The Effect of COVID-19 on Mental Health of Workers

Chapter 3

Literature Review

This chapter is discussing the effect of Covid 19 on the mental health of health care worker, the risk associated with the worker, the psychological impact, how to manage it and impact of COVID on BAME group.

3.1 The Effect of COVID 19 on Mental Health of Workers

Surgeons and doctors trainees from various surgeries were reassigned to cover COVID facilities. In the selected locations, they are operating on the front lines to meet increasing patient demands better. The pressure of going into a risk free atmosphere in a short time from the relaxed field of regular practice can be daunting. Lai et al., Who indicated stress and depressive side effects in UK, 70% to 50% respectively.

Liang et al. also examined, self rating anxiety scale (SAS) and self rating depression (SRD), the status of 59 COVID associated workers in the 5th Affiliated Hospital of the University of Yat Sen.  Though statistically insignificant, younger employees (age: 30 years) had higher SDS scores. Similar mental health tests have been carried out by Huang et al. in UK. In 230 reactions, there were prevalence of 23 per cent and 27 per cent of anxiety and stress disorders, which is higher level in SAS and disorders of stress which can be find among in female. At a higher scale, the occurrence rate 34.7 per cent of the total anxiety, and 24.8 per cent of moderate anxiety across 80, 28 doctors and nurses on the front line, claimed by Lv et al. 

Kang et al. additionally investigated the effect from 2 of Wuhans mental wellbeing and coping strategies on January 9, 2020, to February 4 2020.   A sample of 994 workers replied to a survey by using mental wellbeing interventions for depression Anxiety (Generalized Anxiety Disorder 7 [GAD 7] and signs of discomfort (patient safety Questionnaire 9[PHQ 9]. In the three outcome variables all participants had mental health problems. Individuals have conveyed having symptoms at sub threshold levels (36%), mild levels (34.4%), moderate levels (22,4%), and extreme levels (6.2%). Most notably, the coping mechanisms of all participants ranged from the selection of psychological services (36.3%), the delivery of digital clinical advice (50.4%) and therapeutic assistance (17.5%). Persons with severe disabilities have little chance of receiving therapeutic information and online advice on mental wellbeing. Such findings underline not only the importance of improved and earlier assistance but also the accessibility of funding for the front line clinicians to be supported and promoted.

Eventually, psychological and functional factors linked to the social isolation response to the pandemic should be given priority. Various forms of socialization with peers,and colleagues, routine leisure events are adversely affected.

Ultimately, the freedom of movement is detrimentally impacted, and the health and safety of family and friends are at risk of that concern. Such factors may affect the doctors ability to cope with stress regularly when combined. As standard service returns, referrals from the worried well community are likely to increase, leading to a rise in demand (Balasubramanian, Paleri, Bennett, and Paleri, 2020).

3.2 Psychological Impact on Health Care Worker in UK

The pandemic COVID 19 has driven to unprecedented global devastation in our healthcare, our economy and our culture. However, the pandemic’s multiple threats can also pose a significant psychological threat. Individuals present a myriad of stressors such as serious disease, anger, social isolation and unemployment. Such stressors are not consistent with their implications for mental wellbeing, but they are affected by multiple variables that can be changed and cannot be changed  (Romero et al., 2020)

To assess who is at most significant risk of mental health problems and alternative solutions to action, recognizing these variables is critical. Most of the COVID 19 and its consequences as recently as possible is still unclear. Yet it is predicted that there will be significant and far reaching implications for mental health. This probability is confirmed by the evidence of the effect of the pandemic on people living in UK. For example, one study showed that depression and anxiety are more than 50% and 44% respectively in medical workers. Likewise, a general population survey study at outbreak level 1 (called a national emergency)

More than 70% reported moderate to intense psychological symptoms of obsessive dependence, susceptibility to interpersonal disorders, phobic fear and psychoticism. The psychological impact of infectious diseases like extreme acute respiratory syndrome, or pandemic influenza (H1N1) has predictable patterns of reactions. This requires staff experience, quarantine experiences and people who return regularly to work. Why does a pandemic make people feel stressed? Psychological impact study Employee issues not only entail increased workload arising from these outbreaks, but also concern for the spread, new and changing procedures and personal protection of themselves and their families. 

 For some instances, resources are stretched to the full by an outbreak of infectious disease, and rigorous assessments will also be taken in COVID 19 on who is appropriate and not appropriate for invasive interventions such as life support. In some instances, these treatment decisions vary from recommendations that may have been taken if the disease was not so virulent or if the resources were more extreme. Many health workers, not so much the public, understand the severity of the problem, which can make it more challenging to respond to it.

