Cited by 1,498Healthcare Systems and ChallengesInfection Control and VentilationInfection Control in Healthcare

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Supporting the Health Care Workforce During the COVID-19 Global Epidemic

Adams, James G., Walls, Ron M.·2020·JAMA

DOI 10.1001/jama.2020.3972

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Abstract

This Viewpoint discusses the importance of protecting health care workers caring for patients with coronavirus disease 2019 (COVID-19) and measures that can be taken in and out of the hospital to prevent their and their families' exposure to SARS-CoV-2.

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Crossref · 10.1001/jama.2020.3972

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Del Rio, COVID-19—new insights on a rapidly changing epidemic., JAMA
Bai, Presumed asymptomatic carrier transmission of COVID-19., JAMA
Radonovich, 2019, N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial., JAMA, 322, 824, 10.1001/jama.2019.11645 · DOI · Paper page
Ong, Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient., JAMA
JAMA Network. Coronavirus disease 2019 (COVID-19). https://jamanetwork.com/journals/jama/pages/coronavirus-alert

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“There is still much to investigate, especially regarding prevalence and mortality estimates, since the real dimension of present and future COVID-19 consequences is not yet well established [12,13].”
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One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic
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Food System Workers are the Unexpected but Under Protected COVID Heroes
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“[7] [8] [9] For presumptive and confirmed COVID-19 patients, surgery might be performed with a Level 3 protection (in addition to level 2 protection, medical comprehensive respirator, medical breathing mask or positive pressure headgear are required): this material has not been utilized by surgeons of this survey beca…”
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“children should be considered as highly vulnerable to exposure(11).”
BackgroundInfluential
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“…2020), increasing marginalization of vulnerable populations (Khalid, 2020; United Nations, 2020; Van Lancker & Parolin, 2020), disruptions to education (Van Lancker & Parolin, 2020; Viner et al., 2020) and health care (Adams & Walls, 2020), and severe psychosocial stress (Rajkumar, 2020).”
Background
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“While relaxation, a healthy diet, and recognizing healthcare professionals’ basic needs are all beneficial to their health, so are health protocols and the use of protective equipment [44].”
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“after their use, decontamination and discarding should be safe (Adams and Walls, 2020).”
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“Although health care professionals often accept the increased risk of infection during the COVID-19 pandemic as a part of practising their chosen profession, they worry about familial transmission, especially to family members who are older, immunocompromised or have chronic diseases.(28) In this study, we determined…”
Background
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Background
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Background
Anxiety amongst physicians during COVID-19: cross-sectional study in Pakistan
Mahmood, Q., Jafree, S., Jalil, A., Nadir, S. M. H., & Fischer, F. (2020) · BMC Public Health · doi:10.1186/s12889-020-10134-4 · Cited by 47
Community pharmacy response to infection control during COVID-19. A cross-sectional survey
Sum, Z., & Ow, C. J. W. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.06.014 · Cited by 47
“Providing a set of measures in decontamination not only minimises the spread of COVID-19, but also provides extra assurance to stressed and concerned pharmacy staff and their patients during the pandemic.(26)”
Background
Pandemia COVID-19, la nueva emergencia sanitaria de preocupación internacional: una revisión
Crespo, R. M., & Morales-Crespo, M. M. (2020) · Medicina de Familia SEMERGEN · doi:10.1016/j.semerg.2020.05.010 · Cited by 115
Utility of Tracheostomy in Patients With COVID‐19 and Other Special Considerations
Mecham, J. C., Thomas, O. J., Pirgousis, P., & Janus, J. (2020) · The Laryngoscope · doi:10.1002/lary.28734 · Cited by 47
