COVID-19 pandemic and its impact on mental health of healthcare professionals
Identifieur interne : 000165 ( Pmc/Corpus ); précédent : 000164; suivant : 000166COVID-19 pandemic and its impact on mental health of healthcare professionals
Auteurs : Konstantinos Tsamakis ; Emmanouil Rizos ; Athanasios J. Manolis ; Sofia Chaidou ; Stylianos Kympouropoulos ; Eleftherios Spartalis ; Demetrios A. Spandidos ; Dimitrios Tsiptsios ; Andreas S. TriantafyllisSource :
- Experimental and Therapeutic Medicine [ 1792-0981 ] ; 2020.
Abstract
In light of the unprecedented public health crisis of the COVID-19 pandemic, it is highly important to acknowledge the psychological impact of this mounting threat on healthcare professionals. Previous experience from smaller scale epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that healthcare workers are dealing with, is associated with increased psychological morbidities. We have depicted the psychological burden that the COVID-19 pandemic has posed on healthcare professionals in Greece and have reviewed the literature around the effect of previous epidemics on frontline healthcare staff. Moreover, we discuss potential triggers and the need for measures to minimise the psychological pressure on those at the frontline against this biothreat.
Url:
DOI: 10.3892/etm.2020.8646
PubMed: 32346406
PubMed Central: 7185082
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PMC:7185082Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">COVID-19 pandemic and its impact on mental health of healthcare professionals</title><author><name sortKey="Tsamakis, Konstantinos" sort="Tsamakis, Konstantinos" uniqKey="Tsamakis K" first="Konstantinos" last="Tsamakis">Konstantinos Tsamakis</name><affiliation><nlm:aff id="af1-etm-0-0-8646">Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</nlm:aff></affiliation><affiliation><nlm:aff id="af2-etm-0-0-8646">King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK</nlm:aff></affiliation></author><author><name sortKey="Rizos, Emmanouil" sort="Rizos, Emmanouil" uniqKey="Rizos E" first="Emmanouil" last="Rizos">Emmanouil Rizos</name><affiliation><nlm:aff id="af1-etm-0-0-8646">Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="J Manolis, Athanasios" sort="J Manolis, Athanasios" uniqKey="J Manolis A" first="Athanasios" last="J. Manolis">Athanasios J. Manolis</name><affiliation><nlm:aff id="af3-etm-0-0-8646">Department of Cardiology, Asklepeion General Hospital, 16673 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="Chaidou, Sofia" sort="Chaidou, Sofia" uniqKey="Chaidou S" first="Sofia" last="Chaidou">Sofia Chaidou</name><affiliation><nlm:aff id="af4-etm-0-0-8646">1st Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="Kympouropoulos, Stylianos" sort="Kympouropoulos, Stylianos" uniqKey="Kympouropoulos S" first="Stylianos" last="Kympouropoulos">Stylianos Kympouropoulos</name><affiliation><nlm:aff id="af1-etm-0-0-8646">Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="Spartalis, Eleftherios" sort="Spartalis, Eleftherios" uniqKey="Spartalis E" first="Eleftherios" last="Spartalis">Eleftherios Spartalis</name><affiliation><nlm:aff id="af5-etm-0-0-8646">2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens School of Medicine, 11527 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="A Spandidos, Demetrios" sort="A Spandidos, Demetrios" uniqKey="A Spandidos D" first="Demetrios" last="A. Spandidos">Demetrios A. Spandidos</name><affiliation><nlm:aff id="af6-etm-0-0-8646">Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece</nlm:aff></affiliation></author><author><name sortKey="Tsiptsios, Dimitrios" sort="Tsiptsios, Dimitrios" uniqKey="Tsiptsios D" first="Dimitrios" last="Tsiptsios">Dimitrios Tsiptsios</name><affiliation><nlm:aff id="af7-etm-0-0-8646">Neurology Department, Evexia Rehabilitation Centre, 63080 Chalkidiki, Greece</nlm:aff></affiliation></author><author><name sortKey="S Triantafyllis, Andreas" sort="S Triantafyllis, Andreas" uniqKey="S Triantafyllis A" first="Andreas" last="S. Triantafyllis">Andreas