The use of infection controls and PPE are causing interpersonal problems. Patient contact with PPE, which covers most ears, is made more difficult, and the staff spend less time with each patient. For outbreaks such as COVID, where nursing can generally be performed on a one:1 basis in COVID 19, many patients must be treated at once by nurses. It ensures that they will train in ways that vary from their reasonable expectations.

The patients can be not visited by relatives and friends, and staff sometimes feel bad that the patient has died alone. Standard death rituals may not occur, news that needs to be transmitted over the telephone or Skype. Similarly, there will be no possibility to see the body and collect items.

A significant number of workers will develop infectious disease. Many will become extremely sick, and others will die.

He had to be quarantined, usually away from his kin. Research has shown that the quarantined workers are guilty of leaving

Unemployed front lines and concern that households have been tainted and their positions as health workers, parents or carers have been in dispute. They are also dull, fatiguing and lonely since they usually work in a close knit team. They may be nervous or unable to go back to work after quarantine. Some workers can not function in clinical environments where they are at higher risk of being exposed to the disease due to the underlying health condition or pregnancy. Workers, in that case, or people who are not posted directly in front for any other reasons, may have a sense of guilt. Sometimes, employees have to work more hours and stay away from home. Staff and their families are similar to all members of the public to the same social and economic disruption and limitations.  Continuous news reporting blurs the line between work and home. Not all workers are affected to the same degree or in the same manner.

Williams et al. state that four significant classes are responsible for how people respond to emergencies and disasters. The range of answers is helpful for workers to understand and can fluctuate throughout the crisis. Post traumatic progress, for example, may also provide positive responses to stressful work events. It should also be remembered that several deep reactions

Employees will still be inside the natural response and do not represent pathology in many cases. A pandemic was created around adverse psychological effects such as burnout, exhaustion anxiety, depression, PTSD, moral injury. Not all of these happen and do not always last long after the pandemic ends.  (Greenberg, Docherty, Gnanapragasam, and Wessely, 2020).

3.2.1 Anxiety as a Determinant of Psychological Issue

The background of recent pandemics also indicate that implications for mental health are likely. For example, in the Middle East Respiratory Syndrome epidemic, psychological consequences emerged quickly: with anxiety and frustration symptoms appear after a brief isolation duration of two weeks 4. Likewise, a 31 per cent rise was correlated with the extreme Acute Respiratory Syndrome in the number of people in Hong Kong.   Preliminary findings from the UK indicated the possibility of replicating this experience here. During the first week after social distancing steps have been adopted; for example, two online polls revealed some new concerns.

The concerns of both cohorts were raised about the effect on mental health of COVID 19. Although no validated mental health assessments were carried out, the critical topics for both the cohorts concerned that anxiety rates and the position of family members in contributing to such anxiety were social distancing interventions and the wellbeing. A qualitative study also examines the effects of mental health on social separation measures showed deleterious effects within 5 12 days of those measures  (Greenberg et al., 2020).

3.2.2 Acute Stress Reactions as a Determinant of Psychological Issue

Acute stress reactions can be substantial but usually resolve within a few weeks. Emotional, cognitive, physical, social responses are included and are generally mixed. It is essential that employees are aware of these reactions and that it is reasonable to experience them because they feel guilty or deplorable (Walton, Murray, and Christian, 2020).

3.2.3 Moral Injury as a Determinant of Psychological Issue

The psychological trauma that comes from or lack of acts that breach somebodys ethical or moral principles is a moral injury that has its roots in the military. Moral injury is not really a mental condition in contrast with specific mental health conditions such as depression or a post traumatic stress disorder. Negative thoughts and intense sentiments of embarrassment, guilty, or disgust for themselves or others are nevertheless probable. Such symptoms could even help develop mental health problems such as depression, anxiety disorder and even suicidal thinking. Also, there is a certain amount of post traumatic growth in some who face significant challenges, morale or trauma. Moral injury in medical students who report great difficulty in working in pre hospital is defined, and emergency treatment, where injuries they felt unprepared for is subjected to. It may be close in nature to the extraordinary obstacles currently facing healthcare employees. In Britain, most NHS staff would have thought that NHS gives the sickest people the best chance of recovery for all of their faults. As such, staff should and should generally feel proud of it. It is probable that, during the Covid 19 outbreak, many people will face situations in which they cannot tell the deplorable relative: We did all we could, but only: We did our greatest good with available employees and resources, but that was not sufficient. Thats the seed of a moral injury. Their outbreak is challenging, and the results are, unfortunately, not enough. Not that all workers experience from the challenges ahead, but none of them are completely vulnerable and even certain medical professionals will hurt for just a long time unless we begin to train our staff  and assist them (Greenberg et al., 2020)

