabian monetary agencies are subjected to supervise bank and financial companies.
• Postponement period: Accrued profit or outstanding installment dating from March 14, 2020 CE to September 14, 2020 CE. The program was again extended on September 1st 2020 for more 3 months till 14 December 2020.
• Necessary documents are needed to be signed by the funding parties with monetary agencies in terms of implementing the program.
• The program aims to reduce potential impact as the value has reached 30 million riyals. In further operation the impact of decrease in cash flows that is faced by different SMEs is necessary to be made. Payment related obligation of beneficiaries is derived for nine months and the amount was allocated to financial entities to cover the cost of financing specific products.
• Communication with funding parties is required for beneficiaries in terms of notifying regarding the rescheduling of financing. on the other hand notification related to postponing the due installment is also required to be provided based on the period referred. In times of providing the option the beneficiary does not want any scheduling. In reference to the study of Sher (2020), it can be determined that proper beneficiary can be obtained along with rescheduling the deferred payment program.
• The deferred payment problem only applies to facilities that are classified in the first stage according to IFRS 9. As per the date of 14th March 2020 AD the facilities were classified in second and third stages. This days was very important as it was dealt for funding different agencies

Funding for Lending

• Beneficiaries: Based on all the data of institutional Circular No. 381000064902, dated 16/06/1438 AH all the SMEs and other financial companies have been subjected to obtain supervision of monetary agencies.
• Funding bodies: Saudi Arabian monetary agencies are subjected to supervise bank and financial companies.
• In SMEs providence of concessional financing process amounting 13.2 billion riyals programming facilities from bank and financial company. On the other hand, the funding process is used in order to support business to have continuity and growth in operations in a specific sector during the current stage of operation.
• Duration of program: duration of program is derived as one calendar year from the date of 14 March 2020. The project is also extendable for additional years according to the market condition.
• Credit facilities in the project will also be provided at the price that is supported by different mantri agencies. There are different financial entities that are unable to grant subsidies to the beneficiaries.
• Amortization of financial amounts can be also determined along with participating bodies to complete financing of beneficiaries. In this operation process a maximum period of two weeks from the date of withdrawal can be obtained. In terms of identifying credit facilities program benefits can also be obtained from different faculties. In the time when funding bodies are unable in terms of consuming amounts the return will be provided to monetary agencies.
• Payment term of financing is derived to be the financing period to be paid to the agency (Altig et al. 2020). This project has highlighted that a financial period of 36 month will be provided from the date of granting in terms of paying the financing to the beneficiaries.
• In this project the financial authorities are obligated to open a separate account in bank in terms of implementing the program. The financial parties are also committed to grant financing to the beneficiaries in accordance to the credit policy that is competitive as per market research.
• Periodic report was prepared monthly in terms of providing the monetary agency each and every information regarding the performance of the program. This helps in determining fund amounts to be recovered and efficiency of using the funds.
• the financial expertise also needs to sign necessary agreement along with the monetary institution in terms of having proper implementation regarding the program.
• the financial body that is participating needs to take certain consideration regarding the cost of support granted by a monetary agency. On the other hand during this program the pricing of credit facilities is required to be granted directly to the beneficiaries.

Loan Guarantee Program

• Depositing an amount of approximately 6 million riyals in terms of manufacturing the financial entity to enable SMEs to obtain a fact finding for operations. The main aim was to guarantee reducing the cost of landing two different enterprises and benefiting during the last fiscal year of 2020 AD.
• Beneficiaries: Based on all the data of institutional Circular No. 381000064902, dated 16/06/1438 AH all the SMEs and other financial companies have been subjected to obtain supervision of monetary agencies.
• Exemption period for the beneficiary is derived to be 14th March 2020 CE to 31st December 2020 CE
• Funding parties were analysed as Bank and financial companies that are supervised under monetary agencies. On the other hand the request of beneficiaries was submitted to a program named Kafala based on the current procedure planned.
• Exemption of certain beneficiaries from fees that includes renewal, issuance, rescheduling and extension. Exemption quality is desired to be having guarantee issued by the sponsorship program.
• Official examination can be provided to the financial entities based on notice in terms of facilitating benefits. The guarantee program includes examples of facilities due to sponsorship.
• The financial authorities should provide the foundation stating that total fees provided by the foundation is paid by a sponsorship program on a monthly basis. At the end of March 2020 a copy of the exemption can be submitted in terms of extending the facility program.

Monetary Policy

SAMA has been determined as a continuous dialogue that is provided to local commercial banks in terms of supporting certain factors that are highly impacted by the current circumstances. This is the reason for which asking qualitative measures including

• Instigating of private sector job retention scheme: PSJRC is derived for corporate customers in order to maintain employment it for the customers and providing concession for at least six months
• Extending working capital finance in all corporate sectors and addressing the short term liquidity requirements
• Introducing flexibility in terms of providing repayment of consumer finance to individuals who have lost their job due to the pandemic situation in the year of 2020. In this situation includes relief of repayment for loan and mortgage for the period of six month with earning no extra cost.
• Waiver of all the fees and other charges was resulted along with the use of digital banking for the last period of 6 month.
• Reviewing of credit card and interest rate is also made for adjective reasonable APR rates.

