In the current study, we aimed to evaluate the fear and anxiety among the frontline warriors of Pakistan. For the current study medical doctors, dentists, nurses, and pharmacists working in different health care setup were the Participants.
We analyzed that more than 95% of the HCPs of Pakistan are under the category of moderate level of anxiety to a severe level of anxiety. A study recently conducted in Pakistan has demonstrated similar findings (29).
As per the findings of the current study, among Pakistan’s healthcare professionals, nurses reported the highest anxiety and fear. Nurses have intense workload due to comprehensive monitoring, prompt recognition, and prevention of several complications, close contact with physicians, symptomatic and psychological support (36). In another study performed exclusively on nurses managing the COVID-19 patients in Karachi, Pakistan exhibits similar results(28) . According to the results of this study, females have more anxiety as compare to males which are in agreement with the outcome of other studies (37, 38). Moreover, the results of different studies performed in Pakistan to analyze the anxiety levels of HCPs are in accordance with the finding of the current study (27, 39). On the other hand, we have also noticed that the level of anxiety among the pharmacist is less as compared to medical doctors, dentists, and nurses. In Pakistan the interaction of pharmacists with the patients is limited so in our opinion, this could be the reason.
In contrast to the previous studies conducted in Pakistan on HCP, in the current study we have a sufficient number of dentists. Fear and anxiety among the dentist are nearly close to the nurses' Dentists are categorized in the High-risk zone due to aerosol-generating procedures and close contacts with the patients' (40). During the current pandemic, most of the dentists have temporarily suspended the non-essential dental procedures and many dental clinics have been
temporarily shut down. Few dentists started working from home and provided free telemedicine/consultancy (41).
What is noteworthy that in the current study, we have also observed that instead of losing their life healthcare professionals of Pakistan are more concerned about transmitting the disease to the society or their family members. This shows the dedication of the frontline warriors of Pakistan even though during the last few weeks about 17 healthcare professionals in Pakistan have lost their lives and about 2000 are infected and many of them are in a constant battle between life and death (42). Furthermore, during the current crisis, thousands of HCPs and healthcare workers are infected or died in China, Spain, Italy, France, Turkey, and other parts of the world (16, 43, 44).
A significant majority of the HCPs have a high prevalence of high to severe anxiety. Similars finding from the neighboring countries China, Iran, India further confirms our findings (45- 48). Furthermore, previously a study regarding the SARS outbreak also revealed that more than 50% of the healthcare workers experienced anxiety(49).
Moreover, in the current study, more than 90% of the HCPs are not satisfied with the facilities of health care in Pakistan and a previous study about the health care system of Pakistan further supports the current finding (50). This factor may not only increase the fear but also affects the efficacy of the HCP. And this dilemma may lead to the deterioration of HCPs' health and previous studies have emphasized that additional supplies and beds will not prove to be useful unless there’s sufficient workforce (16, 51, 52).
More than 3/4th HCP have fear of getting infected during the management of COVID-19 patients. Pakistan is a developing country with limited healthcare facilities, hence there’s an immense burden on the health care system during the current pandemic. Healthcare professionals being frontline workers are at a higher risk of disease transmission. They experience a higher chance of exposure risk and face extreme workloads, moral dilemmas, and
rapidly varying working environments but at the same time, they handle societal shifts and emotional stress experienced by patients(51).
Health care professionals experience a higher chance of exposure risk and face extreme workloads, moral dilemmas, and rapidly varying working environments but at the same time, they handle societal shifts and emotional stress experienced by patients (52-55). They are at risk of lower immunity due to long working hours (36). Past studies reported extraordinary stress among health care providers during the SARS and MERS epidemic due to high infection risk, understaffing, stigmatization and uncertainty, and comprehensive support of highlighted during and after the outbreak(56, 57). Speedy spread and severity of symptoms of COVID-19 have acutely burdened the health care system globally. Despite the fear of getting infected, health care professionals still took up their charge, focused on their duties, and showed a spirit of dedication and unity during the current pandemic (36).
The results of our study substantiate with a recent study carried out in the United States of America, pointed out 8 sources of anxiety among health care professionals. These include, (a) access to suitable personal protective equipment, (b) disease exposure at workplace and carrying it to home, (c) non-rapid access to investigation in case of disease symptoms and the concomitant fear of transmission at work, (d) uncertainty that they would get support from their organization for their personal and family needs if they get infected, (e) child care access during increased working period and closure of educational institutes, (f) personal and family support due to increase in work duration and demands including food, transportation, hydration, and lodging, (g) being able to provide efficient medical care if posted to a new department, (h) lack to access to advanced information and communication(51).
In agreement with the finding of the current study, a recent study demonstrates that in Pakistan, medical workers have been under pressure, both psychological and physical along with high infection risk, isolation, insufficient safety equipment, exhaustion, and lack of interaction with
the family. Mental health-related problems are appearing which affects decision making power of the health care professionals and may have a chronic negative impact on overall well- being(58). Therefore, speaking about mental health concerns is important for the prevention and control of the current pandemic (59).To improve mental health among health care professionals, it is important to focus on self-care and reduce overwork by setting maximal duty hours and arranging shifts (53). In addition to this, knowledge of infection, control, and protection of personnel skills should be improved among health care providers. Previous studies have shown that the knowledge among the HCPs of Pakistan is satisfactory (31, 60). Hospitals should play a role in providing a safe working atmosphere along with the provision of sufficient protective supplies (36). Concern about disease transmission to loved ones should be addressed. Supportive measures such as separating living rooms, immediately showering, and changing clothing after work should be practiced by health care providers to reduce anxiety (53).