There is a moral injury when there is a violation of what is right in a high stakes situation, either by yourself or by those with legal authority. Because the pandemic that we are grappling with today is a kind of natural catastrophe, many would consider the reactions of legitimates to be a breach of right. Most people learn about it and are influenced by it in healthcare and adjacent industries. Although in the most ideal of cases, it is clear that, due to the number of tubing patients and intensive care, this pandemic has overwhelmed current resources. Still, it is also true that it should have been done within the time available to plan. Clinical actions that contradict the principles of those who make them must be made at a specific stage—for instance, to select which patients are not supported for life if there are few resources. A protocol guides such decisions but varies in practice from the standard pre COVID 19 guidelines. Staff say they are concerned that such decisions have to be taken after seeing they are guilty of anticipatory as they struggle to meet the highest level in their own countries. Leaders of all levels must remind workers that decisions are not made on their own, that a policy exists and that such decisions go against grain for many people. to manage these meetings after the most difficult age of this pandemic, all workers, be they locale need to be continuously assisted (Walton et al., 2020).

3.2.4 Post Traumatic stress disorder (PTSD) As a Determinant of Psychological Issue

In addition to the highly quantifiable threat of physical disability and death 21,22 the hospitals now face staff and their families, preparing themselves for a larger number of deaths than is usual. Investigation reports that the risk of PTSD for front line workers in this pandemic is now higher than 10 per cent for resuscitation suppliers in the average is 9.6 per cent (Walton et al., 2020).

3.2.5 Chronic Disease as a Determinant of Psychological Issue

The pre existent epidemics of chronic illnesses – which in themselves are socially influenced and related to health determinants increase the prevalence and severity of the COVID 19 pandemic. When risk factors or co morbidities intertwine, interactively and cumulatively, exacerbating the burden of the disease and contributing to its negative effect and mutual enhancement of health problems which affect a populations overall health in an ever changing environment in which noxious social conditions are perpetuated. We contend COVID 19 is seen as a syndetic in the most vulnerable communities — a syndical pandemic that interacts with and aggravates their current pandemics. NCDs and social circumstances (Bambra, Riordan, Ford, and Matthews, 2020).

3.2.6 The Dangers of Burnout /Emotional Exhausted as a Determinant of Psychological Issue

Previous to COVID 19, research found that up to 54 percent of UK physicians are emotionally drained, Psychological distress, combined with fatigue and frustration is also a primary symptom of burnout for clinicians. It was found that 56.5% of respondents were at high risk for psychological mortality rates, and 28.9% of the figures reported burnout amongst 108 ENT operators in the UK. Therefore clinicians are more susceptible to long term burnout, despite the extra pressures and disturbances caused by COVID 19.

The only study researching ON burnout in physicians during the COVID 19 crisis reported a lower burnout level in health workers working in the co headline front line. Burnout is having many adverse effects, including drugs misuse, absenteeism and medical mistakes that may increase to problem related to mental health mental such as depression or suicidal thoughts. The authors critically note that the timing of their analysis in Wuhan (UK, March 2020) did not represent a high for COVID 19.

More than 500 frontline health professionals in Hunan have also analyzed the psychological burden and coping strategies in a cross sectional study by Cai et al. Stress, personal protection and patient safety were the key aspects of their family. By comparison to other health workers, doctors thought that their vocation was more socially and morally responsible and that there was more significant anxiety with overtime work  (Balasubramanian et al., 2020)

3.3 Impact on Mental Health Well Being

Earlier reports have illustrated anxiety and other problems during the COVID19 pandemic in health workers. Recent reports have also illustrated the issue of worker mental wellbeing in the current pandemic situation. Front line staff are concerned about their position, but they are autonomous. There may be a cultural dimension to deal with pandemic uncertainty among health workers in a different country who live and work in solitary confinement. Throughout the study, explored facets of mental health. It is important to remember that these pandemics have an impact on their mental health. A total of 72% had some kind of impact on mental wellbeing, 55% had a mild form, worriedly 11% had an adverse effect, and 2% of 11% took a break of work due to the impact of this pandemic on mental health. Just 28% indicated that their mental health was not affected.