Impact of first qualitative measures will be significant and is currently being discussed with banks and SAMA. On 1st July, SAMA announced that they will be injecting SAR to about 15 millions in the banking sector in order to enhance the liquidity process and enable credit facilities effectively. In terms of measuring support to SAMA aim was highlighted to help the Bank revise reconstruction of private sector loans in order to support plans and maintain employment in the private sector. In 1st September 2020, SAMA extended the viability to measure another 3 month ending for the year December 2020.

Phased easing of lockdown

KSA is designed to be currently in the third and last phase before returning to normal condition.

• There is no curfew across the country with strict restriction for certain activities that includes large gathering of individuals
• Wearing of mask is derived to be compulsory in public, otherwise fine can be suffered for those who are not maintaining the rules properly
• Different types of commercial activities are designed to be back in normal along with both public and private sector companies. Most of the area have resumed their work with a strict health and regulation guidelines
• Different directions are also provided about domestic light opening. On the other hand, international flights are still Limited for those who have valid residency. full international flight is expected in that area from January 2021.
• Performing Umrah for the residents living in that country is now allowed with strict control as has restriction in very important to be maintain
• Schools present across the country are also reopening for the first 7 weeks on an online basis. Physical classes will be started after sometime along with proper health regulation maintenance.

Payment Facilities

• As per the effort to mitigate the impact of covid-19 pandemic over the economic activities the Government of Saudi Arabia has announced several measures that are required to be effectively maintained.
• Postponing commercial payment is also highlighted for more than 116000
• Reduction of 25% export levy is highlighted in operational factories until the end of commercial year
• Social development Bank has an issue 2 in terms of supporting citizen and family to cope up different in efficiency due to covid-19 impact
• Approval of a 30% discount is also obtained for two months for the utility bill in the commercial, industrial and agricultural sector.

Risk of infection:

The world health organization reports that nearly 1 out of 10 healthcare professionals are infected due to the spread of this virus. As of march 2020, nearly 9% of the Covid infected patients had been health workers (Di Tella et al, 2020). Apart from this, the international council of nurses had mentioned that 90000 healthcare workers were infected and along with it 260 nurses had lost their life due to the pandemic (Jalili et al. 2020). Further, as of March 2020, one in four doctors had been placed at isolation as they were infected severely (Galbraith et al. 2020). Despite this, they had been dispatching services for the infected.  In compliance with such situations, the UK government had planned to call retired professionals back into practice. This had further increased the concerns regarding the risk of infection spread amidst the pandemic

Shortage of PPE’s:

 PPE (Personal Protective Equipment) can be considered to be essential for people involved in Covid care services. Reports suggest that several nations are facing shortages of PPE kits .The problem regarding PPE Kit shortage has mainly been dominant within the Low income countries. UNICEF has only been able to provide only 1/10 of the demands for masks (Hacimusalar et al. 2020). In china; lack of understanding regarding the usage of PPE Kits, confused Guidance and many more causes had led to the increase in infection as well as deaths amongst the health care workers.  Reports related to shortages of PPE kits have also been reported from Hospitals within the United States of America. In this context, it can be commented that, with an increase in rates of infection, the United States would require far more surgical equipment than they possess. The shortage of PPE kits have put many healthcare workers at risk for getting infected with Covid 19. It has been reported that the healthcare workers in some of the nations have adopted unconventional measures as an alternative to PPE kit. They have been using the resources they have in stock, like using plastic bags as gowns and bottle cutouts as Eye protective gears accordingly.

Deaths:

Based on the information received by WHO and UNICEF, it can be stated that deaths of nurses and Doctors have been reported from various nations. Experts in the medical field suggest that this has also led to shortages of healthcare staff within these nations. As of March 2020, 50 doctors have been claimed to have died due to the pandemic and the number of Deaths in the country continues to grow considerably. By April 2020, the estimated number of medical deaths were about 119 and for nurses it had been 34 and two of the deaths amongst them had been Nurses (Gavin et al. 2020). Further the Indian Medical Association had claimed death reports of more than 198 doctors. Thus, it can be claimed that the Health and Life of healthcare workers have been jeopardized considerably.

 

Violence against Healthcare Workers:

Reports by experts in the field suggests that healthcare workers in various nations have been subjected to violent crimes like assaults. The hospitals and Governments have taken strict measures to ensure safety of their staff in distress. Despite this, most of the healthcare workers have still been exposed to risks associated with assaults, physical injury and life threats.