S. Triantafyllis</name><affiliation><nlm:aff id="af3-etm-0-0-8646">Department of Cardiology, Asklepeion General Hospital, 16673 Athens, Greece</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32346406</idno><idno type="pmc">7185082</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185082</idno><idno type="RBID">PMC:7185082</idno><idno type="doi">10.3892/etm.2020.8646</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000165</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000165</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">COVID-19 pandemic and its impact on mental health of healthcare professionals</title><author><name sortKey="Tsamakis, Konstantinos" sort="Tsamakis, Konstantinos" uniqKey="Tsamakis K" first="Konstantinos" last="Tsamakis">Konstantinos Tsamakis</name><affiliation><nlm:aff id="af1-etm-0-0-8646">Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</nlm:aff></affiliation><affiliation><nlm:aff id="af2-etm-0-0-8646">King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK</nlm:aff></affiliation></author><author><name sortKey="Rizos, Emmanouil" sort="Rizos, Emmanouil" uniqKey="Rizos E" first="Emmanouil" last="Rizos">Emmanouil Rizos</name><affiliation><nlm:aff id="af1-etm-0-0-8646">Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="J Manolis, Athanasios" sort="J Manolis, Athanasios" uniqKey="J Manolis A" first="Athanasios" last="J. Manolis">Athanasios J. Manolis</name><affiliation><nlm:aff id="af3-etm-0-0-8646">Department of Cardiology, Asklepeion General Hospital, 16673 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="Chaidou, Sofia" sort="Chaidou, Sofia" uniqKey="Chaidou S" first="Sofia" last="Chaidou">Sofia Chaidou</name><affiliation><nlm:aff id="af4-etm-0-0-8646">1st Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="Kympouropoulos, Stylianos" sort="Kympouropoulos, Stylianos" uniqKey="Kympouropoulos S" first="Stylianos" last="Kympouropoulos">Stylianos Kympouropoulos</name><affiliation><nlm:aff id="af1-etm-0-0-8646">Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="Spartalis, Eleftherios" sort="Spartalis, Eleftherios" uniqKey="Spartalis E" first="Eleftherios" last="Spartalis">Eleftherios Spartalis</name><affiliation><nlm:aff id="af5-etm-0-0-8646">2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens School of Medicine, 11527 Athens, Greece</nlm:aff></affiliation></author><author><name sortKey="A Spandidos, Demetrios" sort="A Spandidos, Demetrios" uniqKey="A Spandidos D" first="Demetrios" last="A. Spandidos">Demetrios A. Spandidos</name><affiliation><nlm:aff id="af6-etm-0-0-8646">Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece</nlm:aff></affiliation></author><author><name sortKey="Tsiptsios, Dimitrios" sort="Tsiptsios, Dimitrios" uniqKey="Tsiptsios D" first="Dimitrios" last="Tsiptsios">Dimitrios Tsiptsios</name><affiliation><nlm:aff id="af7-etm-0-0-8646">Neurology Department, Evexia Rehabilitation Centre, 63080 Chalkidiki, Greece</nlm:aff></affiliation></author><author><name sortKey="S Triantafyllis, Andreas" sort="S Triantafyllis, Andreas" uniqKey="S Triantafyllis A" first="Andreas" last="S. Triantafyllis">Andreas S. Triantafyllis</name><affiliation><nlm:aff id="af3-etm-0-0-8646">Department of Cardiology, Asklepeion General Hospital, 16673 Athens, Greece</nlm:aff></affiliation></author></analytic><series><title level="j">Experimental and Therapeutic Medicine</title><idno type="ISSN">1792-0981</idno><idno type="eISSN">1792-1015</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>In light of the unprecedented public health crisis of the COVID-19 pandemic, it is highly important to acknowledge the psychological impact of this mounting threat on healthcare professionals. Previous experience from smaller scale epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that healthcare workers are dealing with, is associated with increased psychological morbidities. We have depicted the psychological burden that the COVID-19 pandemic has posed on healthcare professionals in Greece and have reviewed the literature around the effect of previous epidemics on frontline healthcare staff. Moreover, we discuss potential triggers and the need for measures to minimise the psychological pressure on those at the frontline against this biothreat.