“workers have been infected with COVID-19, and at least 22 have died.(5) This data is still incoming, but approxi-”
Background
Association of changes in work due to COVID-19 pandemic with psychosocial work environment and employee health: a cohort study of 24 299 Finnish public sector employees
Ervasti, J. M., Aalto, V., Pentti, J., Oksanen, T., Mika Kivimaki, B., & Vahtera, J. (2021) · Occupational and Environmental Medicine · doi:10.1136/oemed-2021-107745 · Cited by 58
Coping strategies, optimism, and resilience factors associated with mental health outcomes among medical residents exposed to coronavirus disease 2019 in Qatar
Smida, M., Khoodoruth, M. A. S., Al-Nuaimi, S. K., Al‐Salihy, Z., Ghaffar, A., Khoodoruth, W. N. C., Mohammed, M. F. H., & Ouanes, S. (2021) · Brain and Behavior · doi:10.1002/brb3.2320 · Cited by 55
“Ahigher tendency of females in different populations to use maladaptive or emotionfocused stress-coping strategies and to have more stress have been previously reported (Al-Sowygh, 2013; Levey, 2001; Taft et al., 2011).”
Background
Knowledge, Attitude, and Practice Regarding COVID-19 Among Healthcare Workers in Primary Healthcare Centers in Dubai: A Cross-Sectional Survey, 2020
Albahri, A. H., Alnaqbi, S. A., Alnaqbi, S. A., Alshaali, A. O., & Shahdoor, S. M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.617679 · Cited by 46
“However, infection control measures, such as hand hygiene, social distancing, and proper donning and doffing of personal protective equipment (PPE), have proven to lessen the spread of the infection (5).”
Background
Prevalence and factors associated with depression, anxiety and stress among healthcare workers of Trinidad and Tobago during COVID-19 pandemic: a cross-sectional study
Nayak, B., Sahu, P. K., Ramsaroop, K., Maharaj, S., Mootoo, W., Khan, S., & Extavour, R. M. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044397 · Cited by 70
A Web Survey to Evaluate the Thermal Stress Associated with Personal Protective Equipment among Healthcare Workers during the COVID-19 Pandemic in Italy
Messeri, A., Bonafede, M., Pietrafesa, E., Pinto, I., de'Donato, F. K., Crisci, A., LEE, J. K. W., Marinaccio, A., Levi, M., Morabito, M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18083861 · Cited by 49
“In addition, during the warm season, these symptoms can be exacerbated by heat stress imposed on the body for the enhanced use of Personal Protective Equipment (PPE), which is necessary to reduce the risk of disease transmission [5,6].”
Background
Formal Caregiver Burden in Nursing Homes: An Integrative Review
Kunkle, R., Chaperon, C., & Berger, A. (2020) · Western Journal of Nursing Research · doi:10.1177/0193945920979691 · Cited by 46
“COVID-19 affected formal caregivers’ physical and mental health personally and professionally (Adams & Walls, 2020; McMichael et al., 2020).”
Background
Coping with Dementia in the Middle of the COVID-19 Pandemic
Ryoo, N., Pyun, J., Baek, M. J., Suh, J., Kang, M. J., Wang, M. J., Youn, Y. C., Yang, D. W., Kim, S. Y., Park, Y. H., et al. (2020) · Journal of Korean Medical Science · doi:10.3346/jkms.2020.35.e383 · Cited by 58
Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirugía General y del Aparato Digestivo en un hospital terciario
Gallego, M. Á., Casas, S. G. D. L., Migueláñez, I. P., Perez, I. R., Serrano, C. B., Peña, E. Á., & Domínguez, J. D. (2020) · Cirugía Española · doi:10.1016/j.ciresp.2020.04.001 · Cited by 56
Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID‐19 pandemic response in Singapore
Aloweni, F., Bouchoucha, S., Hutchinson, A., Ang, S. Y., Toh, H. X., Suhari, N. A. B., Sunari, R. N. B., & Lim, S. H. (2022) · Journal of Advanced Nursing · doi:10.1111/jan.15164 · Cited by 45
Telenursing home care and COVID-19: a qualitative study
Kord, Z., Fereidouni, Z., Mirzaee, M., Alizadeh, Z., Behnammoghadam, M., Rezaei, M., Abdi, N., Delfani, F., & Zaj, P. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2021-003001 · Cited by 45
Coping with the burden of the COVID-19 pandemic: a cross-sectional study of community pharmacists from Serbia
Jovičić-Bata, J., Pavlović, N., Milosevic, N. P., Gavarić, N., Goločorbin-Kon, S., Todorović, N., & Lalic-Popovic, M. N. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06327-1 · Cited by 42
Promoting resilience in healthcare workers during the COVID-19 pandemic with a brief online intervention
DeTore, N. R., Sylvia, L., Park, E. R., Burke, A., Levison, J. H., Shannon, A., Choi, K. W., Jain, F. A., Coman, D. C., Herman, J., et al. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.11.011 · Cited by 45