In accordance with the views of Delgado-Gallegos et al. (2020), it can be commented that within the pandemic, more than 600 healthcare professionals have faced injuries related to physical assaults. Thus, it can be stated that they have been facing various forms of negativity. Cases such as patients’ family members attacking doctors that had diagnosed patients suffering from Covid. Similarly instances of Doctors and healthcare professionals being thrown out of their homes as they had been infected with Covid 19 virus or have been dealing with Covid patients. Currently, no vaccine is able to treat the disease, hence, medical systems are dependent on certain tests as well as predefined interventions. However, the outcomes of these interventions had not been satisfying and this had been the main reason for assaults on healthcare professionals

 

Methods:

Study design:

For collecting data that would be related to the study, the concepts associated with structured questionnaires have been implemented. The following steps have been implemented in compliance with the research objectives;

• Identifying relevant articles that would help in identifying the issue
• Selecting the articles amongst the identified ones
• Selection of Articles
• Data extraction processes
• Data analysis and implementation

Apart from the aforesaid points, the main question guiding the research had been “What are the physical, social as well as psychological impacts on Healthcare workers associated with providing care services to patients with Covid infection”.

Literature search strategies

The literature search sources that had been used in the project had been online modes. It is aimed that online journal databases like “PubMed” and “MEDLINE”. Help had also been taken from google scholar for relevant articles from January to December 2020. The Searched item terminology had mostly been related to “Covid 19”, “n-Covid” or”nCoV”. Apart from this terminologies like “Health impacts on healthcare workers on COVID duty” had also been searched.

Eligibility criteria

Studies that had contained the impacts of Covid 19 on the healthcare workers have been chosen primarily for the research. Language had been the primary factor for the search process, hence only articles published in English and Arabic had been considered. Healthcare workers included all clinical staffs from doctors, pharmacists, paramedics and Nurses

Identification and selection of studies

This study had included in the literatures created by researchers that had considered mental, physical as well as Psychological impacts. However, a little sources that contained the social impacts had also been considered in the study. All data and information from the available literature had been compared as well as presented

Mental health impacts

Five different articles that had discussed the mental health impacts on healthcare providers have been considered. In one study, “23.04 %” of the healthcare professionals had psychosocial problems. In another study, it had been observed that “90.57%” of the females than males, “81% of the Nurses” than the Physicians have been suffering from mental health issues due to the pandemic outbreak. In one of the study, the following scales and response had been collected;

• “Overall Anxiety (23-44)%”
• “Severe Anxiety (2.17%)”
• “Moderate Anxiety (4.78%)”
• “Mild Anxiety (16.09%)”
• “Depression (50.4%)”
• “Insomnia (34%)”

Based on the findings, it can be commented that more of nurses compared to the physician have been infected. Further, the frontline social care workers were at a higher rate of depression and distress. The tools that had been used in the study had mainly been;

• “Self-Rating Anxiety Scale”
• “Generalized Anxiety Disorder Scale”
• “General Self-Efficacy Scale”
• “Stanford Acute Stress Reaction Questionnaire”
• “Pittsburgh Sleep Quality Index”
• “Insomnia Severity Index”
• “Social Support Rate Scale”
• “Post-Traumatic Stress Disorder Self-Rating Scale”
• “Impact of Event Scale”

Physical health impacts

Studies from the People’s Republic of China dictates that healthcare workers are more susceptible to Health risks. Studies have also showcased certain departments have been linked with high healthcare departments, however along with it certain departments had also been linked.

• “Infectious disease and pulmonology (RR = 2.13, 95% CI 1.45–3.95)”
• “Diagnosed family member (RR = 2.76, 95% CI 2.02–3.77)”,
• “Inadequate hand hygiene (RR = 2.64, 95% CI 1.04–6.71)”,
• “Suboptimal hand hygiene before and after contact with patients (RR = 2.43, 95% CI 1.34–4.39)”
• “Improper PPE (RR = 2.82, 95% CI 1.11–7.18)”
• “Close contact with patients (12 times/day), long daily contact hours (≥ 15 h)”
• “Unprotected exposure”

The common symptoms mainly included the following;

• “Fever (85%)”
• “Cough (80%)”,
• “Weakness (70%)”,
• “Chest distress (7%)”,
• “Hemoptysis (7%)”,
• “Headache (7%)”
• “Diarrhea (7%)”

Psychological impact:

Studies from Singapore revealed that Healthcare workers that had been caring for patients suffering from Covid 19 infections had reported Anxiety, depression and stress. With so many deaths within healthcare professionals and reduction in healthcare service providers, the pressure has been increasing on the existing professionals. These have been observed to create conflicts with their duties to family as well as friends have been observed to cause psychological stress. Healthcare professionals have also been reflected to be anxious regarding the fact that they would have to stay in Isolation or quarantine when they would fall ill. For healthcare workers, being quarantined was positively linked with minimizing direct contact with patients and not performing their duties. These conditions have also created grave concerns within healthcare professionals. Reports from china also suggested the following impacts;

• About 46.04% of them had anxiety
• 37% of them had depression
• 37% of them had also experienced insomnia.

Such traumatic events have also resulted in professionals to suicide.

Reference List

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