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Docea, Ao" uniqKey="Docea A">AO Docea</name></author><author><name sortKey="Tsatsakis, A" uniqKey="Tsatsakis A">A Tsatsakis</name></author><author><name sortKey="Albulescu, D" uniqKey="Albulescu D">D Albulescu</name></author><author><name sortKey="Cristea, O" uniqKey="Cristea O">O Cristea</name></author><author><name sortKey="Zlatian, O" uniqKey="Zlatian O">O Zlatian</name></author><author><name sortKey="Vinceti, M" uniqKey="Vinceti M">M Vinceti</name></author><author><name sortKey="Moschos, Sa" uniqKey="Moschos S">SA Moschos</name></author><author><name sortKey="Tsoukalas, D" uniqKey="Tsoukalas D">D Tsoukalas</name></author><author><name sortKey="Goumenou, M" uniqKey="Goumenou M">M 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Exp Ther Med</journal-id><journal-id journal-id-type="iso-abbrev">Exp Ther Med</journal-id><journal-id journal-id-type="publisher-id">ETM</journal-id><journal-title-group><journal-title>Experimental and Therapeutic Medicine</journal-title></journal-title-group><issn pub-type="ppub">1792-0981</issn><issn pub-type="epub">1792-1015</issn><publisher><publisher-name>D.A. Spandidos</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32346406</article-id><article-id pub-id-type="pmc">7185082</article-id><article-id pub-id-type="publisher-id">ETM-0-0-8646</article-id><article-id pub-id-type="doi">10.3892/etm.2020.8646</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>COVID-19 pandemic and its impact on mental health of healthcare professionals</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tsamakis</surname><given-names>Konstantinos</given-names></name><xref ref-type="aff" rid="af1-etm-0-0-8646">1</xref><xref ref-type="aff" rid="af2-etm-0-0-8646">2</xref><xref rid="c1-etm-0-0-8646" ref-type="corresp"></xref></contrib><contrib contrib-type="author"><name><surname>Rizos</surname><given-names>Emmanouil</given-names></name><xref ref-type="aff" rid="af1-etm-0-0-8646">1</xref></contrib><contrib contrib-type="author"><name><surname>J. Manolis</surname><given-names>Athanasios</given-names></name><xref ref-type="aff" rid="af3-etm-0-0-8646">3</xref></contrib><contrib contrib-type="author"><name><surname>Chaidou</surname><given-names>Sofia</given-names></name><xref ref-type="aff" rid="af4-etm-0-0-8646">4</xref></contrib><contrib contrib-type="author"><name><surname>Kympouropoulos</surname><given-names>Stylianos</given-names></name><xref ref-type="aff" rid="af1-etm-0-0-8646">1</xref></contrib><contrib contrib-type="author"><name><surname>Spartalis</surname><given-names>Eleftherios</given-names></name><xref ref-type="aff" rid="af5-etm-0-0-8646">5</xref></contrib><contrib contrib-type="author"><name><surname>A. Spandidos</surname><given-names>Demetrios</given-names></name><xref ref-type="aff" rid="af6-etm-0-0-8646">6</xref></contrib><contrib contrib-type="author"><name><surname>Tsiptsios</surname><given-names>Dimitrios</given-names></name><xref ref-type="aff" rid="af7-etm-0-0-8646">7</xref></contrib><contrib contrib-type="author"><name><surname>S. Triantafyllis</surname><given-names>Andreas</given-names></name><xref ref-type="aff" rid="af3-etm-0-0-8646">3</xref></contrib></contrib-group><aff id="af1-etm-0-0-8646"><label>1</label>Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, 12462 Athens, Greece</aff><aff id="af2-etm-0-0-8646"><label>2</label>King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK</aff><aff id="af3-etm-0-0-8646"><label>3</label>Department of Cardiology, Asklepeion General Hospital, 16673 Athens, Greece</aff><aff id="af4-etm-0-0-8646"><label>4</label>1st Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece</aff><aff id="af5-etm-0-0-8646"><label>5</label>2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens School of Medicine, 11527 Athens, Greece</aff><aff