In a recent study posted to the medRxiv* server, researchers assessed the well-being of all workers involved in coronavirus disease 2019 (COVID-19) testing between April and June 2022, i.e., during the Omicron wave lockdown in Shanghai, China.
Study: On the frontlines in Shanghai: Stress, burnout and perceived benefit among COVID-19 testers and other personnel during the Omicron wave lockdown. Image Credit: Graeme Kennedy / Shutterstock
Background
China adhered to the “dynamic zero-COVID” policy; thus, the healthcare providers (HCPs) had to engage in universal mass testing to control Omicron cases. Accordingly, they isolated people testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at central quarantine centers, hospitals, or mobile centers. Additionally, they distributed test kits, masks, and herbal pills, referred to as ‘anti-epidemic packages’ among the masses. This likely represented the greatest stringency in COVID-19 control measures of any country globally.
People struggling due to food scarcity and medical resources expressed frustration to pandemic workers. So not only these HCPs and other support staff, i.e., people working in emergency and testing services, had to handle excessive workloads, they were at higher risk of SARS-CoV-2 infection; subsequently, their mental health suffered. Volunteers, such as full-time community workers, political party workers, police, and community residents, also helped HCPs scan bar codes, distribute disinfectants and other anti-epidemic materials, and fetch medicine for the masses.
Studies have barely investigated the perspectives and well-being of these workers after China implemented such strict COVID-19 control measures.
About the study
In the current cross-sectional study, researchers assessed the stress and burnout, economic impact, and perceived benefits of the work of all HCPs and other staff involved in the recent Omicron-driven COVID-19 pandemic wave. In addition, they stratified their assessments based on the type of worker.
The team used the online survey platform Wenjuanxing to administer the self-report survey among the eligible HCPs and other workers. The study population comprised only those HCPs and support workers who engaged directly in testing, screening, or patient care in communities with strict lockdowns; in other words, they all worked at the frontline.
This 15‐item questionnaire had five-, four-, and six items on emotional exhaustion, cynicism, and professional efficacy, respectively. The participating respondents rated their experience on a 7‐point scale ranging from zero to six, indicating never to every day. The higher scores in exhaustion and cynicism indicated a higher burnout among these people based on the Maslach Burnout Inventory. The other 14-item self-reported questionnaire measured the degree of stress based on the Perceived Stress Scale (PSS). The Chinese version of the PSS scores between 43 to 56 indicated excessive stress. Finally, the researchers used t-tests or chi-square analyses to establish the correlation between stress/burnout and the type of pandemic worker, perceived economic security, and honor in pandemic work. Also, they used logistic regression analysis to derive these correlates.
Study findings
The study reported the participation of 887 workers, of which 77.9% were HCPs working on average for 6.25±1.24 days/week for 9.77±4.28 hours/day. Subsequently, 16.1% and 11% were burnt-out moderately and seriously, respectively, and 39.8% of participants had elevated stress with a total PSS of 26.85±9.92/56.
Many of these workers also felt economically insecure due to the pandemic. Thus, it is likely that many were working in such risky and unpopular occupations to manage their economic situation. Those with economic insecurity did not perceive benefits. In adjusted analyses, those who perceived benefits showed markedly less burnout among other correlates.
Intriguingly, many workers also perceived benefits. While 65.5% thought they fostered more cohesive relationships, 78.1% felt more resilient, and 84.2% were honored to serve. Around 68% of participants also perceived their families as fully supportive. Nevertheless, most wanted counseling and stress relief. Although 430 of 887 workers reported no time for engaging in such activities, two-thirds (601/887) desired to have a few days off to rest. Similar to findings for HCPs in other countries, people involved in pandemic work in China, despite elevated stress and burnout, found commitment and honor in their pandemic work. The authors unanimously found their resilience and commitment encouraging.
Conclusions
The study highlighted the urgent need that China should re-visit its “zero COVID” policy and make ramifications accordingly. Indeed, the majority of people in China disliked the COVID-19 control policies. All those working during the pandemic suffered the wrath of the masses and later needed psychological support interventions. Also, the study results highlighted that these people worked under harsh conditions; yet were not paid appropriately. Also, the government and hospitals promised a bonus but could not payout the same because they were low on money due to low care volumes related to the pandemic.
In the future, authorities should ensure better working conditions for HCPs and other pandemic workers and provide evidence-based psychosocial support.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.