“…of the pandemic in the U.S. when testing was infrequent (when much of these data were collected), healthcare workers may have been highly aware of the increased risk of infection for themselves and their family members that was associated with their jobs (Adams and Walls, 2020; Black et al., 2020).”
The global impact of the COVID-19 pandemic on clinical radiography practice: A systematic literature review and recommendations for future services planning
Akudjedu, T., Mishio, N., Elshami, W., Culp, M., Lawal, O., Botwe, B., Wuni, A.-R., Julka-Anderson, N., Shanahan, M., Totman, J., et al. (2021) · Radiography · doi:10.1016/j.radi.2021.07.004 · Cited by 44
Education and Training Adaptations for Health Workers during the COVID-19 Pandemic: A Scoping Review of Lessons Learned and Innovations
Boutros, P., Kassem, N., Nieder, J., Jaramillo, C., von Petersdorff, J., Walsh, F., Bärnighausen, T., & Barteit, S. (2023) · Healthcare · doi:10.3390/healthcare11212902 · Cited by 43
“These challenges underscored the necessity for better support mechanisms and greater recognition of health workers’ efforts [2].”
Background
The relations between resilience and self-efficacy among healthcare practitioners in context of the COVID-19 pandemic – a rapid review
Baluszek, J. B., Brønnick, K., & Wiig, S. (2023) · International Journal of Health Governance · doi:10.1108/ijhg-11-2022-0098 · Cited by 63
Frontline nurses’ willingness to work during the COVID‐19 pandemic: A mixed‐methods study
Ke, Q., Chan, S., Kong, Y., Fu, J., Li, W.-G., Shen, Q., & Zhu, J.-M. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14989 · Cited by 43
“Therefore, working hours per shift should be set reasonably to support frontline nurses (Adams & Walls, 2020).”
Background
Nanotechnology Interventions in the Management of COVID-19: Prevention, Diagnosis and Virus-Like Particle Vaccines
Balkrishna, A., Arya, V., Rohela, A., Kumar, A., Verma, R., Kumar, D., Nepovimová, E., Kuča, K., Thakur, N., Thakur, N., et al. (2021) · Vaccines · doi:10.3390/vaccines9101129 · Cited by 52
“Antiviral nanoparticles integrated in fabrics can help to overcome the problem of viral contamination in masks and PPE kits [26].”
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Home palliative care professionals perception of challenges during the Covid-19 outbreak: A qualitative study
Franchini, L., Varani, S., Ostan, R., Bocchi, I., Pannuti, R., Biasco, G., & Bruera, E. (2021) · Palliative Medicine · doi:10.1177/02692163211008732 · Cited by 42
Prevalence of Coronavirus Disease 2019 Infection and Outcomes Among Symptomatic Healthcare Workers in Seattle, Washington
Mani, N., Budak, J. Z., Lan, K., Bryson-Cahn, C., Zelikoff, A. J., Barker, G. E. C., Grant, C. W., Hart, K., Barbee, C. J., Sandoval, M., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa761 · Cited by 42
Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff
Verbeek, J. H. A. M., Rajamaki, B., Ijaz, S., Sauni, R., Toomey, E. C., Blackwood, B., Tikka, C., Ruotsalainen, J. H., & Balci, F. S. K. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011621.pub5 · Cited by 121
Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR
Majidi, H., & Niksolat, F. (2020) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2020.04.016 · Cited by 46
“As a general rule, standardized infection control and prevention practices should be implemented for all patients with respiratory illness [23].”
Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy
Saibene, A., Allevi, F., Biglioli, F., & Felisati, G. (2020) · Otolaryngology Head & Neck Surgery · doi:10.1177/0194599820917914 · Cited by 42
“Keeping the department running required implementing strong preventive measures for all professionals, acting proactively with patients, and emphasizing among the team the importance of self-care as the center of the response.(4) During week 1, all operators were asked to wear surgical masks at all times and employ N9…”
Background
Second Victims in Intensive Care—Emotional Stress and Traumatization of Intensive Care Nurses in Western Austria after Adverse Events during the Treatment of Patients
Ganahl, S., Knaus, M., Wiesenhuetter, I., Klemm, V., Jabinger, E. M., & Strametz, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063611 · Cited by 41
“Due to the prevailing COVID-19 pandemic, the associated exceptional situation in health institutions can be viewed as an unforeseen incident, and the resulting traumatization and stress can lead to treating practitioners becoming second victims [3,4].”