id="af6-etm-0-0-8646"><label>6</label>Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece</aff><aff id="af7-etm-0-0-8646"><label>7</label>Neurology Department, Evexia Rehabilitation Centre, 63080 Chalkidiki, Greece</aff><author-notes><corresp id="c1-etm-0-0-8646"><italic>Correspondence to:</italic> Dr Konstantinos Tsamakis, Second Department of Psychiatry, University of Athens, ‘ATTIKON’ University Hospital, Rimini 1, Chaidari, 12462 Athens, Greece <email>ktsamakis@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2020</year></pub-date><pub-date pub-type="epub"><day>07</day><month>4</month><year>2020</year></pub-date><pub-date pub-type="pmc-release"><day>07</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>19</volume><issue>6</issue><fpage>3451</fpage><lpage>3453</lpage><history><date date-type="received"><day>03</day><month>4</month><year>2020</year></date><date date-type="accepted"><day>07</day><month>4</month><year>2020</year></date></history><permissions><copyright-statement>Copyright: © Tsamakis et al.</copyright-statement><copyright-year>2020</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p></license></permissions><abstract><p>In light of the unprecedented public health crisis of the COVID-19 pandemic, it is highly important to acknowledge the psychological impact of this mounting threat on healthcare professionals. Previous experience from smaller scale epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that healthcare workers are dealing with, is associated with increased psychological morbidities. We have depicted the psychological burden that the COVID-19 pandemic has posed on healthcare professionals in Greece and have reviewed the literature around the effect of previous epidemics on frontline healthcare staff. Moreover, we discuss potential triggers and the need for measures to minimise the psychological pressure on those at the frontline against this biothreat.</p></abstract><kwd-group><kwd>COVID-19</kwd><kwd>pandemic</kwd><kwd>mental health</kwd><kwd>anxiety</kwd><kwd>psychological impact</kwd><kwd>depression</kwd><kwd>healthcare professionals</kwd></kwd-group></article-meta></front><body><sec><title>Introduction</title><p>Since December 2019 the world has been facing an outbreak of a novel infectious disease known as Coronavirus disease (COVID-19), that has rapidly spread globally and has now been declared as a pandemic by the World Health Organisation (<xref rid="b1-etm-0-0-8646" ref-type="bibr">1</xref>). Its spread and lethality is proving to be higher than previous epidemics on account of international travel density and immune naivety of the population (<xref rid="b2-etm-0-0-8646" ref-type="bibr">2</xref>), triggering urgent, draconian public health measures in many countries - Greece amongst them. This has caused an unprecedented situation for citizens, policy makers, politicians and healthcare professionals, with the pandemic being described as the worst public health crisis in a generation.</p></sec><sec><title>Psychological implications for general public, patients and children</title><p>Facing this largescale infectious threat, people are under increased psychological pressure. Data derived from previous epidemics, such as the Severe Acute Respiratory Syndrome (SARS) in 2003 and the H1N1 influenza in 2009, illustrate that the community suffered considerable fear and panic, resulting in a significant psychological impact (<xref rid="b3-etm-0-0-8646" ref-type="bibr">3</xref>,<xref rid="b4-etm-0-0-8646" ref-type="bibr">4</xref>). This seems to be the case with COVID-19, as well. A very recent general public survey during the initial phase of the COVID-19 outbreak in China, where the epidemic began, showed that about one-third of the participants reported moderate-to-severe anxiety, whilst more than half rated the psychological impact as moderate-to-severe (<xref rid="b5-etm-0-0-8646" ref-type="bibr">5</xref>). Our personal experience in the outpatient clinics and wards in Greece coincides with the aforementioned report. During the past few weeks we have experienced a significant increase in telephone