key: cord-278907-xuq3iay5 authors: Papoutsi, Eleni; Giannakoulis, Vassilis G.; Ntella, Vasiliki; Pappa, Sofia; Katsaounou, Paraskevi title: Global burden of COVID-19 pandemic on healthcare workers date: 2020-07-06 journal: ERJ Open Res DOI: 10.1183/23120541.00195-2020 sha: doc_id: 278907 cord_uid: xuq3iay5 Provision of PPE, placing experienced HCWs mostly in organisational positions, increasing testing, minimising exposure by adjusting shift schedules, and providing food and sleep facilities could be some restorative measures to protect HCWs from #COVID19 https://bit.ly/2zcVARW Contrary to aforementioned number of infected HCWs from WHO, our research revealed ⩾67 569 cases of COVID-19 infected HCWs. Interestingly, countries in Asia seem to have lower infection rates among HCWs; this could possibly be attributed either to the readiness of these countries to deal with outbreaks [5, 6] or to the relatively lower health workforce density in south-east Asia [7] . However, a possible pitfall in comparing HCW infections across countries is that in each country, different policies regarding testing and other measures apply (e.g. under-reporting of total cases or prioritisation of HCW testing). In Evidently, our findings represent only a "snapshot" of the current situation. However, they highlight the fact that the number of infected or deceased HCWs embody a concerning percentage of total cases in many countries. What is more, the median age of HCWs as calculated in the In Memoriam list reveals that a substantial proportion of them belonged to a vulnerable population subgroup. Nonetheless, the age of the deceased ranged between 24 and 93 years, highlighting that young and healthy HCWs could also be in danger. A month after the declaration of COVID-19 as a pandemic, global health systems showed gross unreadiness for such a pandemic, leaving some of their HCWs as casualties. Adequate personal protective equipment (PPE) is essential for all healthcare professionals involved in the treatment of COVID-19 in order to protect their health and safety. However, the shortage of PPE worldwide, leaves most HCWs exposed to COVID-19. Moreover, since the virus is in the community and could be spread from asymptomatic carriers, HCWs not working with already diagnosed COVID-19 patients risk exposure to the virus and, hence, also need protective measures. Consequently, prioritising the provision of PPE, increasing testing, placing older, more experienced HCWs mostly in organisational positions, minimising exposure by adjusting shift schedules, providing food and sleep facilities, and regular breaks and adequate time off between shifts could be some first restorative measures in the right direction [8, 9] . Additionally, the importance of provisions for the mental wellbeing of HCWs should not be underestimated [10, 11] . Finally, adequate training of HCWs in the proper use of respiratory devices and handling of COVID-19 patients is essential, as this pandemic sets new norms. The study is not without flaws as the use of grey literature and unsophisticated methodology present some challenges. However, in the absence of a completely consolidated picture, the present work is indicative and presents an opportunity to open vigorous public discourse on the safety of HCWs. This is an important paper but from my personal observations of how we are handling the pandemic in hospitals, it is perhaps not the risk of dealing with the patients that is the problem. In my institution, we have been fortunate to have sufficient personal protective equipment (PPE) and we are well protected when entering the ward environment. However, wearing PPE is uncomfortable and it is disposed of on leaving the patient's room. Staff then congregate at the nurses' station and in the offices, where it is impossible to observe social isolation. I believe that the main threat to healthcare workers its other healthcare workers! We have had ward-based outbreaks with staff all contracting the virus simultaneously, presumably from an asymptomatic carrier in the workplace. This issue needs to be urgently addressed. Hull York Medical School, Cottingham, UK. Statement of the European organisations of Health Professionals on COVID-19 World Health Organization. Coronavirus disease (COVID-19) situation reports. www.who.int/emergencies/ diseases/novel-coronavirus-2019/situation-reports. Date last accessed Searching and synthesising "grey literature" and "grey information" in public health: Critical reflections on three case studies Memoriam: Healthcare Workers Who Have Died of COVID-19 The SARS epidemic in Hong Kong: what lessons have we learned? A lesson learned from the MERS outbreak in South Korea in 2015 World Health Organization. The world health report 2006: working together for health COVID-19: protecting health-care workers Older clinicians and the surge in novel coronavirus disease 2019 (COVID-19) Managing mental health challenges faced by healthcare workers during COVID-19 pandemic Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis Acknowledgements: The authors thank Ilias I. Siempos from Weill Cornell Medicine, New York, NY, USA, for his insightful thoughts towards improving the manuscript, and Alexander Osarogue for proofreading. Conflict of interest: V. Ntella has nothing to disclose. S. Pappa reports travel grants and honoraria from Janssen, Sunovion and Recordati outside the submitted work. V.G. Giannakoulis has nothing to disclose. E. Papoutsi has nothing to disclose. P. Katsaounou reports travel grants, honoraria and grants from Astra, GSK, Pfizer and Chiesi outside the submitted work.