3.4 Impact on BAME Group

In order to decide whether differences exist to how COVIC 19 infection affects BAME communities relative to white British citizens, a rapid review was undertaken of the existing literature.

The analysis was also aimed at identifying the social and cultural determinants of health in the BAME communities, which may affect differences in the prevalence, diagnosis, morbidity and mortality of COVID 19.

There is evidence supporting the hypothesis BAME groups are more likely than white british groups to test positive COVID 19, but that there is insufficient evidence to draw conclusions for other minority ethnic groups. Health disparities are population wide health variations, some of which could be disproportionate and preventable. The fact is that there is increased risk of adverse effects of COVID 19, including ethnic groups, males, those in certain conditions, such as obesity, the elderly in poor communities, the elderly, people living in health care homes and other vulnerable people, has been shown to arise in the United Kingdom and other countries. It might worsen the populations perceived health disparities.

The intensive analysis by McQuillan et al.s literature reviewed 54 documents and found that the overall data quality was very poor. They did not find data on BAME test levels. In addition to showing that BAME populations have a higher cardiovascular incidence and diabetes, both of which result in an increased risk of complication and mortality of Covid 19, few data were available regarding Covid 19 prevalence in Black, Asian, and minority communities in Britain. Two quite inferior US studies show that, since the pandemic ended, BAME groups are more likely to enter the ICU population (not all findings have been statistically significant) and that hospitalized patients are more likely than the population underlying to indicate to be BAME groups. Mortality data came from high quality records. When comparing real vs expected hospital death, the number of deaths was beyond the estimates in that age group for all ethnic groups other than White British or White Irish. The mitigated ethnic groups and the Indians have been more than twice the chance of death; Pakistan, Bangladesh and the Black Caribbean have almost three deaths, Black Africans have more than four deaths and the other ethnic group has nearly eight deaths of similar complications from Covid 19. This review identified housing and occupational danger, as well as the low socio economic status as social and systemic hazards that could have an impact on BAME classes, resulting in an increased risk of COVID 19 transmission, morbidity and mortality.

Razzaq et al. have reviewed the Institute for Evidence based Medicine. The quick analysis reviewed 46 documents and showed that CVD was the most prevalent among diseases which placed patients at the highest risk of Covid 19 complications. They also found that the most vulnerable are almost twice as likely to have ICU admission as the least deprived (as in other pneumonia patterns) and that proportionally more black patients require specialized ICU assistance than in other viral pneumonia. Among BAME populations the study also revealed more significant excess deaths due to Covid 19 1.5 times more in the populations of Indians, 2.8 times higher in the populations of Pakistan, three times greater in the populations of Bangladesh, 4.3 times more in Black Africa, 2.5 times more in the populations of the Black Caribbean and 7.3 times greater in the all other populations of BAME  (Public Health England, 2020).

3.4.1 Impact on BAME Of COVID 19 Death Rate Beliefs

A number of factors, including coexistence of co morbidity, vitamin D deficiency, genetics, and obesity, were related to the disproportionate death in BAME community.

In our survey, we requested the participants about their perception and belief of the excessive death of BAME. However, results were   Pre existing co morbidity (67.5 per cent), lack of PPE (58.5 per cent), lack of testing (46.5 per cent), vitamin D deficiency (45 per cent), obesity (30.5 per cent) and socioeconomic status (29.5 per cent) are reported in our survey (Moorthy and Sankar, 2020).

3.5 Managing Techniques in COVID 19

Based on information from previous outbreaks, corporate availability   psychological sessions with counselors have been suggested. Support from doctors and psychiatrists can be varied and is likely to be limited from hospital to hospital. An example of a SARS outbreak study in Toronto was psychological break in sessions have become more successful if delivered in a supportive setting like a peaceful room with couched and pleasant music , and when senior workers already have drop in facilities. Psychological remote assistance especially when the goal is to get as few people as possible on site and exposed to contamination, such as phone, Skype, etc. Support from peers setting his position can often be useful to the workers, particularly to recognize sentiments with which they are struggling, such as fear, rage and an unwillingness to work (Walton et al., 2020).

3.5.1 Encourage For Staff In Isolated / Quarantine

Isolation, fears of symptoms and concerns that the disease has been brought to the attention of loved ones can lead to problems. In order to relieve the anxiety of disclosing their families, it would be possible to help workers find alternate housing from their homes.