contacts and visits from patients or relatives expressing distress and fear about the virus and the surrounding uncertainty. Patients with mental health conditions, such as depression and anxiety have been reporting relapses in their mental state, such as fear-triggered panic attacks or resurface of psychosomatic symptoms; patients with medical comorbidities, such as cardiovascular disease, have been expressing distress and associated worsening of symptoms, in particular angina and worsening of heart failure status. Even though children have been reported to be less susceptible to COVID-19 infection (<xref rid="b6-etm-0-0-8646" ref-type="bibr">6</xref>), we have witnessed considerable psychological implications on them: the shutting down of schools and playgrounds, the restriction of outdoor activities alongside their parents' fears of contamination have been triggering manifestations of anxiety, such as panic attacks and psychosomatic symptoms.</p></sec><sec><title>Psychological impact on healthcare professionals</title><p>The general population, however, are not the only ones at risk for psychological distress during this pandemic. Experience from SARS and H1N1 epidemics underline that the psychological strain on healthcare professionals, who find themselves at the frontline of attempts to quell the outbreak, is significant (<xref rid="b3-etm-0-0-8646" ref-type="bibr">3</xref>,<xref rid="b4-etm-0-0-8646" ref-type="bibr">4</xref>). In the early rapid expansion phase of the SARS outbreak, similar to the current course of COVID-19 pandemic, healthcare professionals reported feelings of extreme vulnerability, uncertainty and threat to life, alongside somatic and cognitive symptoms of anxiety (<xref rid="b3-etm-0-0-8646" ref-type="bibr">3</xref>), whilst during the 2009 H1N1 pandemic more than half of healthcare workers in a Greek tertiary hospital reported moderately high anxiety and subsequent psychological distress (<xref rid="b4-etm-0-0-8646" ref-type="bibr">4</xref>).</p><p>During the COVID-19 outbreak, clinicians in Greece have been confronted with mounting challenges that have not been faced before. Decisions have to be made fast, ranging from efficiently triaging and isolating patients with suspicion of infection, to deciding whether to shut down departments and operating theatres when a patient or staff test positive; all these whilst being on limited resources. The pressure to act timely and to successfully diagnose, isolate and treat has been overwhelming, especially amid intense public and media scrutiny. This is in concordance with experience in other countries (<xref rid="b7-etm-0-0-8646" ref-type="bibr">7</xref>). In addition, due to the increased risk of exposure to the virus, our frontline doctors, nurses and healthcare workers fear that they may contract COVID-19 themselves. They worry about bringing the virus home and passing it on to loved ones and family members - elderly parents, newborns and immunocompromised relatives. Our healthcare staff also report increased stress levels when dealing with patients unwilling to cooperate or not adhering to safety instructions, and feelings of helplessness when dealing with critically ill patients, in the context of limited intensive care beds and resources. The use of protective equipment for long periods causes difficulties in breathing and limited access to toilet and water, resulting in subsequent physical and mental fatigue. Very similar experiences of healthcare personnel have been recorded in the emerging scientific literature (<xref rid="b8-etm-0-0-8646" ref-type="bibr">8</xref>) and media reports in the two countries at present most heavily hit by COVID-19: China and Italy.