Background
Psychological distress among frontline workers during the COVID-19 pandemic: A mixed-methods study
van der Goot, W. E., Duvivier, R. J., Yperen, N. W. V., Filho, C., Noot, K. E., Ikink, R., Gans, R. O. B., Kloeze, E., Tulleken, J. E., Lammers, A. J. J., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255510 · Cited by 50
“The COVID-19 pandemic has had an enormous impact on both healthcare systems and healthcare professionals [2].”
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Burnout among Portuguese radiographers during the COVID-19 pandemic
Pereira, J. M., Silva, C., Freitas, D., & Salgado, A. (2021) · Radiography · doi:10.1016/j.radi.2021.05.001 · Cited by 45
Mental health shame, self‐compassion and sleep in UK nursing students: Complete mediation of self‐compassion in sleep and mental health
Kotera, Y., Cockerill, V., Chircop, J., & Forman, D. (2020) · Nursing Open · doi:10.1002/nop2.749 · Cited by 41
“As seen in the current coronavirus 2019 (COVID-19) pandemic, having a sturdy nurse workforce is crucial for the country (Adams & Walls, 2020).”
Background
Caring Advanced Cancer Patients at Home During COVID-19 Outbreak: Burnout and Psychological Morbidity Among Palliative Care Professionals in Italy
Varani, S., Ostan, R., Franchini, L., Ercolani, G., Pannuti, R., Biasco, G., & Bruera, E. D. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.11.026 · Cited by 42
“COVID-19 pandemic increased PCPs’ distress because of work overload, fear of contagion, and difficulty in delivering effective PC despite isolation and necessary barrier precautions.(30,31,40) On the other hand, the PCPs, playing a strategic role in the management of the health emergency, may acquire a pride that prev…”
Understanding and addressing challenges for advance care planning in the COVID-19 pandemic: An analysis of the UK CovPall survey data from specialist palliative care services
Bradshaw, A., Dunleavy, L., Walshe, C., Preston, N., Cripps, R. L., Hocaoglu, M., Bajwah, S., Maddocks, M., Oluyase, A., Sleeman, K., et al. (2020) · medRxiv · doi:10.1177/02692163211017387 · Cited by 41
“The following iterative steps were followed: (1) familiarisation and coding; (2) developing an analytic framework; (3) indexing; (4) charting (by developing matrices to understand differences in main themes across key variables); and (5) interpreting the data.”
The burden of COVID-19 on pharmacists
Johnston, K., O’Reilly, C. L., Cooper, G., & Mitchell, I. (2020) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2020.10.013 · Cited by 47
Insights on COVID-19 from Community Health Worker State Leaders
Mayfield-Johnson, S., Smith, D., Crosby, S., Haywood, C., Castillo, J., Bryant-Williams, D., Jay, K., Seguinot, M., Smith, T., Moore, N., et al. (2020) · The journal of ambulatory care management · doi:10.1097/jac.0000000000000351 · Cited by 41
Bolstering clinician resilience through an interprofessional, web-based nightly debriefing program for emergency departments during the COVID-19 pandemic
Azizoddin, D., Gray, K. V., Dundin, A., & Szyld, D. (2020) · Journal of Interprofessional Care · doi:10.1080/13561820.2020.1813697 · Cited by 41
Medical Leave Associated With COVID-19 Among Emergency Medical System Responders and Firefighters in New York City
Prezant, D., Zeig-Owens, R., Schwartz, T., Liu, Y., Hurwitz, K., Beecher, S., & Weiden, M. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.16094 · Cited by 41

Authors: Adams, J. G., & Walls, R. M.
Affiliations: Northwestern University (US)
Brigham and Women's Hospital (US)
Corresponding author: Adams, James G.
ORCID: Adams, James G.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2020-04-21
Volume: 323
Issue: 15
Pages: 1439
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2020.3972
OpenAlex: W3010574983
Cited by: 1,498
References: 0
Citations by year: 2026: 18 · 2025: 41 · 2024: 79 · 2023: 142 · 2022: 265 · 2021: 420 · 2020: 526
FWCI: 353.03
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Keywords: COVID-19 pandemic, SARS-CoV-2, healthcare workers, occupational exposure, infection control, personal protective equipment, family exposure
MeSH terms: Betacoronavirus, Workforce, COVID-19, SARS-CoV-2, Health Personnel, Humans, Pneumonia, Viral, Infectious Disease Transmission, Patient-to-Professional, Coronavirus Infections, Disease Transmission, Infectious, Pandemics

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Supporting the Health Care Workforce During the COVID-19 Global Epidemic

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