TCT CONNECT-219 Psychosocial Impact of COVID - 19: Insights From a Cohort of Health Care Workers in the Cardiac Intensive Care Unit of a Tertiary Care Hospital in India

Background: COVID-19 has been the catalyst for a quantum shift in our professional and personal lives, literally and figuratively within the blink of an eyelash Healthcare workers (HCWs) have been profoundly impacted by this disruption at all levels, especially those working in high-stress specialties, such as cardiology, in resource-deprived and population-dense areas in developing countries, such as India We studied the impact of COVID-19 on a cohort of HCWs working in a high-stress, high-turnover cardiac intensive care unit (CICU) of a tertiary care center in India Questionnaires, results, and conclusions detailed in this presentation Considering the fact that India has not even reached the peak of the pandemic, the negative psychosocial impact of COVID-19 on HCWs of the cardiovascular community is highly concerning and disheartening Simplistic, sustainable long-term action plans are the need of the hour We must use the cataclysm wrought by COVID-19 to plug our broken healthcare systems For that, our frontline warriors should be in the best state of physical, mental, and emotional well-being to face up to this challenge The time to take action is NOW!! Methods: Evaluate the psychosocial impact of COVID-19 on HCWs working in a highly-stressed environment with high patient burden and turnover rates (45 bedded CICU including 15 step-down beds;average occupancy 90% to 100%) Understand perceived psychological burden and risk of post-traumatic stress disorder [PTSD] in these HCWs [Formula presented] Delineating Stressors for this HCW Cohort A Public Healthcare System and Bureaucratic Policies 1 Population-dense and resource-scarce developing Country 2 Despair at the inadequacy of the public healthcare system 3 Inability to understand and / or keep pace with fast-changing bureaucratic policies B Updating knowledge on COVID-19 1 Stress of updating oneself on explosion of knowledge on COVID-19 2 Ambiguous / continuously-evolving admission guidelines and treatment algorithms on: i COVID-19 patients with cardiac manifestations ii COVID-19 patients presenting with an cardiac ailment iii Patients presenting with decompensation of previous cardiac ailments due to COVID-19 Defining Stressors for this HCW Cohort C Personal Protective Equipment [PPE] 1 Training on Donning and Doffing 2 Efficacy 3 Quality 4 Availability D Workplace Disruption 1 Disruption of the existing workspace to incorporate demands of the pandemic 2 Redeployment to COVID-19 ICU 3 Creation of a separate cardiac ICU for COVID-19 cardiac patients 4 Revising process flows for admission / discharge / follow- up for cardiac patients E Direct Psychological Impact of the Pandemic 1 Fear of getting infected by the virus 2 Fear of being an asymptomatic carrier for friends and family 3 Fear of job security 4 Jeopardy of future professional goals / growth / goals due to pandemic 5 Feelings of inadequacy / hopelessness / helplessness burn-out F Societal Stigma / Ostracization due to Professional Hazard Snapshot - Questionnaire 1 to Assess Psychosocial Impact of COVID-19 * A Personal Sphere: 1 Fear that you / your family are infected by COVID-19 2 Your likelihood of getting infected by COVID-19 3 Your fear regarding possibility of becoming infected by COVID-19 4 Increased familial responsibilities / load 5 Inability to destress as leisure and / or social activities impacted 6 Preventive measures at home to protect relatives during pandemic [ shift to another place - 10/ separate room - 6 / PPE at home while in common places – 4/ not possible to distance - 0] * Scale of 01 – 10 [01 – lowest / least;10 – highest / maximum] B Professional Sphere – Impact of COVID-19 on Daily Workload 1 Tense working environment 2 Scarce social support from team 3 PPE usage a burden ( gloves, aprons, long-sleeved gowns, surgical masks, eye goggles) ? 4 Willingness to get redeployed to COVID-19 ICU, if required at peak of pandemic 5 Willingness to transit to remote / virtual consults for follow-up patients [post-discharge] 6 Increa ed bureaucracy 7 Extended working hours * Scale of 01 – 10 [01 – lowest / least;10 – highest / maximum] Snapshot - Questionnaire 2 to Assess Psychosocial Impact of COVID-19 ** 1 Emotionally drained from work 2 Fatigued in morning at prospect of going to work 3 Working with people all day – strain 4 Burnt – out / frustrated 5 Trouble sleeping 6 Reminder of negative work situations pertaining to pandemic 7 Irritable / angry 8 Surreal / unreal 9 Denial that in midst of a pandemic 10 Numb 11 Jumpy 12 Trouble with concentration ** Rate – 01 - Never / 02 - rarely / 03 - sometimes / 04 - frequently / 05 – always Snapshot - Questionnaire 3 to Assess Psychosocial Impact of COVID-19 *** 1 Feeling nervous, anxious or on the edge 2 Not able to stop / control worrying 3 Little interest / pleasure in doing things 4 Feeling down, depressed, or hopeless 5 Asked for psychological support 6 Heading for burnt – out syndrome 7 Afraid of suffering from burnout 8 Afraid of asking for help Timeframe: April – June 2020 *** Scale: 01 – Never / 02 – less than 10 days / 03 - less than 1/4th of three months / 04 – more than 50% of timeframe / 05 – Nearly everyday Results: Based on the preliminary data accumulated from this HCW cohort, COVID-19 has had a major negative psychosocial impact on it 40% of HCWs are fearful of getting infected with COVID-19 and /or infecting family with it 5% resigned from fear of contracting the virus 35% faced social ostracization / discrimination to some extent since the pandemic onset 3% came in contact with suspected COVID-19 patients and were quarantined, which has led to PTSD-like symptoms in that subset Based on the preliminary data accumulated from this HCW cohort, COVID-19 has had a major negative psychosocial impact on it 60% feel that their stress levels are higher by 50% or more due to direct / indirect impact of the pandemic 70% opine that their workloads are higher since pandemic onset due to additional bureaucratic demands / PPE burden / reinforcement of infection control protocols / ambiguous admission / treatment criteria 80% believe that they / their family members are at heightened risk of getting infected with COVID-19 60% have symptoms of burnout However, 80% of these hesitant to seek help for symptoms of burn-out Conclusion: Action Plan: Simplified admission / discharge / follow-up protocols Emphasis on virtual / remote follow-up visits for patients Education / awareness on COVID-19, especially for nursing staff Addressing PPE usage, its gaps and emphasizing adherence to it Addressing gaps in infection control protocol Reducing viral load by staggered workhours / breaks Anonymous in-house psychologist counseling options Categories Other: COVID-19 Lectures