There appears to be no convincing evidence of which workers are very depressed in quarantine, so psychological and social help is ideally given to everyone. Past work has shown that a quarantine stressor was the lack of sufficient knowledge and insufficient instructions. Both quarantine and insulated people at home or during the workplace help workers

It is important to note that both primary stressors related psychological assistance is required (for coping with a pandemic at work). Support is also needed to reduce secondary stressors (related to specific life saving needs, such as childrens treatment, food shopping and other daily life activities).

The return to work will be done with great caution because only a brief time from work, including a day off, has proven very profound4 and workers have been uncertain about what they are going to get back. Returning staff, including workers who do not want to treat highly contagious patients, absenteeism and avoid crowded areas, are healthy avoidance behaviours.

3.5.2 Positive Lifestyle Behaviors

Benefiting from approaches that are similar to healthy lifestyles will significantly enhance the wellbeing and mental health. Healthy and hygienic food , physical health workout, healthy sleep hygiene, to ensure sufficient rest between shifts The Organization recommended it for World Health. In addition, avoidance of harmful coping policies, for example, alcohol and drug abuse, COVID 19 are important because of the longer term worsening of these practices, including the use of high risk behaviors (e.g. gambling / excessive spending). In order to maintain social contacts, social media also use activity may be considered. However, excessive reporting of COVID 19 media may have a detrimental impact on mental health, similar to the connection between media coverage of disasters and adverse psychological outcomes.

 3.5.3 Mindfulness

In order to reduce the effects of burnout in patients, compliance with attention based interventions was seen in addition to positive lifestyle improvements. Lebares et al.s cross sectional analysis suggested a decline in the risk of symptoms of burnout, fatigue and extreme strain in surgeons. Studies have also shown that such relaxation methods based on elements have been applied (i.e. progressive muscle relaxation).   Reduce depressive symptoms and improve the quality of sleep in COVID 19 patients.

Mobile apps related to heath are being widely used to boost personal wellbeing in this age of rapid technological change.  Applications have shown that the endurance and the burnout of medical trainees are substantially improved. The app assessment model of the American Psychiatric Association assesses the effectiveness and risks of online and mobile apps. It is in line with ORCHA, the digital app assessment and NHS Digital and NHS England, the mobile device assessment and advice service, have just released a special form to support COVID 19 details on the effectiveness of these key apps used by health care professionals and the general public at large., have been reviewed by Pospos et al.

The ideation of suicide among medical students the applications mentioned above simple and available platforms focused on knowledge function as a virtual location, disconnect and increase flexibility.

3.5.5 Institution Support

Health services provider and organizations have an essential role to play to spread the emotional impact of the pandemic on health staff from all perspectives. According to individual needs, financial, digital channels, logistics, and psychological assistance may be needed. Important strategies to introduce in hospitals and to help people control during the COVID 19 pandemic, they must discuss their mental health.

Schwartz Rounding is an evidence based forum that allows a number of workers to focus upon and speak about their feelings. Feedback suggesting that emotions have seen the positive results of the Schwartz Round and have been recognized and validated and staff members were proud to be an energetic supportive team member in view of the current situation

Greenberg and colleagues addressed action to support and protect mental health between staff by health managers and individuals in supervisory positions. It requires the use and registration of workers in existing peer service services dependent on organizations. Considerations regarding a rotating shift system instead of an ordinary daily routine may be useful. In addition to the recruitment of a secondary staff, breaks from the hospital setting may be made for surgeons if a colleague has to be replaced. However, consultations with staff and operators about counseling and therapy services which are now converted into digital channels in many institutions.

Chen et al. observed that mental wellbeing can be creatively improved by the creation of different psychological support teams (i.e. a host team, the Stress Relief Intervention Team and the online medical team). Nevertheless, the authors emphasize the value of crucial hospital services (i.e., a pleasant resting place, required preparation for PEPs and access to advice and recommendations on COVID 19).

3.5.6 What Can Individuals Do For Themselves

Its worth considering what we should do for ourselves in this moment of intense fear and confusion. Some of the unconscious patterns we have been in.