</p><p>Therefore, healthcare professionals dealing with COVID-19 are under increased psychological pressure and experience high rates of psychiatric morbidity, resembling the situation during the SARS and H1N1 epidemics (<xref rid="b3-etm-0-0-8646" ref-type="bibr">3</xref>,<xref rid="b9-etm-0-0-8646" ref-type="bibr">9</xref>). A very recent study among healthcare professionals in a tertiary infectious disease hospital for COVID-19 in China, revealed a high incidence of anxiety and stress disorders among frontline medical staff (<xref rid="b10-etm-0-0-8646" ref-type="bibr">10</xref>), with nurses having a higher incidence of anxiety than doctors. Experience in our hospitals in the past few weeks, although anecdotal, is concordant with these reports. The disruption of routine clinical practice, the sense of loss of control and the subsequent fear of potential destabilization of the health services, has provoked ‘overflowing’ anxiety and depression among healthcare professionals, a feature which is not uncommon of epidemics (<xref rid="b9-etm-0-0-8646" ref-type="bibr">9</xref>,<xref rid="b11-etm-0-0-8646" ref-type="bibr">11</xref>). Depression is associated with poor medication adherence (<xref rid="b12-etm-0-0-8646" ref-type="bibr">12</xref>) which may increase morbidity among older healthcare professionals with coexisting medical conditions.</p></sec><sec><title>Willingness of staff to work and their need for psychological support</title><p>On a positive note, experience from our Departments so far, indicates that willingness of staff to work has not been really affected, in line with reports from previous pandemics (<xref rid="b4-etm-0-0-8646" ref-type="bibr">4</xref>). Despite the initial shock, the health professionals in the Greek National Health Service appear to exhibit high levels of commitment and professionalism. We know that confidence in safety, risk perception and confidence in skills are proven facilitators for willingness to work (<xref rid="b11-etm-0-0-8646" ref-type="bibr">11</xref>). Our impression is that the increasing knowledge about preventing and dealing with the disease, and the development of more specific procedural and treatment protocols, alongside educational activities, will contribute to improving the morale of healthcare workers dealing with the pandemic. However, in light of the increased psychological pressure of frontline healthcare staff, measures for psychological support and interventions to protect their mental health should be adopted promptly, as depicted from previous experience (<xref rid="b4-etm-0-0-8646" ref-type="bibr">4</xref>,<xref rid="b9-etm-0-0-8646" ref-type="bibr">9</xref>) and emerging initiatives and literature (<xref rid="b7-etm-0-0-8646" ref-type="bibr">7</xref>,<xref rid="b8-etm-0-0-8646" ref-type="bibr">8</xref>,<xref rid="b13-etm-0-0-8646" ref-type="bibr">13</xref>).</p><p>We are facing unprecedented circumstances; this bio-threat is the most serious global crisis of our generation. Healthcare staff are in the frontline of this fight, which is taking a serious psychological toll; we therefore need to support them.</p></sec></body><back><ack><title>Acknowledgements</title><p>Not applicable.</p></ack><sec><title>Funding</title><p>No funding was received.</p></sec><sec sec-type="data-availability"><title>Availability of data and materials</title><p>The information generated and analyzed during the current study is available from the corresponding author on reasonable request.</p></sec><sec><title>Authors' contributions</title><p>KT wrote the original draft, edited and critically revised the manuscript. ER, ES, DAS, DT, SK, AJM, SC and AST critically revised and edited the manuscript. All authors substantially contributed to the conception, writing and revision of the work and approved the final content of the manuscript.</p></sec><sec><title>Ethics approval and consent to participate</title><p>Not applicable.</p></sec><sec><title>Patient consent for publication</title><p>Not applicable.</p></sec><sec><title>Competing interests</title><p>The authors declare that they have no competing interests.</p></sec><ref-list><title>References</title><ref id="b1-etm-0-0-8646"><label>1</label><mixed-citation publication-type="journal"><comment>World Health Organisation: WHO announces COVID-19 outbreak a pandemic. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic. 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