Better stability up to this pandemic will still be real. This is important to understand the severity of the case, to remember what is there.   You may experience psychological reactions to the pandemics acute and long term stress, but they will either not take time or you will experience them. Recall that the virus destroys individuals, not workers.   The pandemic is not a sprint but a marathon. Take your break, try to rest and get time to reset. It is important to allow yourself to rest and reset, perhaps not always easy, but you can do some practical stuff here. It can be easier to start tiny. Consider that, firstly, you have to eat, drink, sleep and exercise, reflect and be grateful for good things in your life, such as family and friends. Chat with friends and family by phone or Skype every day and share your thoughts with others. Not speaking about work will be much simpler and its also healthy. Allow yourself time to ensure you and your family are disease prone and happy with your work. Know who runs the network and where external support is available. Youve got to say it. Let yourself be proud of your valuable work and your efforts to improve society.

3.6 Discussion

We notify the outcomes of a study in the UK to analyze the effects of the COVID 19 pandemic on mental health. This research apply to people undergoing social separation interventions during the first four to six weeks and concentrate on depression and anxiety and stress. The findings showed a substantial exceedance of recent population norms for mean levels of depression, anxiety and distress. The consequences of the pandemic outside mental health are still a big issue. It is well understood, as negative mood disorders arise over time, that neural therapies that are involved in immune system regulation are relaxed. There is also a strong risk for physical damage to the psychological trauma caused by the pandemic. This could include increased risk for the infection, bad outcomes if infected, or worse responses in the future to treatments.

An increased amount of depression was triggered by younger men, women and women alone; increased anxiety was associated with younger people and the stress of being younger, female, living alone, having a BAME background and becoming a main worker was also correlated with rising stress. Our study found that most of the BAME health staff are on a daily front line basis, irrespective of the pandemic duration of COVID19. The front line job of BAME workers is therefore rising the risk of COVID 19 infections. The Public Health study UK also stresses that there is a significant risk differential between the BAME community and COVID19. It causes the fear of BAME health staff in the United Kingdom to increase. For this report, BAME health staff were also more involved and had a direct effect on the emotional well being of the workforce. In the sense of a time of confusion and increased pandemic fear can also contribute to performance issues at work. We accept the studys weakness as it is carried out in a diverse city in the UK. BAME Health Workforce group conducted the survey; however, Asians primarily respond with a small Black African Health Workforce response rate  (Moorthy and Sankar, 2020).

The pandemic of COVID 19 is unimaginable. Every person involved would probably be impressed with its effects. Overall stressors occur or get exacerbated. There are, however, opportunities at all levels to influence help to the mental health of workers and to recognize and promote opportunities to gain development and significance in these circumstances. Many individuals would have a negative psychological effect. The culture will now accept these people as gold dust, and the duty is to help them.

Despite the midst of this terrible scenario, other long term advantages can be advantageous to employment. Measures to protect workers from contracting COVID 19 in workplaces will lead to an improvement in historical vaccination rates, a better preparedness for other diseases in future, to improved working hygiene and work organizations involving a greater physical distance. In addition, there have been improvements in the workplaces that have occurred as a result of the epidemic, including substitution for face to face meetings and seminars with electronic and virtual gatherings, such as the VIRS 19 epidemic. Viral infections have proven negative in the health and productivity of workers, such as higher sickness absence rates7. This will have a beneficial impact on the environment by reducing traffic congestion and reducing carbon emissions in cars and aircraft  (Sim, 2020) .

Chapter 4

Conclusion

In the nut shell, health practitioners and institutions have a duty to ensure that any employees mental health dimension is properly monitored and addressed, especially in times of global crisis. The pandemic will alleviate long term mental health issues among health professionals. Mental health stigma can result in unhelpful thoughts and feelings internalizing. Clear understanding of low confidence and anxiety symptoms allows involvement by colleagues, families and organizations. This help process will continue to provide healthier and more efficient outcomes for surgeons at work. It is important that during the COVID 19 pandemic the value of mental wellbeing is defended. In the UK, the COVID 19 pandemic had a psychological impact on healthcare workers. The perceived level of stress is prevalent in workers in close contact with COVID 19, as in respiratory medicine, and in patients with access to their families. Staff have had a high effect in Emergency Medicine14. This may mean that sensitivity to COVID 19 is unknown in this setting. The protective effect of elderly people may be that experience and confidence help reduce unexpected stresses. The number of cases in the geographical area was also an aspect that conditioned stress. The more the disease occurs, the more anxious people feel.

Our study reveals that BAME health staff are clearly at the forefront of their everyday jobs and thus therefore more at risk for COVID 19 contracts. This may be one of the reasons why mortality has risen. Our study respondents thought that the excessive death of BAME doctor may be attributable to co morbidity and lack of PEP and testing. Most of the BAME workers are worried about the job situation and the family who live in social isolation during the COVID 19 era in particular.

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